Nanjing University Research Articles

Personalized ctDNA monitoring to assess the recurrence of early stage pancreatic cancer after surgery.

774 Background: Up to 80% of patients with resected pancreatic cancer recur within 2 years. Here, we assessed the feasibility and accuracy of a personalized, tumor-informed circulating tumor DNA (ctDNA) test for early warning of recurrence risk during long-term surveillance. Methods: This study retrospectively analyzed 43 patients who underwent radical surgery for pancreatic cancer between November 2021 and June 2023 at the Comprehensive Cancer Centre of Drum Tower Hospital, Clinical Cancer Institute of Nanjing University. A personalised panel was constructed to detect ctDNA in plasma based on whole-exon mutation information from tumour tissue. A total of 139 ctDNA samples were obtained from periods including postoperative, during adjuvant therapy, and post-treatment. Results: Until the last follow-up time (May 13, 2024), a personalised ctDNA monitoring panel was successfully constructed for 35 (81.4%) stage I-III patients with a median follow-up of 11.82 months (range: 2-17.8 months). A total of 16 patients experienced recurrence within 15.7 months (range: 5.4-30 months), with a median lead time from first positive ctDNA to imaging recurrence of 3.6 months (range: 1-9.3 months). ctDNA positivity was detected in 25.8% (8/31) of ctDNAs at the landmark time point (postoperative prior to adjuvant therapy), with a positive predictive value (PPV) of 75% (6/8) and a negative predictive value (NPV) of 69.6% (16/23). Patients with positive ctDNA at the landmark time point had inferior DFS (6.9 months vs undefined. HR 3.955, P=0.007) and OS (15 months vs undefined. HR 5.599, P=0.001) compared to those with negative ctDNA. When integrating longitudinal time points, PPV and NPV were 68.2% (15/22) and 91.7% (11/12), respectively. For all 16 relapsed patients, the sensitivity of positive ctDNA detected longitudinally was 93.75% (15/16). The ctDNA-MRD status at longitudinal time points had a more significant difference with DFS (undefined vs 12.6 months. HR 5.096, P=0.002) and OS (undefined vs 21 months. HR 6.487, P=0.038). Conclusions: Personalized ctDNA surveillance is effective in identifying high recurrence risk after pancreatic surgical resection. Long-term longitudinal warning of arbitrary ctDNA positivity suggests a recurrence probability of up to 93.75%; therefore, full ctDNA dynamic monitoring is essential. And ctDNA monitoring will be further used to guide the decision-making in the clinic to prolong patient survival.

Exploration of the research hotspot and application rule of Tengligen in anti-digestive system tumor based on bibliometric analysis and data mining

Objective: Based on the systematic bibliometric and data mining of the literature on the anti-digestive system tumor of Tengligen, the state of research, research hotspots and medication rules in this field were explored. Methods: From January 2004 to October 2024, literature pertaining to Tengligen’s anti-digestive system tumor was obtained from the CNKI, Wanfang, and VIP databases. CiteSpace 6.3.R1 and VOSviewer 1.6.20 software were used to intuitively display the number of publications, authors, institutions, keywords and other information, and then analyzed. The medical record information of famous Chinese medicine treating digestive system tumors with prescriptions containing Tengligen was extracted, a database was established, and the association rule analysis and cluster analysis of Chinese medicine compatible with Tengligen were carried out by IBM SPSS Modeler18.0, SPSS Statistics 26.0 and other software. Results: There were 115 publications in all, and there was a growing tendency in the quantity of papers published in this area. There were 295 authors total, with 28 serving as key authors. The primary publishing institutions are Zhejiang Chinese Medicine University, the First Clinical School of Zhejiang Chinese Medicine University, and Nanjing University of Chinese Medicine. Seven core tags were obtained by keyword cluster analysis, and research focuses on the mechanism of action, extract of Tengligen, clinical efficacy, etc. A total of 41 prescriptions containing Tengligen were included, involving 125 Chinese medicines, among which Tengligen was the most associated with Fuling, Huangqi and Yiyiren, respectively. Cluster analysis showed that Tengligen, Ezhu, Yiyiren and Huangqi were the core prescriptions. Conclusion: The scientific knowledge graph directly shows the research progress and hot trends of Tengligen against digestive system tumors, analyzes the rule of its clinical application, and provides a cutting-edge perspective for new research.

