Quantitative susceptibility mapping in rats with minimal hepatic encephalopathy: Does iron overload aggravate cognitive impairment by promoting neuroinflammation?

BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is a mild form of hepatic encephalopathy that lacks observable signs and symptoms. Nevertheless, MHE can cause neurocognitive dysfunction, although the neurobiological mechanisms are not fully understood. Here, the effects of hippocampal iron deposition on cognitive function and its role in MHE were investigated. MATERIALS AND METHODS: Eighteen rats were assigned to experimental and control groups. MHE was induced by thioacetamide. Spatial memory and exploratory behavior were assessed by the Morris water and elevated plus mazes. Hippocampal susceptibility was measured by quantitative susceptibility mapping, iron deposition in the hippocampus and liver by Prussian blue staining, and inflammatory cytokine and ferritin levels in the hippocampus were measured by ELISA. RESULTS: MHE rats showed impaired spatial memory and exploratory behavior (P < 0.05 for all parameters). The bilateral hippocampal susceptibility values were significantly raised in MHE rats, together with evidence of neuroinflammation (increased pro-inflammatory and reduced anti-inflammatory cytokine levels (all P < 0.05). Further analysis indicated good correlations between hippocampal susceptibility values with latency time and inflammatory cytokine levels in MHE but not in control rats. CONCLUSION: MHE induced by thioacetamide was associated with hippocampal iron deposition and inflammation, suggesting that iron overload may be an important driver of neuroinflammatory responses.

In Situ Electrospinning of "Dry-Wet" Conversion Nanofiber Dressings for Wound Healing.

Rapid wound dressings provide an excellent solution strategy for the treatment of wounds in emergency situations. In this study, aqueous solvent-based PVA/SF/SA/GelMA nanofiber dressings fabricated by a handheld electrospinning device could deposit quickly and directly on the wound, perfectly fitting wounds with various sizes. Using an aqueous solvent overcame the disadvantage of using the current organic solvents as the medium for rapid wound dressings. The porous dressings had excellent air permeability to ensure smooth gas exchange at the wound site. The distribution range of the tensile strength of the dressings was 9-12 Kpa, and the tensile strain was between 60-80%, providing sufficient mechanical support during wound healing. The dressings could absorb 4-8 times their own weight in solution and could rapidly absorb wound exudates from wet wounds. The nanofibers formed ionic crosslinked hydrogel after absorbing exudates, maintaining the moist condition. It formed a hydrogel-nanofiber composite structure with un-gelled nanofibers and combined the photocrosslinking network to maintain a stable structure at the wound location. The in vitro cell culture assay indicated that the dressings had excellent cell cytocompatibility, and the addition of SF contributed to cell proliferation and wound healing. The in situ deposited nanofiber dressings had excellent potential in the urgent treatment of emergency wounds.

The role of butyrylcholinesterase in the regulation of cognitive dysfunction in minimal hepatic encephalopathy: A potential blood marker of disease evolution.

Background and aims: Patients with cirrhosis commonly experience minimal hepatic encephalopathy (MHE), and alterations in neurotransmitters have been thought to be related to cognitive function. However, the relationship between alterations in peripheral and central butyrylcholinesterase (BuChE) with MHE disease progression remains unknown. As such, this study was designed to investigate potential changes in peripheral and central BuChE activity and their effects on cognitive function in the context of MHE. Materials and methods: We enrolled 43 patients with cirrhosis secondary to hepatitis B, 20 without MHE and 23 with MHE, and 25 with healthy controls (HC). All the selected subjects underwent resting-state functional MRI, and the original images were processed to obtain the regional homogeneity (ReHo) brain maps. Thereafter, the correlation of BuChE activity with ReHo, number connection test of type A (NCT-A), and digital symbol test (DST) scores with MHE patients were analyzed using Person correlation analysis. Meanwhile, we purchased 12 Sprague-Dawley (SD) rats and divided them into an experimental group (n = 6) and a control group (n = 6). The rats in the experimental group were intraperitoneally injected with thioacetamide (TAA) to prepare MHE model rats. After modeling, we used the Morris water maze (MWM) and elevated plus maze (EPM) to assess the cognition function and exploratory behavior of all rats. The activity of serum, hippocampus, and frontal lobe tissue BuChE was detected by ELISA. Results: BuChE activity gradually decreased among the HC, patients with cirrhosis, and MHE groups (all P < 0.01). We observed a linear correlation between serum BuChE and NCT-A and DST scores in MHE patients (all P < 0.01). We noted that BuChE activity can negatively correlate with ReHo values in the left middle temporal gyrus and left inferior temporal gyrus, and positively correlate with ReHo values in the right inferior frontal gyrus, and also found that the peripheral BuChE activity of MHE rats was significantly lower than their control counterparts, and the BuChE activity in frontal lobe extracts was significantly higher than the control rats (all P < 0.05). Conclusion: The altered activity of BuChE may contribute to cognitive impairment in MHE patients, which may be a potential biomarker of disease evolution in the context of MHE.

