ObjectiveTo investigate the effect of trophoblast-derived mesenchymal stem cell （T-MSC） on concanavalin A （Con A）-induced immune-mediated liver injury in mice， as well as its association with the changes in inflammatory response. MethodsMorphological assessment， flow cytometry， and tri-lineage differentiation assay were used to observe the biological characteristics of T-MSC. In the pilot experiment， mice were divided into PBS group， T-MSC monotherapy group， and Con A groups at a concentration of 10， 15， or 20 mg/kg to evaluate the safety of T-MSC monotherapy on liver function and determine the appropriate dose for modeling. In the formal experiment， mice were divided into healthy control group （HC group）， Con A group， and Con A+T-MSC group， with 5 mice in each group. The mice were given injection of Con A （15 mg/kg） via the caudal vein to establish a mouse model of immune-mediated liver injury， while the mice in the T-MSC monotherapy group were given transfusion of 1×10⁶ T-MSCs via the caudal vein at 3 hours after modeling， and samples were collected 12 hours later. The serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and lactate dehydrogenase （LDH） were measured； liver histopathological changes were observed， and Ishak inflammatory activity score and inflammatory necrosis area were assessed； the serum levels of inflammatory cytokines were measured； transcriptome sequencing， immunofluorescence assay， and Western blot were used to measure the changes in inflammation-related molecules in liver tissue. The Shapiro-Wilk test was used to assess the normality of continuous data， and the homogeneity of variance test was also performed； a one-way analysis of variance was used for comparison of normally distributed data with homogeneity of variance between multiple groups， and the Tukey’s post-hoc test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed data with heterogeneity of variance between multiple groups， and the Wilcoxon test was used for further comparison between two groups. ResultsT-MSC had a long spindle shape， showed the characteristics of fibroblast-like morphology and adherent growth， and possessed the osteogenic， chondrogenic， and adipogenic differentiation abilities. Flow cytometry showed high expression levels of CD90， CD105， and CD73 in T-MSC， with a positive rate of 96.8%， 99.0%， and 99.9%， respectively， while there was low or no expression of CD31， human leukocyte antigen DR， CD45， and CD34， with a positive rate of 0.120%， 0， 0.061%， and 0， respectively. Administration of T-MSC alone did not cause obvious abnormalities in ALT， AST， or LDH. Con A at the concentrations of 10， 15， and 20 mg/kg all increased the serum levels of biochemical parameters for liver injury in a dose-dependent manner， with mortality observed in the 20 mg/kg group. In the formal experiment， compared with the HC group， the Con A group had significant increases in the serum levels of ALT， AST， and LDH （P<0.01）， and after T-MSC treatment， there were significant reductions in these markers compared with the Con A group （P<0.01）. HE staining showed that the Con A group had disordered structure of the liver， accompanied by marked inflammatory cell infiltration and focal/patchy necrosis， and these pathological changes were alleviated after T-MSC treatment. Compared with the HC group， the Con A group had significant increases in Ishak score and the percentage of inflammatory necrosis area （P<0.001）， while there were significant reductions in these indicators after T-MSC treatment compared with the Con A group （P<0.01）. ELISA showed that compared with the HC group， the Con A group had significant increases in the serum levels of interleukin-21 （IL-21）， interleukin-1β （IL-1β）， interleukin-2 （IL-2）， interleukin-17A （IL-17A）， and tumor necrosis factor-α （TNF-α） （P<0.05）， and there were significant reductions in these markers after T-MSC treatment compared with the Con A group （P<0.05）， with no significant differences in IL-21， IL-1β， IL-17A， and TNF-α compared with the HC group （P>0.05）； although there was a significant reduction in the level of IL-2， the Con A+T-MSC group still had a significantly higher level of IL-2 than the HC group （P=0.001）. In contrast， compared with the HC group， the Con A group had a significant increase in IL-10 （P<0.05）， with a further increase after T-MSC treatment （P<0.05）. The transcriptome analysis showed that T-MSC treatment downregulated the expression of the inflammation- and chemokine-related genes including Ccl2， Cxcl10， Il-21， and Il-6 and inhibited the inflammation-related pathways such as TNF， IL-17， nuclear factor-κB， and JAK-STAT. Immunofluorescence assay showed that compared with the HC group， the Con A group had a significant increase in the expression of IL-21 in the liver （P<0.001）， and there was a significant reduction in IL-21 after T-MSC treatment compared with the Con A group （P<0.001）； the results of Western blot showed the same trend. ConclusionT-MSC can alleviate Con A-induced immune-mediated liver injury in mice， as evidenced by the improvement in liver biochemical parameters， the alleviation of histopathological damage， and the overall downregulation of inflammation-related molecules. T-MSC exerts marked anti-inflammatory and immunomodulatory effects in this model， and IL-21 shows a significant change in inflammatory response and can be used as a candidate molecule for further investigation.