Bibliometric analysis of literature on natural medicines against chronic kidney disease from 2001 to 2024.

Chronic kidney disease (CKD) is a globally common and progressive disease. There has been few bibliometric study to analyze the status, hot spots, and trends in the field of natural medicines (NMs) against CKD. To comprehensively understand the status, hot spots, and trends in the field of NMs against CKD. The documents concerning NMs against CKD are extracted from the Web of Science Core Collection database (WOSCC). The literature analysis was conducted using VOSviewer 1.6.20 and CiteSpace 6.3.R1 software. In total, 641 publications were encompassed, which were produced by 3 548 authors and 823 organizations, 241 journals, and 56 countries/regions. The most productive author, institution, country, and journal were Li, Ping, Nanjing University of Chinese Medicine, China, and Journal of Ethnopharmacology, respectively. The first high-cited article was published in Medicinal Research Reviews with 457 citations authored by Huang and colleagues in 2007. Oxidative stress, anti-inflammatory, renal fibrosis, and gut microbiota were the emerging keywords. Rhubarb, Astragalus, Angelica, and Cordyceps, which contain anthraquinones, cordycepin, adenosine, or various polysaccharides, are promising NMs to prevent or treat CKD. Currently, the main hot spot is the elucidation of cellular and molecular mechanisms using novel technologies such as network pharmacology, molecular docking, and experimental validation. Future studies are needed to focus on the inherent molecular mechanisms and clinical applications. In addition, potential side effects of the bioactive compounds cannot be ignored.

New horizons in nanoelectrochemistry: concluding remarks.

The aim of this paper is to overview the meeting on New horizons in nanoelectrochemistry held at Nanjing University in China in October 2024 and to give some perspective to the work presented. This paper is based on my summary talk and breaks down the subjects in the following areas of nanoelectrochemistry presented at the meeting: nanowires, nanonets, and nanoarrays; nanopores; nanopipettes; spectroelectrochemistry, scanning ion-conductance microscopy and light-active processes at nanointerfaces; scanning electrochemical microscopy and scanning electrochemical cell microscopy; and nanosensors. I end with some discussion of online meetings and where the field might go including artificial intelligence and by asking AI to define the challenges and future of nanoelectrochemistry.

Clinicopathological significance and prognostic value of serum 25-hydroxyvitamin D3 level in children with IgA vasculitis nephritis

To study the significance of serum 25-hydroxyvitamin D3 [25-(OH)D3] level in the clinicopathological characteristics and prognosis of children with immunoglobulin A vasculitis nephritis (IgAVN). A retrospective analysis was conducted on the clinical data of children with IgAVN who underwent renal biopsy at Suzhou Hospital Affiliated to Anhui Medical University and Jinling Hospital of the Medical School of Nanjing University from June 2015 to June 2020. Based on serum 25-(OH)D3 level, the patients were divided into a normal group and a lower group. The clinicopathological characteristics and follow-up data of the two groups were collected and compared. A total of 359 children with IgAVN were included. Compared to the normal group (62 cases), the lower group (297 cases) exhibited higher incidences of hematochezia and gross hematuria, higher levels of serum creatinine, blood urea nitrogen, urinary retinol protein, urinary N-acetyl-β-D-glucosaminidase, and quantitative urinary protein, and a longer duration from renal biopsy to urinary protein becoming negative, as well as lower estimated glomerular filtration rate and albumin level (P<0.05). Renal pathology in the lower group showed a higher occurrence of tubular interstitial injury, crescent formation, segmental sclerosis in glomeruli, and inflammatory cell infiltration in the renal interstitium compared to the normal group (P<0.05). Survival analysis indicated that the cumulative renal survival rate was lower in the lower group (P<0.05). Multivariate Cox regression analysis revealed that low serum 25-(OH)D3 level is an independent risk factor for poor prognosis in children with IgAVN. Children with IgAVN and low serum 25-(OH)D3 level have relatively severe clinicopathological manifestations. Low serum 25-(OH)D3 level is an independent risk factor for poor prognosis in children with IgAVN.

