Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

Pancreatic cancer is characterized by nerve invasion and a high mortality rate， and its pathological process depends on the complex interaction network between tumor and the nervous system. Based on the concept of “pancreatic cancer neuroecology”， this article analyzes the mechanism of action of peripheral motor nerve， sensory nerve， and central nerve in tumorigenesis， pain regulation， and cachexia formation and emphasizes the synergistic regulatory role of immune cells， Schwann cells， and extracellular matrix in the microenvironment of perineural invasion. At the same time， this article further elaborates on the metabolic interaction and chemotaxis between neuraxis and tumor， the effect on promoting chemotherapy resistance， and the dynamic relationship between neuroplasticity and tumor adaptability. In clinical practice， this article summarizes the key value of perineural invasion in prognostic evaluation， preoperative evaluation， and the selection of surgical strategy. In addition， this article reviews the basic research advances in the biomarkers and potential targets associated with perineural invasion in pancreatic cancer and points out the limitations of current model and transformation research. In the future， systematically analyzing the nerve-tumor-immune network and targeting its key nodes may provide multi-dimensional strategies and new breakthroughs for the precise intervention of pancreatic cancer， the reversal of drug resistance， and the relief of symptoms.

Objective:To investigate the iodine nutrition status of key populations in Linfen City, scientifically evaluate the current situation of iodine deficiency disorders prevention and control, and provide scientific basis for timely and targeted prevention and control of iodine deficiency disorders.Methods:According to the requirements of the "Monitoring Plan for Iodine Deficiency Disorders in Shanxi Province", from 2019 to 2023, monitoring was conducted annually in 17 counties (cities, districts, hereinafter referred to as county) under the jurisdiction of Linfen City. Each county was divided into five districts: east, west, south, north, and middle. One township/street was selected from each district, and 40 students aged 8 to 10 years from one primary school and 20 pregnant women were selected from each township/street as survey subjects. Household edible salt samples and one random urine samples were collected to test salt iodine and urinary iodine levels, and thyroid volume was measured on some children.Results:From 2019 to 2023, a total of 25 695 household edible salt samples were collected from children and pregnant women in 17 counties of Linfen City, with an average salt iodine range of 22.20 - 23.80 mg/kg. The qualified iodized salt consumption rates were 90.99% (4 674/5 137), 94.75% (4 889/5 160), 95.27% (4 889/ 5 132), 94.50% (4 843/5 125), and 95.82% (4 926/5 141), respectively; the iodized salt coverage rates were > 95%, and the qualified iodized salt rates were > 90%. And all the three showed an increasing trend year by year (χ 2trend = 56.31, 110.92, 137.24, P < 0.001). A total of 17 145 urine samples were collected from children, and the medians urinary iodine from 2019 to 2023 were 213.03, 187.40, 185.07, 190.70, and 189.30 μg/L, respectively. There were 8, 8, 9, 5, and 11 counties with appropriate iodine for children in each year, 0, 1, 0, 2, and 1 county with excessive iodine, and no county with iodine deficiency. A total of 8 548 urine samples were collected from pregnant women. The medians urinary iodine for pregnant women from 2019 to 2023 were 181.59, 187.40, 194.40, 187.25, and 187.10 μg/L, respectively. There were 14, 13, 15, 15, and 16 counties with appropriate iodine levels for pregnant women in each year, and 2, 4, 1, 0, and 1 county with iodine deficiency. A total of 5 670 children were examined for thyroid. The thyroid enlargement rates in children from 2019 to 2023 were 1.57%, 2.94%, 2.86%, 3.80%, and 2.82%, respectively. From 2019 to 2023, there were no new cases of endemic cretinism in Linfen City, and the thyroid enlargement rates in children were < 5%. Conclusions:From 2019 to 2023, all 17 counties in Linfen City are in a state of eliminating iodine deficiency disorders, and children and pregnant women are generally at an appropriate iodine and exceeding the appropriate iodine level. We should continue to strengthen the monitoring of iodine nutrition for key populations, carry out health education on scientific iodine supplementation, and effectively consolidate the achievements of iodine deficiency disorders prevention and control.