Objective:To observe and analyze the abnormal gait characteristics and lower limb kinematic chain in patients with bilateral moderate-to-severe hallux valgus(HV)during adaptive walking.Method:From September 2022 to August 2023,33 patients with moderate-and-severe HV were selected from the department of arthrology,Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine and en-rolled in the observation group.A group of 29 healthy subjects were matched and enrolled in the control group.DC-G-150-F2 three-dimensional gait analysis system was used to collect gait characteristics and lower limb motion chain of two groups during a 10m adaptive walking test.Temporal-spatial gait parameters and ki-nematic changes in the hip,knee,and ankle joints were observed and analyzed.Result:The gait time-space parameters of left and right support phase,total double support phase,left lateral foot deviation angle,step length,stride length and pace in the observation group were significantly lower than those in the control group(P＜0.05).In contrast,the time-space parameters of left and right swing phase and stride frequency in the observation group were significantly higher than those in the control group(P＜0.05).The two groups had no significant difference in right lateral foot deviation angle and step width(P＞0.05).The range of flexion and extension of the right hip joint,rotation of the left hip joint,rotation of the left and right knee joint and flexion and extension of the left and right ankle joint in the observation group were significantly lower than those in the control group(P＜0.05).There were no significant differences be-tween the two groups in the range of motion of left hip flexion and extension,right hip rotation,left versus right hip spreading,left versus right knee flexion and extension,and left versus right ankle rotation(P＞0.05).However,the range of motion of right hip rotation and right knee flexion and extension was lower than that of the control subjects(P=0.084,P=0.093).Conclusion:Gait changes in patients with bilateral moderate-to-severe bunions are characterized by shortened sin-gle and double support phases,prolonged swing phase,increased step frequency,reduced step length and stride length,and a"broken stride and slow catching up"walking pattern.The range of motion of each lower limb joint in the sagittal plane and horizontal plane is reduced,resulting in a rigid and twisted state through-out the lower limb kinematic chain.

Exposure to acceleration can have Various effects on the physiology,psychology,and performance of human.With the increasing density and complexity of China's space mission,and the significant differences between deep space exploration and near Earth orbit flight,unprecedented challenges have been posed to the emotions of astronauts and the ability of human-machine collaboration to complete complex operational tasks in special environments.Similarly,with the continuous development of high-performance fighter jets,air combat operation are becoming increasingly complex,and the payload generated by the aircraft is also increasing.The requirements for the anti-overload ability of fighter pilots are also becoming higher and higher.A review of recent studies on physiological and cognitive load of acceleration exposure on humans.The research on human physiology is relatively systematic,but there is limited research on cognitive load.The corresponding evaluation methods,assessment methods,and assessment systems are not comprehensive enough,and there is a lack of mechanistic analysis.Multimodal analysis and modeling are even rarer.Further in-depth research is needed on the cognitive load and evaluation techniques of overweight environment in the future.This article provides reference for the selection,adaptive training,and related experimental research of overweight endurance for astronauts and pilots in the future.

With the development of surgery and technology, robot-assisted pancreatic surgery has gradually become a popular choice for surgeons, and is favored by patients and their families. As the first pancreatic disease treatment center in China to carry out robot-assisted pancreatic surgery, the author's team has unique experience and insight into robot-assisted pancreatic surgery. With the updating and domestication of surgical robots, the domestic multi-port robot-assisted surgical system has begun to be applied in clinical practice. The paper gave an overview of the development of domestic multi-port robotic surgical system in the clinical practice of pancreatic surgery.

AIM:To establish a cell model of visceral hypersensitivity and nerve hyperplasia in irritable bowel syndrome(IBS)by conducting an in vitro co-culture of mouse P815 mast cells and N2a nerve cells and explore its possible mechanism.METHODS:Enzyme-linked immunosorbent assay(ELISA)with three replicates was used to confirm the C48/80-induced P815 degranulation.The length of neurites was observed under bright field microscopy to determine the number of differentiated neurons,thereby selecting the concentration of retinoic acid(RA)for stimulating the differentia-tion of N2a cells,with four replicates.A co-culture system of P815 and N2a cells was established using Transwell cham-bers with four replicates.The following groups were established:N2a cells cultured alone,N2a cells co-cultured with P815 cells,N2a cells co-cultured with P815 cells plus C48/80,and N2a cells plus RA group.After co-culturing,the num-ber of differentiated N2a cells was observed under bright field.The expression of nerve growth factor(NGF),tyrosine ki-nase receptor A(TRKA),growth-associated protein-43(GAP43),neuron-specific enolase(NSE),synapsin(SYN),and postsynaptic density protein-95(PSD-95)at both protein and gene levels in N2a cells was detected using Western blot and polymerase chain reaction(PCR),with four replicates.RESULTS:The best condition for N2a differentiation was stimulation with 10 μmol/L RA for 24 hours,whereas the best condition for degranulation was stimulation of P815 cells with 20 mg/L C48/80 for 24 hours.Compared with N2a cells cultured alone,the differentiation ratio of the N2a+P815+C48/80 and N2a+RA groups was significantly increased(P<0.01),and the protein and mRNA expressions of NGF,TRKA,GAP43,NSE,SYN,and PSD-95 were significantly increased(P<0.05).CONCLUSION:Our results revealed that mast cell degranulation enhances the level of nerve hyperplasia in enteric nerve cells and promotes changes in nerve structure and function.Synaptic remodeling regulated by abnormal expression of key proteins such as NGF,TRKA,and GAP43 is involved in the nerve hyperplasia induced by mast cell degranulation.