Role of macrophage polarization in diabetic foot ulcer healing: A bibliometric study.

Diabetic foot ulcers (DFUs) are a significant contributor to disability and mortality in diabetic patients. Macrophage polarization and functional regulation are promising areas of research and show therapeutic potential in the field of DFU healing. However, the complex mechanism, the difficulty in clinical translation, and the large heterogeneity present significant challenges. Hence, this study was to comprehensively analyze the publication status and trends of studies on macrophage polarization and DFU healing. To examine the relevant literature on macrophage polarization in DFU healing. A bibliometric analysis was conducted using the Web of Science database. Relevant literature was retrieved from the Web of Science Core Collection database between 2013 to 2023 using literature visualization and analysis software (VOSviewer and CiteSpace) and bibliometric online platforms. The obtained literature was then subjected to visualization and analysis of different countries/regions, institutions, journals, authors, and keywords to reveal the research's major trends and focus. The number of publications on the role of macrophage polarization in DFU healing increased rapidly from 2013 to 2023, especially in the latter period. Chinese researchers were the most prolific in this field, with 217 publications, while American researchers had been engaged in this field for a longer period. Qian Tan of Nanjing Drum Tower Hospital and Qian Ding of Nanjing University were the first to publish in this field. Shanghai Jiao Tong University was the institution with the most publications (27). The keywords "bone marrow", "adjustment, replacement, response, tissue repair", and "activation, repair, differentiation" appeared more frequently. The study of macrophage polarization in DFU healing focused on the regulatory mechanism, gene expression, and other aspects. This study through the bibliometric method reveals the research trends and development trends in this field of macrophage polarization in DFU healing from 2013 to 2023 in the Web of Science Core Collection database. The key hotspots in this field mainly include the regulation of macrophage activation, gene expression, wound tissue repair, and new wound materials. This study provides references for future research directions.

Association between body esteem and sugar-sweetened beverage intake among Chinese undergraduate students: a cross-sectional study.

High intake of sugar-sweetened beverages has been linked to a range of physical, psychological, and emotional issues. Although there were various factors influencing sugar-sweetened beverage intake, the relationship between body esteem and sugar-sweetened beverage intake remains unclear. This study aimed to investigate the association between three dimensions of body esteem (body esteem-appearance, body esteem-attribution, and body esteem-weight) and the likelihood of high sugar-sweetened beverage intake. A cross-sectional study was conducted among undergraduate students at Nanjing University of Chinese Medicine. Logistic regression analyses were used to assess the association between the three dimensions of body esteem and the risk of high sugar-sweetened beverage intake. Additionally, restricted cubic splines and subgroup analyses were implemented to further explore the associations. A total of 969 participants were included in the study, with 771 females (79.6%). The mean age of the participants was 20.07 years (standard deviation [SD] = 1.65). After adjusting for covariates, body esteem-appearance was found to be negatively associated with high sugar-sweetened beverage intake (OR = 0.962, 95% CI = 0.935-0.989, p = 0.007), while body esteem-attribution was positively associated with high sugar-sweetened beverage intake (OR = 1.091, 95% CI = 1.046-1.139, p < 0.001). However, no significant association was found between body esteem-weight and high sugar-sweetened beverage intake (p = 0.781). Restricted cubic spline plots showed no non-linear associations between any dimensions of body esteem and the risk of high sugar-sweetened beverage intake (p-nonlinear was 0.912, 0.225, 0.109, respectively). Subgroup analyses revealed no significant interactions. These findings underscored the significance of targeted health promotion strategies and provided references for educational institutions or governmental bodies to steer undergraduate beverage consumption toward healthier patterns.

Current status and trend of global research on the pharmacological effects of emodin family: bibliometric study and visual analysis.

