Objective To study the variations in lower limb muscle strength and gait after long-distance load marching in soldiers and to investigate the effects of muscle fatigue of the lower limbs on the walking and running gait.Methods Fifteen male soldiers completed a 15 km march with a 17.5 kg load carriage.The isometric muscle strength of the hip,knee,and ankle joints under flexion and extension were tested.The walking and running gait parameters were collected with a Vicon motion capture system and AMTI force platform.Results After load marching,the peak moment of the hip decreased significantly(P＜0.05),the mean power of the right knee decreased significantly(P＜0.05),and the relative peak moment and mean power of the ankle plantar flexion decreased significantly(P＜0.05).During walking,the left hip flexion,knee flexion and extension,ankle dorsiflexion,and inversion angles(P＜0.05)decreased significantly in conjunction with a significant increase in the knee inversion angle(P＜0.05).Additionally,the moments of left hip flexion,knee flexion,ankle plantar flexion,and bilateral knee inversion(P＜0.05)decreased significantly,coupled with a significant increase in the moments of right hip extension and vertical ground reaction forces(P＜0.05).During running,the step frequency decreased significantly(P＜0.01),and the left step width increased(P＜0.05).Both left and right ankle dorsiflexion angles decreased significantly(P＜0.05),whereas the knee adduction angle increased significantly(P＜0.05).Additionally,the moment of bilateral hip flexion,left knee flexion,right ankle dorsiflexion,and knee adduction decreased significantly(P＜0.05),and the ground reaction force on the right side increased significantly(P＜0.05).Conclusions The lower limb muscle strength decreased after long-distance marching.This was particularly so in the hip joint.The hip drive mechanism was used in the walking gait after marching.However,knee hyperextension and valgus occurred owing to the decreased muscle strength.The ankle joint was used more frequently during running.This increased the risk of ankle injury.It is necessary to strengthen the hip and hamstring muscle groups to optimize the gait,increase the load capacity,and prevent injury.

Objective To study the variations in lower limb muscle strength and gait after long-distance load marching in soldiers and to investigate the effects of muscle fatigue of the lower limbs on the walking and running gait.Methods Fifteen male soldiers completed a 15 km march with a 17.5 kg load carriage.The isometric muscle strength of the hip,knee,and ankle joints under flexion and extension were tested.The walking and running gait parameters were collected with a Vicon motion capture system and AMTI force platform.Results After load marching,the peak moment of the hip decreased significantly(P＜0.05),the mean power of the right knee decreased significantly(P＜0.05),and the relative peak moment and mean power of the ankle plantar flexion decreased significantly(P＜0.05).During walking,the left hip flexion,knee flexion and extension,ankle dorsiflexion,and inversion angles(P＜0.05)decreased significantly in conjunction with a significant increase in the knee inversion angle(P＜0.05).Additionally,the moments of left hip flexion,knee flexion,ankle plantar flexion,and bilateral knee inversion(P＜0.05)decreased significantly,coupled with a significant increase in the moments of right hip extension and vertical ground reaction forces(P＜0.05).During running,the step frequency decreased significantly(P＜0.01),and the left step width increased(P＜0.05).Both left and right ankle dorsiflexion angles decreased significantly(P＜0.05),whereas the knee adduction angle increased significantly(P＜0.05).Additionally,the moment of bilateral hip flexion,left knee flexion,right ankle dorsiflexion,and knee adduction decreased significantly(P＜0.05),and the ground reaction force on the right side increased significantly(P＜0.05).Conclusions The lower limb muscle strength decreased after long-distance marching.This was particularly so in the hip joint.The hip drive mechanism was used in the walking gait after marching.However,knee hyperextension and valgus occurred owing to the decreased muscle strength.The ankle joint was used more frequently during running.This increased the risk of ankle injury.It is necessary to strengthen the hip and hamstring muscle groups to optimize the gait,increase the load capacity,and prevent injury.

Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.