Objective:To observe and analyze the abnormal gait characteristics and lower limb kinematic chain in patients with bilateral moderate-to-severe hallux valgus(HV)during adaptive walking.Method:From September 2022 to August 2023,33 patients with moderate-and-severe HV were selected from the department of arthrology,Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine and en-rolled in the observation group.A group of 29 healthy subjects were matched and enrolled in the control group.DC-G-150-F2 three-dimensional gait analysis system was used to collect gait characteristics and lower limb motion chain of two groups during a 10m adaptive walking test.Temporal-spatial gait parameters and ki-nematic changes in the hip,knee,and ankle joints were observed and analyzed.Result:The gait time-space parameters of left and right support phase,total double support phase,left lateral foot deviation angle,step length,stride length and pace in the observation group were significantly lower than those in the control group(P＜0.05).In contrast,the time-space parameters of left and right swing phase and stride frequency in the observation group were significantly higher than those in the control group(P＜0.05).The two groups had no significant difference in right lateral foot deviation angle and step width(P＞0.05).The range of flexion and extension of the right hip joint,rotation of the left hip joint,rotation of the left and right knee joint and flexion and extension of the left and right ankle joint in the observation group were significantly lower than those in the control group(P＜0.05).There were no significant differences be-tween the two groups in the range of motion of left hip flexion and extension,right hip rotation,left versus right hip spreading,left versus right knee flexion and extension,and left versus right ankle rotation(P＞0.05).However,the range of motion of right hip rotation and right knee flexion and extension was lower than that of the control subjects(P=0.084,P=0.093).Conclusion:Gait changes in patients with bilateral moderate-to-severe bunions are characterized by shortened sin-gle and double support phases,prolonged swing phase,increased step frequency,reduced step length and stride length,and a"broken stride and slow catching up"walking pattern.The range of motion of each lower limb joint in the sagittal plane and horizontal plane is reduced,resulting in a rigid and twisted state through-out the lower limb kinematic chain.

AIM:To establish a cell model of visceral hypersensitivity and nerve hyperplasia in irritable bowel syndrome(IBS)by conducting an in vitro co-culture of mouse P815 mast cells and N2a nerve cells and explore its possible mechanism.METHODS:Enzyme-linked immunosorbent assay(ELISA)with three replicates was used to confirm the C48/80-induced P815 degranulation.The length of neurites was observed under bright field microscopy to determine the number of differentiated neurons,thereby selecting the concentration of retinoic acid(RA)for stimulating the differentia-tion of N2a cells,with four replicates.A co-culture system of P815 and N2a cells was established using Transwell cham-bers with four replicates.The following groups were established:N2a cells cultured alone,N2a cells co-cultured with P815 cells,N2a cells co-cultured with P815 cells plus C48/80,and N2a cells plus RA group.After co-culturing,the num-ber of differentiated N2a cells was observed under bright field.The expression of nerve growth factor(NGF),tyrosine ki-nase receptor A(TRKA),growth-associated protein-43(GAP43),neuron-specific enolase(NSE),synapsin(SYN),and postsynaptic density protein-95(PSD-95)at both protein and gene levels in N2a cells was detected using Western blot and polymerase chain reaction(PCR),with four replicates.RESULTS:The best condition for N2a differentiation was stimulation with 10 μmol/L RA for 24 hours,whereas the best condition for degranulation was stimulation of P815 cells with 20 mg/L C48/80 for 24 hours.Compared with N2a cells cultured alone,the differentiation ratio of the N2a+P815+C48/80 and N2a+RA groups was significantly increased(P<0.01),and the protein and mRNA expressions of NGF,TRKA,GAP43,NSE,SYN,and PSD-95 were significantly increased(P<0.05).CONCLUSION:Our results revealed that mast cell degranulation enhances the level of nerve hyperplasia in enteric nerve cells and promotes changes in nerve structure and function.Synaptic remodeling regulated by abnormal expression of key proteins such as NGF,TRKA,and GAP43 is involved in the nerve hyperplasia induced by mast cell degranulation.

Evoked Potentials ; Social Isolation ; Attention ; Humans

Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.