Monomethyl lithospermate alleviates ischemic stroke injury in middle cerebral artery occlusion mice in vivo and protects oxygen glucose deprivation/reoxygenation induced SHSY-5Y cells in vitro via activation of PI3K/Akt signaling.

Stroke is a fatal neurological disease, which seriously threatens human health and life. Ischemic stroke (IS) is the most common type of stroke in clinic. Its pathogenesis is very complex, mainly caused by nerve damage caused by brain blood supply disorder. Previous studies have confirmed that natural products play important roles in improving neurological disorders. Furthermore, our previous results also suggested that Shenxiong Tongmai granule, a clinically used herbal medicines' prescription, has a good ameliorating effect on IS. In the present study, we found that Monomethyl lithospermate (MOL), a constituent of Shenxiong Tongmai granule, significantly improved the neurological damage in middle cerebral artery occlusion (MCAO) rats. MOL can significantly improve the neurological deficit score of MCAO rats, and improve the damage of hippocampal neurons caused by ischemia-reperfusion (IR). At the same time, we also found that MOL could reduce the level of oxidative stress in the brain tissues of MCAO rats. Furthermore, the oxygen and glucose deprivation/Reoxygenation (OGD/R)-induced SHSY-5Y cell model was established in vitro to investigate the pharmacological activity and molecular mechanisms of MOL in improving the nerve injury of IS rats. The results showed that MOL could increase the cell viability of SHSY-5Y cells, inhibit the mitochondrial membrane potential (MMOP) collapse and suppress apoptosis. In addition, MOL also ameliorated the elevated oxidative stress level caused by OGR/R treatment in SHSY-5Y cells. Further mechanistic studies showed that MOL could activate the PI3K/AKT pathway via promoting the phosphorylation of PI3K and AKT in MCAO rats and OGR/R-induced SHSY-5Y cells, which could be partially blocked by addition of PI3K/AKT pathway inhibitor of LY294002. Taken together, our current study suggested that MOL exerts a protective effect against neural damage caused by IS in vivo and in vitro by activating the PI3K/AKT pathway.

Altered anterior insula-superior frontal gyrus functional connectivity is correlated with cognitive impairment following total sleep deprivation.

Sleep deprivation is an important cause of cognitive impairment, and anterior insular subregions are core brain regions linked to cognitive function. However, the relationship between anterior insular subregions functional connectivity (FC) and the cognitive impairment that occurs following total sleep deprivation (TSD) remains unknown. As such, this study was designed to evaluate how such anterior insular subregions FC alterations are linked with impaired cognitive activity after TSD. This study recruited 20 healthy volunteers who underwent two rounds of resting-state functional magnetic resonance imaging (rs-fMRI), with one being conducted while in a state of rested wakefulness (RW) and the other being conducted following 24 h of TSD. These rs-fMRI data were then used to conduct seed-based FC analyses for the bilateral anterior insular subregions, including the dorsal anterior insula (dAI) and the ventral anterior insula (vAI). The Psychomotor Vigilance Test (PVT) was used to gauge cognitive performance, and associations between altered FC in these anterior insular subregions and PVT performance following TSD were measured using Pearson correlation analyses. Significant changes in the FC of these bilateral insular subregions were observed following 24 h of TSD relative to the RW state. Significantly enhanced FC was evident between the left dAI and right superior frontal gyrus (SFG), right dAI and bilateral SFG and right putamen, and right vAI and left medial SFG. Moreover, the observed enhancement of FC between the left vAI and right SFG functional connectivity was positively correlated with worse PVT performance. These data suggest that altered FC in the anterior insular subregions represents a prominent neuroimaging biomarker associated with cognitive impairment following TSD.

Decreased brain noradrenaline in minimal hepatic encephalopathy is associated with cognitive impairment in rats.

BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is a common neuropsychiatric complication in patients with cirrhosis. Alterations in monoamine neurotransmitters have been associated with the pathogenesis of MHE. We investigated the levels of hippocampal noradrenergic neurotransmitter in a rat model of thioacetamide-induced chronic liver failure-related MHE, and their role in cognitive impairment. MATERIALS: 18 male Sprague-Dawley (SD) rats were equally divided in MHE and control groups. A rat model of MHE was established by intraperitoneal injection of thioacetamide (TAA) for 12 weeks. Cognitive function was assessed using the Morris water maze (MWM) test and locomotor activity and exploratory behavior assessed with open field test. The concentration of hippocampal noradrenaline (NE) was detected by ELISA, and the magnetic susceptibility value in the hippocampus was detected by quantitative susceptibility mapping. Hippocampal iron content was quantified by Prussian blue staining. RESULTS: MHE rats performed significantly poorer than their control counterparts in the MWM test, as seen by decreased number of platform crossings and time in the target quadrant, and increased path length to reach the target zone (P < 0.05 for all parameters). In the open field test, the MHE group exhibited lower locomotor activity and exploratory behavior than the control group (P < 0.05 for all parameters). We detected pronounced iron staining in the hippocampus of MHE rats, whereas no iron-stained particles were found in control rats. We observed an imbalance of inflammatory (increased pro- and decreased anti-) cytokines in the hippocampus of MHE rats. Further analysis of the data showed that the level of hippocampal noradrenaline in MHE rats was significantly lower than that of control rats (P < 0.05). We observed a correlation between the level of inflammatory cytokine and noradrenaline land susceptibility value in the rat hippocampus of the MHE group. CONCLUSION: Our results suggest that MHE associated with TAA-induced chronic liver failure is associated with alterations in noradrenergic neurotransmission. We propose that iron imbalance in the brain might lead to reduction in the levels of noradrenaline, and cognitive impairment.

Microstructural white matter changes in chronic migraine patients with liver-yang hyperactivity and qi-blood deficiency syndrome: a diffusion tensor imaging study.

White matter alterations in patients with chronic migraine (CM) have been reported. Traditional Chinese medicine (TCM) syndromes are clinical syndromes proposed by TCM doctors based on long-term clinical observation and classification of the clinical symptoms and signs of CM patients. This study aimed to analyze the whole-brain diffusion tensor imaging (DTI) data of CM patients with different types of TCM syndromes. Sixteen CM patients diagnosed with liver-yang hyperactivity (LH) syndrome and 16 CM patients with qi-blood deficiency (QD) syndrome were recruited in this study. Thirty-one healthy controls (HCs) were also enrolled. All subjects underwent DTI and T1-weighted MRI acquisition. Thirty HCs and 30 CM patients (LH group: n = 15; QD group: n = 15) were included in the final analysis. No significant difference was observed in the DTI indexes between CM patients and HCs, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). The mean FAs of the left tapetum and the mean MD values for the right medial lemniscus and the right inferior cerebellar peduncle were significantly different in the LH and HC groups. The mean AD values for the right cingulate gyrus and the left uncinate fasciculus, as well as the mean RD for the right inferior cerebellar peduncle and the left tapetum, were also significantly different between these two groups. CM patients with LH and QD syndrome showed altered FA and diffusivity in comparison to healthy controls, suggesting that there may be significant white matter microstructural alterations in these patients.

Kearns-Sayre syndrome with rare imaging finding of SLC25A4 Mutation.

Kearns-Sayre Syndrome (KSS) is a subtype of chronic progressive external ophthalmoplegia (CPEO). In this case, A 21-year-old man diagnosed with KSS, and presented with chronic progressive blepharoptosis (ptosis) and external ophthalmoplegia, diffuse depigmentation of the retinal pigment epithelium, and cerebellar ataxia, with a cerebrospinal fluid protein of 254 mg/dL, was reported. Genetic screening revealed a novel mutated gene in SLC25A4 in the patient as well as in his mother: NM_001151:c.170G>C in exon 2. Its imaging finding is a characteristic progressive atrophy of the right cerebellar hemisphere. In conclusion, we found a case of KSS with a novel mutated gene in SLC25A4: NM_001151:c.170G>C in exon 2 as the pathogenic mechanism, and found that KSS can be caused only when the proportion of mutations in the SLC25A4 gene reach a certain degree, and the patient with KSS showed a unique cranial imaging feature of unilateral progressive cerebellar atrophy.

A Novel CT-Based Radiomics Features Analysis for Identification and Severity Staging of COPD.