Emodin, as a natural active ingredient, has shown great application potential in the fields of medicine, food and cosmetics due to its unique pharmacological effects, such as anti-inflammatory, antioxidant, anti-cancer, etc. In recent years, with the development of science and technology and the increase of people's demand for natural medicine, emodin research has been paid more and more attention by the global scientific research community.The bibliometric analysis of emodin and the construction of knowledge map are still blank. We searched the publications of emodin related studies in the Web of Science Core Collection (WoSCC) database from 2004 to 2024 and conducted a bibliometric analysis. Data processing was done using the R packages Bibliometrix, VOSviewer and CiteSpace.The consensus identified 4,125 emodin related articles from multiple countries, with China being the main contributor. The number of publications in this field is increasing year by year. China Medical University, the Chinese Academy of Sciences, and Nanjing University of Traditional Chinese Medicine are all prominent research institutions in this field. The Journal of ethnopharmacology published the most articles on the subject. The total number of authors of these articles has reached 14,991, among which Yi Wang is the author with the most output and Xiaoxv Dong is the author with the most cited times. "emodin", "apoptosis", and "liver injury" were the main research focuses. Topics such as "pharmacology", "photodynamic therapy", "advancing drug discovery" and "gallbladder cancer cell" may represent emerging areas of research in medicine.The results of this study help to identify the latest research frontiers and hot topics, and provide a valuable reference for the study of emodin family.

Comparison of short-term outcomes of robotic and laparoscopic surgery for mid-low rectal cancer: a propensity matched analysis

Objective: To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer. Methods: This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients. Results: (1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant (P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups (P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ2 = 4.009, P = 0.044). Conclusion: In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications.

Robotic versus laparoscopic intersphincteric resection for patients with low rectal cancer: Short-term outcomes.

This study aimed to evaluate the short-term outcomes between laparoscopic intersphincteric resection (L-ISR) and robotic intersphincteric resection (R-ISR) for low rectal cancer. We performed a retrospective clinical analysis between August 2018 and August 2021 at the Department Of General Surgery, the Affiliated Hospital of Nanjing University Medical School. A total of 28 patients were recruited in this research. Among these patients, there were 12 patients who underwent L-ISR and assigned to L-ISR group, and the remaining 16 patients underwent R-ISR and assigned to R-ISR group. The time to start oral fluids, time to start soft diet and time to first motion in R-ISR group were earlier than those in L-ISR group ( P < 0.05). The hospital stay in R-ISR group was shorter than that in L-ISR group ( P < 0.05). However, the operation time of R-ISR was longer compared to L-ISR group ( P < 0.05). Most important of all, the Kelly score in R-ISR group was 5.1 ± 0.9, which was higher than that in L-ISR group ( P = 0.004). R-ISR is safe and feasible for patients with low rectal cancer. R-ISR is superior to L-ISR despite the operation time of R-ISR is longer. A randomised controlled trial will be performed to confirm the conclusion further.

Clinical and genetic analysis of a case with 2p23.2p22.1 duplication

To report on the phenotype of an adult patient with 2p23.2p22.1 duplication and explore its genotype-phenotype correlation. A pregnant woman who had presented at the Affiliated Drum Tower Hospital of Nanjing University Medical School on January 12, 2024 for a high risk signaled by NIPT was selected as the study subject. Amniotic fluid and peripheral blood samples were collected and subjected to chromosomal microarray analysis (CMA). The phenotype of the patient was observed, the medical history was taken, combined with the result of CMA assay, relevant database was searched for similar cases reported in the literature, and the correlation between genotype and phenotype was analyzed. The CMA result of the patient was arr[GRCh38]2p23.2p22.1(27961669_39280633)×3, which indicated a 11.31 Mb duplication. The woman was found to have short stature, learning disability, visual deficit, sleep disorder and other disorders. The duplication of PPP1CB and SOS1 genes within the 2p23.2p22.1 region can result in Noonan syndrome-like clinical manifestations such as short stature and reduced visual acuity. The duplication of the PPP1CB gene may be associated with the abnormal visual phenotype.