Objective:To investigate the clinical effect of composite surgery in the treatment of chronic common carotid artery occlusion(CCAO).Methods:A retrospective descriptive study was conducted. The clinical data of 7 patients with CCAO admitted to Xuanwu Hospital, Capital Medical University from October 2020 to December 2023 were collected retrospectively. There were 6 males and 1 female. The age was (66.7±10.9) years, ranging from 52 to 83 years. Outpatient or telephone follow-up were conducted after surgery, carotid artery ultrasound or computed tomography angiography were performed at 3 months, 6 months, and 1 year postoperatively to determine vascular patency. The selection of surgical methods and clinical effect were analyzed. Normally distributed measurement data were expressed as mean±standard deviation ( ± s). The measurement data of skewed distribution were expressed by M ( Q1, Q3). Count data were expressed as frequency. Results:All 7 patients were diagnosed with chronic CCAO before operation, 6 on the left and 1 on the right. 3 cases affected the middle and distal segments of the common carotid artery, 1 case affected the proximal segment, and 1 case each affected the middle and distal segments, the remaining case involves the entire common carotid artery. All the procedures were successfully performed, among which 4 cases underwent carotid endarterectomy combined with stent placement, and 3 cases did not receive stent placement after carotid endarterectomy. 1 patient developed neck hematoma after surgery and the remaining patients recovered well after surgery without any complications or deaths. The follow-up time was 13.5(4.0, 20.5) months; 1 patient was lost to follow-up, and 6 patients received effective follow-up. the common carotid artery remained unobstructed in all 6 patients, and there were no transient ischemic attacks or strokes during the follow-up period.Conclusion:Composite surgery is a safe and feasible method that can be used to treat chronic CCAO lesions, and has satisfactory short-term results.

Objective To compare the difference between sperm floating plate and density gradient centrifugation combined with swim-up in human sperm preparation.Methods The semen samples were obtained from 50 infertile men in the clinic of Reproductive Medi-cine of Northwest Women's and Children's Hospital excluding azoospermia,severe oligoasthenozoospermia and semen volume less than 2 mL.After semen liquefaction,the differences of sperm concentration,total progressively motile sperm count(TMSC),percentages of progressively motile sperm and normal morphology sperm,recovery rate and DNA fragmentation index(DFI)were measured by both the methods of sperm floating plate and density gradient centrifugation combined with swim-up,and the results were compared.Results Compared with the pre-sorting samples,sperm concentrations[(16.08±13.39)x 106/mL,(8.88±8.06)x 106/mL vs(60.05± 27.21)×106/mL],TMSC[(7.41±6.14)×106,(3.98±3.57)×106vs(22.24±13.74)×106]and DFI[(2.20±3.44)％,(5.20± 10.79)％vs(26.38±13.92)％]in the sorting groups by sperm floating plate and density gradient centrifugation combined with swim-up were decreased significantly,and the percentages of progressive motile sperm[(91.67±4.75)％,(87.86±7.90)％vs(40.21± 16.83)％]and normal morphology sperm[(9.58±5.08)％,(7.72±4.01)％vs(3.58±2.06)％]were increased significantly.Com-pared with the density gradient centrifugation combined with swim-up,the results of sperm floating plate were higher in sperm concen-tration,percentages of progressively motile sperm and normal morphology sperm,TMSC and sperm recovery rate[(30.74±13.70)％vs(17.09±9.20)％],but DFI was lower,time-consuming was shorter[(32.38±1.01)min vs(60.08±2.06)min],and the difference between the two groups was statistically significant(P＜0.05).Conclusion The sperm floating plate may have certain clinical applica-tion prospects in the future due to better parameters of sperm preparation than those of density gradient centrifugation combined with swim-up in simple operation and shorter time-consuming.

Overexpression of exogenous lineage-determining factors succeeds in directly reprogramming fibroblasts to various cell types. Several studies have reported reprogramming of fibroblasts into induced cardiac progenitor cells (iCPCs). CRISPR/Cas9-mediated gene activation is a potential approach for cellular reprogramming due to its high precision and multiplexing capacity. Here we show lineage reprogramming to iCPCs through a dead Cas9 (dCas9)-based transcription activation system. Targeted and robust activation of endogenous cardiac factors, including GATA4, HAND2, MEF2C and TBX5 (G, H, M and T; GHMT), can reprogram human fibroblasts toward iCPCs. The iCPCs show potentials to differentiate into cardiomyocytes, smooth muscle cells and endothelial cells . Addition of MEIS1 to GHMT induces cell cycle arrest in G2/M and facilitates cardiac reprogramming. Lineage reprogramming of human fibroblasts into iCPCs provides a promising cellular resource for disease modeling, drug discovery and individualized cardiac cell therapy.

Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area.Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area,who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018,including gestational age,perioperative management,surgical procedures,postoperative complications,pregnancy outcomes and pathological results.Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients.Space-occupying lesions in saddle area were detected by cranial MRI (plain scan).The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy,Two patients were operated in the third trimester and three in the second trimester.Postoperative pathology showed there were two cases with meningioma,two with pituitary macro adenoma and one with abscess of pituitary.Only one patient had mild postoperative cerebrospinal fluid rhinorrhea,which was improved three months later,and no complications were reported in the other four cases.All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months.(2) Four gravidas continued their pregnancies to full or nearly full term,among which three underwent cesarean section due to obstetrical indications (one breech pregnancy,one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally.Postpartum involution of the uterus was well in all of the four cases 42 d after delivery.The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation.Five neonates were all born with Apgar scores of 10 at 1,5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth.Conclusions For gravidas with space-occupying lesions in saddle area,it is necessary to weigh the pros and cons and choose an individualized treatment plan.Resection of saddle area lesions in the second or third trimester backed by a multidisciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences.

Objective To investigate the MRI findings of duodenal papillary adenocarcinoma(DPA),and to evaluate the importance of diffusion-weighted imaging(DWI)in diagnosis of DPA.Methods A complete data of 52 patients with DPA were prospectively collected.All patients underwent surgery within 72 hours after conventional MRI,DWI and MRCP scans.Before surgery,four different MRI findings were used to calculate the sensitivity,specificity and the probability of correctness.Two experienced radiologists who were blind to the pathologic diagnosis handled the MRI findings.Thirty eight patients were pathologically diagnosed for DPA.Based on the pathological diagnosis,the detection rate of DPA by the MR sequence was recorded and the chi square test was used to do the statistical analysis. Results The accuracy rate in diagnosis of DPA with MRI was 78.8% in our study.The findings of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.Corresponding sensitivities were 70.5%,66.7%,86.3% and 87.9%,and specificities were 75.0%,30.0%,50.0% and 63.1% respectively.The incidences of positive on T2WI and T1WI,MRCP,DWI scans were 60.5%,76.3% and 92.1% respectively.The detection rate of each sequence has significant difference(χ2=10.48,P<0.005).Conclusion The MRI manifestations of DPA consist of thickening wall of duodenal,duodenal papilla node imaging,DWI showing high signal of duodenal papilla and"beak"sign of dilated bile duct.The detection rate of DWI sepuence on DPA lesions is significantly higher than that of other sequences.

Objective To compare the clinical curative effects of PTA and simple pharmacotherapy for intrapopliteal artery ischemic disease.Methods Seventy-three patients with intrapopliteal artery ischemic disease were divided into PTA group (n=37) and pharmacotherapy group (n=36).Their ABI,claudication distance,vascular patency,rest pain and amputation rate were recorded and analyzed with SPSS 22.0 at months 1,3,6,12,18 and 24 respectively before and after treat ment.The vascular patency and amputation rate were analyzed according to the Kaplan-Meier curve.Results The ABI was higher in PTA group than in pharmacotherapy group during the 1-24 months following up period after treatment,and was still higher in PTA group than in pharmacotherapy group at month 24 after treatment (0.640±0.238 vs 0.500±0.152,P=0.038).The claudication distance was shorter and the rest pain was milder in PTA group than in pharmacotherapy group at months 1 and 3,and at months 1-18 respectively (P＜0.05,P＜0.01).No significant difference was found in amputation-free survival curves between the two groups (Plogrank =0.618).Conclusion The symptom improvement of PTA is better than that of pharmacotherapy for patients with severe rest pain or severe intermittent claudication.

Objective To evaluate the influence of different load carriages during military walking on the gait of lower limbs. Methods In a randomized cross-over design, 15 healthy young males were asked to perform self-paced walking with a normal uniform under a load carriage of 0 kg, 7.5 kg, 27 kg, and 50 kg for four times. The kinematics parameters of the pelvis, knee, and ankle were evaluated by the Vicon motion capture system and AMTI force plates. Results With increasing load carriage, the stride frequency relatively improved, whereas the stride reduced and the speed was maintained on the whole. The peak left/right hip flexion and extension angle and peak knee adduction angle were obviously affected by the load carriage, whereas the movement magnitudes could be maintained. The peak varus angle of the left ankle and peak valgus angle of the right ankle were also affected. The peak force and moment of the left/right knee and ankle increased. Conclusions With increasing load carriage, overall, the movement magnitudes of lower limb joints were maintained under the given loads, whereas the lower limb loads were increased, which could increase the potential risk of lower limb injuries.