RATIONALE AND OBJECTIVES: To evaluate the role of radiomics based on Chest Computed Tomography (CT) in the identification and severity staging of chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This retrospective analysis included 322 participants (249 COPD patients and 73 control subjects). In total, 1395 chest CT-based radiomics features were extracted from each participant's CT images. Three feature selection methods, including variance threshold, Select K Best method, and least absolute shrinkage and selection operator (LASSO), and two classification methods, including support vector machine (SVM) and logistic regression (LR), were used as identification and severity classification of COPD. Performance was compared by AUC, accuracy, sensitivity, specificity, precision, and F1-score. RESULTS: 38 and 10 features were selected to construct radiomics models to detect and stage COPD, respectively. For COPD identification, SVM classifier achieved AUCs of 0.992 and 0.970, while LR classifier achieved AUCs of 0.993 and 0.972 in the training set and test set, respectively. For the severity staging of COPD, the mentioned two machine learning classifiers can better differentiate less severity (GOLD1 + GOLD2) group from greater severity (GOLD3 + GOLD4) group. The AUCs of SVM and LR is 0.907 and 0.903 in the training set, and that of 0.799 and 0.797 in the test set. CONCLUSION: The present study showed that the novel radiomics approach based on chest CT images that can be used for COPD identification and severity classification, and the constructed radiomics model demonstrated acceptable performance.

Magnetic resonance imaging radiomics to differentiate ovarian sex cord-stromal tumors and primary epithelial ovarian cancers.

Objective: To evaluate the diagnostic ability of magnetic resonance imaging (MRI) based radiomics and traditional characteristics to differentiate between Ovarian sex cord-stromal tumors (SCSTs) and epithelial ovarian cancers (EOCs). Methods: We consecutively included a total of 148 patients with 173 tumors (81 SCSTs in 73 patients and 92 EOCs in 75 patients), who were randomly divided into development and testing cohorts at a ratio of 8:2. Radiomics features were extracted from each tumor, 5-fold cross-validation was conducted for the selection of stable features based on development cohort, and we built radiomics model based on these selected features. Univariate and multivariate analyses were used to identify the independent predictors in clinical features and conventional MR parameters for differentiating SCSTs and EOCs. And nomogram was used to visualized the ultimately predictive models. All models were constructed based on the logistic regression (LR) classifier. The performance of each model was evaluated by the receiver operating characteristic (ROC) curve. Calibration and decision curves analysis (DCA) were used to evaluate the performance of models. Results: The final radiomics model was constructed by nine radiomics features, which exhibited superior predictive ability with AUCs of 0.915 (95%CI: 0.869-0.962) and 0.867 (95%CI: 0.732-1.000) in the development and testing cohorts, respectively. The mixed model which combining the radiomics signatures and traditional parameters achieved the best performance, with AUCs of 0.934 (95%CI: 0.892-0.976) and 0.875 (95%CI: 0.743-1.000) in the development and testing cohorts, respectively. Conclusion: We believe that the radiomics approach could be a more objective and accurate way to distinguish between SCSTs and EOCs, and the mixed model developed in our study could provide a comprehensive, effective method for clinicians to develop an appropriate management strategy.

Safety and immunogenicity of inactivated SARS-CoV-2 vaccines in healthy individuals: protocol for a systematic review and meta-analysis.

INTRODUCTION: COVID-19 has spread with high morbidity and mortality worldwide. Many inactivated SARS-CoV-2 vaccines are being tested at various clinical trial stages for the control and prevention of COVID-19. We aim to comprehensively and objectively evaluate the safety and immunogenicity of inactivated SARS-CoV-2 vaccines in healthy individuals through a systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS AND ANALYSIS: We will search electronic databases of PubMed, the Cochrane Library, Web of Science and EMBASE for RCTs from inception to 31 December 2021. We will also search conference abstracts, reference lists, and grey literature of all available records. Two reviewers will independently screen and extract information from the literature. Bias and the quality of included studies will be evaluated with the risk-bias assessment tool provided by the Cochrane Collaboration. Statistical analysis will be performed using Cochrane's Review Manager (RevMan), V.5.3. ETHICS AND DISSEMINATION: Ethics approval and patient informed consent are not required because we will be including published literature only. The findings of this research will be disseminated in a peer-reviewed journal and likely through other scientific events such as conferences, seminars and symposia. PROSPERO REGISTRATION NUMBER: CRD42021266285.

Severity Assessment of COVID-19 Using a CT-Based Radiomics Model.