Characteristics of Atmospheric Circulation Patterns and the Associated Diurnal Variation Characteristics of Precipitation in Summer over the Complex Terrain in Northern Xinjiang, Northwest China

Statistical characteristics of atmospheric circulation patterns (ACPs) and associated diurnal variation characteristics (DVCs) of precipitation in summer (June–August) from 2015 to 2019 over the complex terrain in northern Xinjiang (NX), northwestern arid region of China, were investigated based on NCEP FNL reanalysis data and Weather Research and Forecasting model simulation data from Nanjing University (WRF-NJU). The results show that six different ACPs (Type 1–6) were identified based on the Simulated ANealing and Diversified RAndomization (SANDRA), exhibiting significant differences in major-influencing synoptic systems and basic meteorological environments. Types 5, 3, and 2 were the most prevalent three patterns, accounting for 21.6%, 19.7%, and 17.7%, respectively. Type 5 mainly occurred in June and July, while Types 3 and 2 mainly occurred in August and July, respectively. From the perspective of DVCs, Type 1 reached its peak at midnight, while Type 5 was most frequent in the afternoon and morning. The overall DVCs of hourly precipitation intensity and frequency demonstrated a unimodal structure, with a peak occurring at around 16 Local Solar Time (LST). Basic meteorological elements in various terrain regions exhibit significant diurnal variation, with marked differences between mountainous and basin areas under different ACPs. In Types 3 and 6, meteorological elements significantly influence precipitation enhancement by promoting the convergence and uplift of low-level wind fields and maintaining high relative humidity (RH). The Altay Mountains region and Western Mountainous regions experience dominant westerly winds under these conditions, while the Junggar Basin and Ili River Valley regions benefit from counterclockwise water vapor transport associated with the Iranian Subtropical High in Type 6, which increases RH. Collectively, these factors facilitate the formation and development of precipitation.

Effect of electroacupuncture on discomfort in patients undergoing colonoscopy: protocol for a multicentre, randomised, controlled clinical trial

IntroductionColonoscopy is currently the most commonly used and effective method for early detection, diagnosis and treatment of tumours of the colon and rectum. However, similar to other invasive procedures, it...

LncRNA Gm20063 alleviates cognitive impairment in APPswe/PS1dE9 mice

AbstractBackgroundCompelling evidence has shown that long non‐coding RNAs (lncRNAs) contribute to Alzheimer’s disease (AD) pathogenesis including β‐amyloid plaque deposition (Aβ) and intracellular neurofibrillary tangles. In this study, we aimed to investigate the critical role of lncRNA Gm20063 in AD.MethodSix‐month‐old male APP/PS1 transgenic mice and wild type (WT) C57BL/6 (B6) littermates were obtained from the Nanjing University Animal Model Research Center. AAV mediated over‐expression or knockdown of Gm20063 in hippocampus neurons though stereotactic technique. Behavioral tests were performed to evaluate the cognitive and memory function of APP/PS1. Electrophysiological tests, Golgi staining and Western blotting was applied to determine the synaptic plasticity. The potential targets of Gm20063 were identified by mass spectrometry (MS), RNA‐binding protein immunoprecipitation (RIP) and RNA in situ hybridization (RNA scope).ResultThe expression of Gm20063 was significantly increased in the hippocampus of APP/PS1 mice. Overexpression of Gm20063 ameliorated cognitive decline, reduced Aβ deposition, enhanced synaptic plasticity and Aβ phagocytized by microglia in APP/PS1. In addition, knockdown of Gm20063 accelerated the memory deficits and worsened the AD pahogenesis in APP/PS1 mice. Furthermore, Gm20063 interacted with TDP‐43 in the hippocampus, and regulated the post‐translational modifications of TDP‐43.ConclusionGm20063 attenuated cognitive decline in AD mice, and targeting Gm20063 might be an effective therapy for AD treatment.