Objective:To investigate the iodine nutrition status of key populations in Linfen City, scientifically evaluate the current situation of iodine deficiency disorders prevention and control, and provide scientific basis for timely and targeted prevention and control of iodine deficiency disorders.Methods:According to the requirements of the "Monitoring Plan for Iodine Deficiency Disorders in Shanxi Province", from 2019 to 2023, monitoring was conducted annually in 17 counties (cities, districts, hereinafter referred to as county) under the jurisdiction of Linfen City. Each county was divided into five districts: east, west, south, north, and middle. One township/street was selected from each district, and 40 students aged 8 to 10 years from one primary school and 20 pregnant women were selected from each township/street as survey subjects. Household edible salt samples and one random urine samples were collected to test salt iodine and urinary iodine levels, and thyroid volume was measured on some children.Results:From 2019 to 2023, a total of 25 695 household edible salt samples were collected from children and pregnant women in 17 counties of Linfen City, with an average salt iodine range of 22.20 - 23.80 mg/kg. The qualified iodized salt consumption rates were 90.99% (4 674/5 137), 94.75% (4 889/5 160), 95.27% (4 889/ 5 132), 94.50% (4 843/5 125), and 95.82% (4 926/5 141), respectively; the iodized salt coverage rates were > 95%, and the qualified iodized salt rates were > 90%. And all the three showed an increasing trend year by year (χ 2trend = 56.31, 110.92, 137.24, P < 0.001). A total of 17 145 urine samples were collected from children, and the medians urinary iodine from 2019 to 2023 were 213.03, 187.40, 185.07, 190.70, and 189.30 μg/L, respectively. There were 8, 8, 9, 5, and 11 counties with appropriate iodine for children in each year, 0, 1, 0, 2, and 1 county with excessive iodine, and no county with iodine deficiency. A total of 8 548 urine samples were collected from pregnant women. The medians urinary iodine for pregnant women from 2019 to 2023 were 181.59, 187.40, 194.40, 187.25, and 187.10 μg/L, respectively. There were 14, 13, 15, 15, and 16 counties with appropriate iodine levels for pregnant women in each year, and 2, 4, 1, 0, and 1 county with iodine deficiency. A total of 5 670 children were examined for thyroid. The thyroid enlargement rates in children from 2019 to 2023 were 1.57%, 2.94%, 2.86%, 3.80%, and 2.82%, respectively. From 2019 to 2023, there were no new cases of endemic cretinism in Linfen City, and the thyroid enlargement rates in children were < 5%. Conclusions:From 2019 to 2023, all 17 counties in Linfen City are in a state of eliminating iodine deficiency disorders, and children and pregnant women are generally at an appropriate iodine and exceeding the appropriate iodine level. We should continue to strengthen the monitoring of iodine nutrition for key populations, carry out health education on scientific iodine supplementation, and effectively consolidate the achievements of iodine deficiency disorders prevention and control.

Currently, the teaching work for postgraduates mainly centers on specific disciplines, and there is a lack of effective connection between disciplines, which leads to the insufficient ability of postgraduates in effectively integrating and applying the knowledge of various disciplines and restricts the development of innovation ability. This paper proposes a program for the cultivation of innovation ability of postgraduate students in clinical laboratory diagnostics based on multi-disciplinary integration from the three aspects of curriculum setting, multi-disciplinary interactive platform construction, and tutor team construction, aiming at helping postgraduate students to enhance the ability of knowledge integration and application and form a comprehensive disciplinary perspective. Additionally, the paper explores the practical application and effect of the cultivation program, offering novel insights and approaches for talent cultivation in the realm of clinical laboratory diagnostics.

Objective:To analyze the anti effect of chimeric antigen receptor (CAR)-T cells targeting hepatitis B surface antigen (HBsAg) on hepatocellular carcinoma cells.Methods:HBsAg-CAR gene was transduced into T cells (obtained from the blood of healthy donors) through a lentiviral vector. CD19-CAR-T cells were included as mock group, and untransduced T cells were included as control group. Cells of the three groups were co-cultured with hepatocellular carcinoma cells expressing HBsAg or not to detect the anti effect and releasing level of anti-tumor cytokines (tumor necrosis factor-α, interferon-γ, interleukin-2). Subcutaneous xenograft PLC/PRF/5 tumor model using NPG mice were established and HBsAg-CAR-T cells (experimental group, n=5) or untransfected T cells (control group, n=5) were injected through tail vein. Tumor volume was measured 15 days after injection. Results:HBsAg-CAR-T cells proliferation was good under in vitro culture, and the expression rate of CAR was stable. After co-cultured with hepatocellular carcinoma cells expressing HBsAg, the level of anti-tumor cytokines released by HBsAg-CAR-T cells was significantly higher than that of the other two groups of T cells, and the difference was statistically significant (all P<0.05); the anti rate of HBsAg-CAR-T cell group on HBsAg-positive hepatocellular carcinoma cells was significantly higher than that of the other two groups, and the difference was statistically significant (all P<0.05). The tumor volume of NPG mice in the experimental group was (250.8±62.8) mm 3, which was lower than that of the control group (757.5±102.6) mm 3, and the difference was statistically significant ( P<0.05). Conclusion:HBsAg-CAR-T cells can specifically recognize and kill HBsAg-positive hepatocellular carcinoma cells and release high level of anti-tumor cytokines.