The coronavirus disease of 2019 (COVID-19) has evolved into a worldwide pandemic. Although CT is sensitive in detecting lesions and assessing their severity, these works mainly depend on radiologists' subjective judgment, which is inefficient in case of a large-scale outbreak. This work focuses on developing a CT-based radiomics model to assess whether COVID-19 patients are in the early, progressive, severe, or absorption stages of the disease. We retrospectively analyzed the CT images of 284 COVID-19 patients. All of the patients were divided into four groups (0-3): early (n = 75), progressive (n = 58), severe (n = 75), and absorption (n = 76) groups, according to the progression of the disease and the CT features. Meanwhile, they were split randomly to training and test datasets with the fixed ratio of 7 : 3 in each category. Thirty-eight radiomic features were nominated from 1688 radiomic features after using select K-best method and the ElasticNet algorithm. On this basis, a support vector machine (SVM) classifier was trained to build this model. Receiver operating characteristic (ROC) curves were generated to determine the diagnostic performance of various models. The precision, recall, and f 1-score of the classification model of macro- and microaverage were 0.82, 0.82, 0.81, 0.81, 0.81, and 0.81 for the training dataset and 0.75, 0.73, 0.73, 0.72, 0.72, and 0.72 for the test dataset. The AUCs for groups 0, 1, 2, and 3 on the training dataset were 0.99, 0.97, 0.96, and 0.93, and the microaverage AUC was 0.97 with a macroaverage AUC of 0.97. On the test dataset, AUCs for each group were 0.97, 0.86, 0.83, and 0.89 and the microaverage AUC was 0.89 with a macroaverage AUC of 0.90. The CT-based radiomics model proved efficacious in assessing the severity of COVID-19.

Network meta-analysis on efficacy and safety of different anti-CGRP monoclonal antibody regimens for prophylaxis and treatment of episodic migraine.

BACKGROUND: Currently, studies have shown that anti-CGRP monoclonal antibodies are effective drugs for the prophylaxis and treatment of episodic migraine. Therefore, for the first time, we classified and concluded 10 treatment regimens according to the different doses, drugs, routes of administration, and courses of treatment, so as to provide a reference for further clinical studies. METHODS: We studied relevant randomized controlled trials (RCTs) published before August 2020 on PubMed, Embase, Ovid MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials. RESULTS: Eleven RCTs involving 6397 patients were included in our analysis. Network meta-analysis results suggested that in the comparison of the average migraine days per month, Erenumab  (140 mg), Galcanezumab (120 mg, 240 mg), Fremanezumab (225 mg, 675 mg) were superior to placebo, Erenumab(7 mg), and the difference was statistically significant; Fremanezumab (225 mg, 675 mg) was superior to Erenumab (21 mg, 70 mg), and the difference was statistically significant; in the comparison of average medication days of acute migraine-specific drug per month, Erenumab (70 mg, 140 mg), Galcanezumab (120 mg, 240 mg), Fremanezumab (225 mg, 675 mg) was superior to placebo, and Erenumab (140 mg) and Galcanezumab (120 mg, 240 mg) were superior to Erenumab (70 mg), and the difference was statistically significant; there was no statistically significant difference in the average migraine days in the last month or in the medication days of acute migraine-specific drug. CONCLUSION: Fremanezumab (225 mg) and Galcanezumab (120 mg) may be the best clinical protocol after a comprehensive assessment.

Damage to the central nucleus of the thalamus via atypical Holmes tremor: a case report.

Holmes tremor (HT) is a rare symptomatic movement disorder characterized by a combination of resting, postural, and action tremors. HT is usually caused by lesions in the brain stem, thalamus, and cerebellum, and the pathogenesis is believed to be related to the nigrostriatal pathway and/or the cerebello-thalamo-cortical pathway. Many medications have been used to treat HT with various degrees of effectiveness. We herein present a case involving an elderly woman who developed atypical HT 23 months after cerebral hemorrhage. The atypical HT manifested as a tremor of the right limb with involuntary flexion of the distal five fingers of the right upper limb. Imaging findings suggested the existence of an old hemorrhage in the left thalamus. Specifically, diffusion tensor imaging data of the whole brain and multimodal three-dimensional medical imaging revealed significant white matter microstructural changes in the centromedian nucleus of the left thalamus. Treatment with high-dose oral levodopa was not efficient, but the symptoms gradually decreased in severity and disappeared 1 month after switching to oral clonazepam treatment.

A framework for assessing carbon effect of land consolidation with life cycle assessment: A case study in China.