Beyond dissonance: the transformative power of thought analysis in philosophical practice

This paper provides a comprehensive examination of thought analysis as a contemporary practice within philosophical inquiry, exploring its theoretical foundations, methodological approaches, and practical implications. Rooted in classical philosophical traditions yet acutely relevant to modern life, thought analysis—officially conceptualized by Tianqun Pan—serves as a bridge between knowledge and action, addressing the cognitive dissonance that often hinders personal growth and rational decision-making. Through an analysis of historical and recent sources, including case studies from the laboratory of thought analysis at Nanjing University, we investigate whether logical reasoning is an innate human capacity or developed through education and practice, highlighting the importance of fostering logical skills in thought analysis. Ethical considerations, such as trust between analyst and visitor and the principle of value neutrality, are critically examined to underscore the necessity of maintaining visitor autonomy and preventing bias. We explore the relationship between thought analysis and therapeutic practices, emphasizing that while thought analysis is not inherently therapeutic, it possesses qualities that can lead to psychological relief and personal development through the clarification of thought. Comparative analyses with Logic-based Therapy and Logotherapy illustrate the unique position of thought analysis within philosophical practice. By reframing thought analysis as a form of humanistic care rather than clinical therapy, the paper advocates for its role in promoting clear thinking, self-awareness, and ethical living, thereby contributing to individual well-being and social harmony. Ultimately, the study affirms thought analysis as a transformative practice that aligns philosophical inquiry with practical life, empowering individuals to achieve greater coherence between their beliefs and actions.

Relationship between ripretinib concentration and the prognosis of advanced gastrointestinal stromal tumors in China: a multicenter study

Objective: To investigate the prognosis and safety of ripretinib in the treatment of patients with advanced gastrointestinal mesenchymal stromal tumors (GISTs) and to analyze the relationship between blood concentrations of this drug and prognosis. Methods: In this retrospective study, we investigated the effects of ripretinib in patients with advanced GISTs. The inclusion criteria comprised: (1) daily oral administration of ripretinib scheduled; and (2) uninterrupted treatment for at least 1month, with a stable and relatively fixed daily dosage maintained for a minimum of 2 weeks. Exclusion criteria comprised concurrent use of other tyrosine kinase inhibitors and presence of significant organ dysfunction. We retrospectively identified 79 patients with advanced GISTs who had received ripretinib across seven medical centers, namely Jiangsu Provincial Hospital, Jiangsu Cancer Hospital, Nanjing Drum Tower Hospital Affiliated to Nanjing University, Sir Run Run Shaw Hospital of Zhejiang University, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and the General Hospital of the People's Liberation Army, from 1 June 2021 to 31 March 2024. The cohort included 48 men and 31 women, 19 of whom had received ripretinib as second-line, 13 as third-line, and 47 as fourth-line therapy. Two peripheral venous blood samples were obtained from each participant and high-performance liquid chromatography-tandem mass spectrometry used to determine peak (Cmax) and trough (Cmin) concentrations of ripretinib. Machine learning methodologies, specifically the K-nearest neighbor algorithm combined with the Gridsearch CV strategy, were employed to establish the threshold for Cmin. We analyzed adverse reactions, treatment efficacy, median progression-free survival (mPFS), and the relationship between drug blood concentration and selected clinical parameters. Results: In the entire cohort, the Cmin and Cmax of ripretinib were 467 ± 360 μg/L and 986 ± 493 μg/L, respectively. Notably, female patients and individuals in the high-dose group exhibited significantly higher values for both Cmin and Cmax (both P<0.05). However, variations in drug concentrations associated with the line of ripretinib therapy, treatment efficacy, disease progression, and presence of selected specific genetic mutations were not significantly associated with values of Cmin and Cmax (P>0.05). Among the 79 patients with advanced GISTs receiving ripretinib, reported adverse reactions included alopecia (53, 67.09%), hand-foot syndrome (24, 30.38%), fatigue (22, 27.85%), and myalgia (21, 26.58%). Two patients (2.53%) had grade III complications, both classified as hand-foot syndrome. The correlation between Cmax and adverse reactions was not statistically significant (P > 0.05). By the time of the latest follow-up, five deaths (6.3%) had occurred within the cohort. The mPFS for the group was 16.3 months, with a mPFS of 14.4 months for those receiving standard dosage and 7.0 months for those receiving escalating dosage. Among the 65 patients treated with standard doses of ripretinib, those with Cmin exceeding a threshold of 450 μg/L exhibited a significantly longer mPFS (18.0 months vs.13.7 months; P < 0.05). Conclusion: In China, patients with advanced GISTs exhibit a notable tolerance to ripretinib, with no evidence for a correlation between adverse reactions and Cmax for the drug. Additionally, a Cmin exceeding 450 μg/L may be associated with an extended mPFS.