Objective:To determine the risk factors of drainage time longer than 1 day in patients with selective abdominal drainage after laparoscopic cholecystectomy.Methods:The clinical data related to patients with selective abdominal drainage undergoing laparoscopic cholecystectomy from November 2009 to November 2019 at Chinese PLA General Hospital were retrospectively analyzed. Of 233 patients enrolled into this study, there were 147 males and 86 females, with a median aged 59.0 (47.5, 65.5) years old. The patients were divided into drainage time 1 day group of 65 patients and longer than 1 day group of 168 patients according to postoperative drainage time. The baseline data and perioperative data were collected, the risk factors correlated with drainage time longer than 1 day were analyzed.Results:The drainage time was 1 in the 1 day group and 2~8 in another group. Among the 233 patients, there was one with biliary leakage and 14 patients had abdominal bleeding, all of them healed after 2~3 days. All of the 233 patients were recovered when discharged. Independent risk factors related to drainage time longer than 1 day include BMI≥28 kg/m 2 ( OR=3.443, 95% CI: 1.411-8.405, P=0.007), operation time ≥65 min ( OR=2.570, 95% CI: 1.310-5.045, P=0.006), thickness of gallbladder wall ≥0.5 cm ( OR=12.720, 95% CI: 1.350-5.478, P=0.005), postoperative stomachache ( OR=13.537, 95% CI: 1.685-108.748, P=0.014) and postoperative fever ( OR=8.156, 95% CI: 1.035-64.249, P=0.046). Conclusion:For patients undergoing selective abdominal drainage after laparoscopic cholecystectomy with BMI ≥28 kg/m 2, operation time ≥65 min, gallbladder wall thickness ≥0.5 cm, postoperative abdominal pain and fever, clinicians should appropriately prolong the drainage time to ensure medical safety.

Advanced hepatocellular carcinoma has a high degree of malignancy and poor prognosis. Studies showed that there is a close relationship between the progression of hepatocellular carcinoma and the immune status in tumor microenvironment. Adoptive cell therapy showed anti-tumor effects and improve immunosuppression by infusing patients with activated specific immune cells, which become a central issue in tumor therapy and shown promising effects in the treatment of various malignant tumors, indicating great application potential. Adoptive cell therapy based on neoantigen may become a new hot spot in the treatment of hepatocellular carcinoma, and their application, safety and effectiveness evaluation, efficacy prediction and assessment have become urgent issues to be solved. The purpose of this article is to introduce the progress related to adoptive cell therapy for advanced hepatocellular carcinoma and elaborate the problems that need to be solved in the future.

Objective:To establish a new bile duct injury and repair model in mice by generating bile duct distal stricture and proximal dilatation.Methods:The mice were randomly divided into sham operation group, bile duct stricture (BDS) group and bile duct ligation (BDL) group. The dilated bile duct of BDS mice was injured and then repaired 14 days after the modeling operation. Biochemical markers were detected and histopathological changes were analyzed.Results:14 days after the establishment of the model, the body mass in BDL group was significantly lower than that of the sham group ( P<0.05), while the body mass in BDS group was similar to sham group. Compared with the sham group, the bile duct and gallbladder of the BDS group and BDL group were both prominently dilated, but the sum of the diameters of bile duct and gallbladder in BDS group was significantly smaller than that in the BDL group ( P<0.05). Indocyanine green fluorescence imaging confirmed that biliary tract of BDS group could still drain bile. Serum ALT, AST and TBil levels in the BDS group were slightly higher than those in the sham group (all P<0.05), but significantly lower than those in the BDL group ( P<0.05). Bile ducts of BDS mice were injured by notching and repaired with bile duct path. 30 days after the repairing, HE staining showed that the bile duct epithelium around the patch was arranged in orderliness. Immunohistochemistry confirmed the positive staining of green fluorescent protein (EGFP) and CK19 in those groups. Conclusion:This model of bile duct injury and repair in mice can provide a new model for the study of the mechanism of bile duct injury and repair and the evaluation of tissue engineering bile duct.

Objective To investigate the value of strong ion gap (SIG) for predicting acute heart failure (AHF) after acute myocardial infarction. Methods A total of 189 patients with acute myocardial infarction were enrolled from July 2015 to December 2016 in the First Affiliated Hospital of Soochow University. Based on AHF occurrence, the patients were divided into the AHF group (n=76) and the non-AHF group (n=113). General clinical data and laboratory tests were compared between the two groups. The univariate analysis and multivariate logistic regression analysis were performed to estimate the contribution of clinical risk factors to triggering AHF after acute myocardial infarction. Spearman correlation analysis was performed to estimate the correlation between SIG and Killip classification. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of ALB, anion gap (AG) and SIG in AHF after acute myocardial infarction. Results Age, proportion of history of diabetes, the serum level of C-reactive protein (CRP), AG and SIG of the AHF group were higher than those of the non-AHF group (P<0.05). Meanwhile, the serum level of albumin (ALB) of the AHF group were lower than those of the non-AHF group (P<0.05). Univariate analysis showed AHF after acute myocardial infarction was closely associated with age, history of diabetes, serum ALB, AG and SIG (P<0.05). Multivariate logistic regression analysis showed that history of diabetes (OR=2.034, 95％CI:1.075-4.113, P<0.05) and SIG (OR=2.445, 95％CI: 1.538-4.297, P<0.05) were significantly correlated with AHF after acute myocardial infarction. The ROC analysis revealed SIG (AUC=0.837,95％CI:0.781-0.893) had a large area under curve compared to ALB (AUC=0.671,95％CI: 0.593-0.750) and AG (AUC=0.728,95％CI: 0.654-0.802). The optimal diagnostic intercept value was 5.24 mmol/L, and the sensitivity and specificity were 76.32％ and 78.36％, respectively. Conclusions SIG could be used as an independent predictor for AHF secondary to acute myocardial infarction, and was significantly correlated with severity of AHF.