Ecological transformation is an inevitable trend for the development of land consolidation (LC) worldwide, and the research on carbon effect of LC is an important theoretical basis for promoting the construction of Eco-LC. However, there is currently a lack of analysis of the carbon effect based on the whole process of LC, ignoring the stage elements and temporal factors. This study applied Life Cycle Assessment (LCA) method to construct a research framework and accounting system for carbon footprint assessment of LC, and explored the carbon effect in a typical land consolidation project area (LCPA) of China. Results showed that: (a) The carbon effect of the project area was characterized as carbon emission during the whole life cycle of LC. Carbon footprint before and after LC was 3.251 tCE·ha-1·a-1 and 2.401 tCE·ha-1·a-1 respectively. The carbon storage reduced and the carbon footprint is declined by 0.850 tCE·ha-1·a-1. (b) Carbon effect varied among different stages of LC. The Benefit Period (BP) was the only stage that was manifested as carbon absorption (-14.65%), while all the other stages were manifested as carbon emission. Among them, as to the carbon emission, the Construction Period (CP) played a decisive role with the most proportion (102.74%), followed by DP and RP, and the carbon effect of PP was negligible. (c) The dominant factors of carbon effect at different stages were also different. During CP, cement contributed the most to the carbon emission in this case. During RP, carbon sequestration effect of cropland proved to be the most significant. During RP, the carbon sequestration effect of cultivated land and the carbon emission effect of unused land were the most prominent. During BP, the carbon sequestration capacity of farmland ecosystems proved to be greater than the carbon emissions from agricultural activities. This study contributes to providing certain theoretical guidance and method reference for the realization of Low-Carbon LC project planning, with this comprehensive and reliable method.

Rutin-loaded cellulose acetate/poly(ethylene oxide) fiber membrane fabricated by electrospinning: A bioactive material.

Considering its health benefits, rutin provides promising applications in the pharmaceutical and cosmetic industries. However, the low bioavailability and low water solubility limit its application and remain to be resolved. In this study, cellulose acetate/poly(ethylene oxide) (CA/PEO) fiber was used as carrier for releasing it to relieve these problems. Bioactive fiber membrane was prepared by mixing it with CA/PEO solution. The surface morphology, encapsulation efficiency, antioxidant activity, antibacterial, and drug release of the rutin-loaded fiber membranes were studied. And the characteristics of the membranes were evaluated by the molecular interaction, thermal stability and mechanical properties. The results reveal that the fiber membrane loaded with 1.2 wt% rutin exhibited antioxidant activity of 98.3% and antibacterial properties of 93.5% and 95.0% against E. coli and S. aureus, respectively. Rutin release profiles were best fitted to Korsmeyer-Peppas model, and the fiber membrane released about 90% of rutin after 4 h. This indicates that rutin-loaded CA/PEO fiber membrane is a potential bioactive material.

A new framework of land use efficiency for the coordination among food, economy and ecology in regional development.

Great challenges regarding land use conflicts in rapid urbanization call for deeper research on land use efficiency (LUE) from the perspective of sustainable land use for the coordination among food security, economic development, and ecological protection. This study firstly develops a new framework of LUE based upon the expectations in land use and the coordination among three sub-categories in food production, economic development, and ecological protection, then, uses the coupling coordination degree model to quantify the spatial differentiation characteristics and coupling coordination relationships among three sub-categories, and finally uses the multivariable linear regression and geographical detectors to analyze the impact factors of sub-category efficiency. The framework is applied to Jiangsu Province in eastern China by using ten indicators (i.e., cultivated land quality, grain output, multiple cropping index, average GDP per km2, population density, proportion of industry and service industry, vegetation cover index, water conservation index, soil retention index, and carbon sequestration index) in terms of food production, economy, and ecology analysis at the county level. Compared with expectations, the LUE of Jiangsu in food production, economic development, and ecological protection is 54.15%, 85.56%, and 54.95%, respectively, indicating that Jiangsu has great potential for sustainable land use. The coupling coordination degree in land use generally synchronizes with the coupling degree, accounting for 65.34% of the province's area, of which 75.00% are in lower-coupling & lower-coordination, medium-coupling & medium-coordination. Among all the factors, proportion of industry and service industry, population density, multiple cropping index, average GDP per km2, and water conservation index have the most important roles in the coordinated development of land use sub-systems. Therefore, we suggest land use/urban management need to implement more integrated planning and differentiated strategies to stimulate land use potential and maintain efficient and sustainable land use.