Insights from the international workshop on "Adapting agriculture to climate change and air pollution".

An international workshop on "Adapting Agriculture to Climate Change and Air Pollution" took place at Nanjing University of Information Science and Technology, Nanjing, China, during 23-27 October, 2023. Experts working in various multi-disciplinary areas of agroecosystem and environmental research gathered for academic communication and discussions. Two discussion groups focused on "agriculture under air pollution and climate change: current challenges and priorities for the future" and "adapting agriculture to air pollution and climate change: current status and next steps." Insights derived from the discussions are summarized in this article and include opinions about current issues, knowledge gaps' identification, and potential priorities and actions that could be taken. The first discussion mainly addresses ozone impact estimates; ozone metrics for impact and risk assessments; ozone monitoring; air pollution impacts and policy; and thepivotal role of agriculture and consumer choices. The second discussion covers adaptation and mitigation; greenhouse gases and energy efficiency; concerns about the link between adaptation and mitigation; local food, planetary-health diets and carbon footprint; irrigation and climate change adaptation; scientific evidence and policy-making; air pollution and crop adaptation; machine learning and crop modeling; and challenges faced by smallholder farmers and large-scale enterprises. Hence, this report could be useful for research, educational, and policy purposes, collating opinions of experts working in diverse research areas.

Entry point and screw path study of second sacral alar-iliac screw trajectory in spinal pelvic fixation under O-arm navigation

Objective: To explore the feasibility of using the entry point and screw path parameters of sacroiliac (S2AI) screws inserted under O-arm 3D computer navigation as a reference for freehand screw insertion in patients with degenerative spinal deformities. Methods: A retrospective analysis was conducted on the clinical data of 66 patients with degenerative spinal deformities who received S2AI screw fixation assisted by the O-arm 3D computer navigation system at Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2017 to April 2022. The patients included 6 males and 60 females, with a mean age of (64.3±5.9) years. Preoperatively, the entry point was set as the intersection of 1 mm from the outer and lower edges of the S1 foramen, adjusted intraoperatively by navigation, and verified postoperatively by full spinal CT scans and 3D reconstructions. Using the S1 screw entry point as the origin, the position of the bilateral S2AI screw entry points, tailward angulation (SA), outward angulation (TA), and vertical distance from the entry point to the skin (SD) were measured on postoperative CT 3D images. The accuracy of S2AI screw placement and any intraoperative and postoperative complications were recorded. Differences in entry point coordinates and screw path parameters between the left and right sides were compared. The intraclass correlation coefficient (ICC) was used to assess intra-observer and inter-observer agreement. Results: The coordinates and screw path parameters for the S2AI screws placed using the O-arm navigation demonstrated good intra-observer and inter-observer consistency (ICC>0.75). The left entry point was located (8.08±1.39) mm laterally and (24.47±2.20) mm caudally from the S1 entry point, while the right entry point was (8.09±1.41) mm laterally and (24.40±2.54) mm caudally, with no significant difference between the left and right sides (both P>0.05). The left TA was 46.33°±3.44°, SA was 39.14°±6.12°, and SD was (60.38±13.37) mm; the right TA was 46.37°±3.41°, SA was 39.59°±5.89°, and SD was (60.30±12.24) mm, with no significant differences between the left and right parameters (all P>0.05). There was no significant neurovascular complications intraoperatively or two weeks postoperatively, with a screw insertion accuracy of 97.7% (129/132). Conclusions: In the fixation of the pelvis in degenerative spinal deformities, the use of O-arm navigation-assisted S2AI screw insertion has a high accuracy rate. It is recommended that for freehand screw insertion, the entry point should be located 24 mm caudally and 8 mm laterally from the outer and lower edges of the superior articular process of S1, with an TA of approximately 46° and a SA of approximately 39°.

AUTOMATIC PATH PROGRAMMING FOR THE MANUFACTURING OF SHEET METAL COMPONENTS USING INCREMENTAL FORMING TECHNOLOGY

Asymmetric Incremental Sheet Forming (AISF) is an unconventional forming technology that involves localized and progressive plastic deformation of a sheet using a tool, typically a punch, following a continuous and numerically controlled path. Due to its specific characteristics and advantages, such as flexibility and relatively low implementation cost, it is considered a technology with great potential for competitively producing small series of sheet metal components. However, there are still some challenges, such as the lack of specific CAM tools for this technology, which has hindered its industrialization. Although the process may appear simple, with a 3D path sufficient to transform the original flat sheet into the final part, it has been observed that the manufacturing of real designs requires extensive knowledge of the technology to choose the appropriate path based on the target geometry. In this regard, this study presents a new solution developed by Tecnalia that incorporates expert process knowledge and enables automatic programming of Incremental Forming paths. Specifically, the solution allows programming paths aimed at manufacturing different geometric features commonly found in sheet metal components. This development has been validated through the manufacturing of several parts in a robotic cell implemented at Southeast University in Nanjing.

Effect of prophylactic infusion of norepinephrine on the prevention of hypotension during vertebroplasty: a randomized clinical trial

BackgroundTransient hypotension is a common occurrence during the implantation of bone cement. This placebo-controlled randomized clinical trial study investigated the effect of prophylactic infusion of norepinephrine on the incidence of hypotension in senior patients who underwent vertebroplasty.MethodsThe trial recruited patients who were greater than or equal to 65 years of age, had an American Society of Anesthesiologist physical status classification of I to III, and underwent vertebroplasty from August 2020 to August 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine in China. The patients were randomly grouped according to whether they received either a norepinephrine infusion of 0.05 µg/kg/min or an equivalent volume of saline 10 min before implantation of bone cement. Intraoperative hemodynamics were monitored continuously by the MostCare system at the following 7 time points: 10 min before implantation of bone cement and immediately, 30 s, 1, 3, 5, and 10 min after implantation of bone cement. We also recorded the number of hypotensive episodes and the total number of vasopressors after implantation of bone cement. Multivariable logistic regression was used to assess the risk factors associated with hypotension after implantation of bone cement.ResultsA total of 63 patients were randomized to the control group (n = 31; median [IQR] age, 74 [69–79] years) and the norepinephrine group (n = 32; median [IQR] age, 75 [71–79] years). The incidence of hypotension in the norepinephrine group was significantly lower than that in the control group after implantation of bone cement (12.5% vs. 45.2%; relative risk [RR], 3.61 [95% CI, 1.13–15.07]; P = 0.005). Moreover, the median (IQR) number of hypotensive episodes (0 [0–0] vs. 0 [0–2]; P = 0.005) and the total number of vasopressors (0 [0–0] vs. 0 [0–1]; P = 0.004) in the norepinephrine group were significantly lower than those in the control group. Furthermore, compared with the baseline, the MAP significantly decreased at 1 min (P = 0.007) and 3 min (P < 0.001) after bone cement implantation in the control group. However, the MAP at 3 min in the norepinephrine group was significantly higher than that in the control group (P < 0.001). The incidence of complications was not different between the groups. In multivariable logistic regression, the FRAIL score (OR, 2.29; 95% CI, 1.21–4.31) was identified as a risk factor associated with hypotension.ConclusionProphylactic infusion of norepinephrine before bone cement implantation can stabilize hemodynamics and reduce the incidence of hypotension after implantation of bone cement.