Objective:Chimeric antigen receptor T-cell(CAR-T)immunotherapy has made major breakthroughs in the treatment of blood tu-mors.However,current CAR-T therapies face several limitations:they require autologous cells,involve a lengthy and costly production pro-cess,and use lentiviral transduction that carry risk of insertional carcinogenesis due to random integration.Therefore,there is an urgent need to develop a universal cost-effective cancer immunotherapy method generating CAR-T cells for in vivo cancer immunotherapy.Meth-ods:This study successfully established an exosome-mediated,T-cell targeted delivery system,demonstrating both precise design and func-tional efficacy for biomedical applications.To optimize CAR-T cell generation the transfection dose was adjusted,and the kinetics of CAR-T cell percentage were recorded.The cytotoxicity of the resulting CAR-T cells was evaluated in vitro by calcein-AM release.To test the tumor-killing in vivo of engineered exosomes,human PBMCs were injected into NPG mice via the tail vein to establish humanized mice,followed by intravenous injection of tumor cells to induce cancer.Results:To overcome the limitations of conditional autologous CAR-T cells,we de-veloped a T cell-targeted exosome system capable of specifically targeting human CD3+,CD4+,and CD8+T cells.CAR-T production was dose-dependent,with transfection efficiency reaching upto 97.8%at 106 particles/cell.Both in vitro cytotoxicity assays and in vivo animal experi-ments demonstrated that exosome-incubated CAR-T cells effectively eliminated CD19-positive Raji cells,highlighting their specificity and therapeutic potential in antigen-directed applications.Conclusions:We successfully established a CD8-targeting exosome delivery system for CAR-T cell production capable of transforming CD8+T cells into functional CAR-T cells,which showed significant tumor-killing ability in vitro and in mice.Compared with the traditional lentiviral vector for the preparation of CAR-T cells in vitro,in vivo-reprogrammed CAR-T cells us-ing our CD8-targeted exosome delivery system,with higher transfection efficiency,shorter production period,lower cost,and eliminated the risk of insertion carcinogenesis.This strategy promises to bring a new era of universal CAR-T medicine,which can improve cancer immuno-therapy and may hold promise as a therapeutic platform to treat various diseases.

Non-ketotic hyperglycemic hemichorea associated with non-ketotichy perglycemia(HC-NH)is a syndrome of poorly controlled diabetes mellitus without diabetic ketoacidosis and cerebrovascular disease that manifests as involuntary choreographic movements of the lateral limbs.This article reports a middle-aged case of HC-NH.

Extramedullary plasmacytoma(EMP)is a malignant neoplasm characterized by monoclonal plasma cell proliferation originating outside the bone marrow and hematopoietic tissues.The co-occurrence of multiple myeloma(MM)with mammary EMP is clinically rare.This case report describes the diagnostic and therapeutic management of a middle-aged female patient with MM and mammary EMP,accompanied by a litera-ture review.The patient presented with persistent fever and was found to have a right breast mass via PET/CT during routine follow-up for MM.The lesion was biopsy-confirmed as mammary EMP,and the patient subse-quently underwent chemotherapy.This case highlights the critical importance of differential diagnosis between breast cancer and rare hematologic metastatic tumors in early prevention of disease progression.

Objective:To sinicize the English version of the rapid eye movement sleep behavior disorder symptom severity scale (RBDSSS) and to evaluate the reliability and validity of the Chinese version of RBDSSS (RBDSSS-C) among Chinese patients with rapid eye movement sleep behavior disorder (RBD).Methods:RBDSSS-C was ultimately formed through translation, back translation and revision according to the Brislin's translation model, including patient version (RBDSSS-PT) and bedpartner version (RBDSSS-BP). A questionnaire survey was conducted among 120 RBD patients to test the reliability and validity of the RBDSSS-C, using Cronbach’s α coefficient, Spearman-Brown coefficient, Spearman correlation analysis, content validity index and factor analysis. The correlation between RBDSSS-C and RBDQ-HK was examined.Results:For the Chinese version of RBDSSS-PT, the Cronbach’s α was 0.795, the split-half reliability was 0.756, and the test-retest reliability was 0.940. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, and the scale-level CVI (S-CVI) was 0.937.For the Chinese version of RBDSSS-BP, the Cronbach’s α was 0.712, the split-half reliability was 0.813, and test-retest reliability was 0.950, with both I-CVI and S-CVI at 1.000.The scores of Chinese version of RBDSSS-PT and RBDSSS-BP were both significantly correlated with RBDQ-HK scores ( r=0.638, P<0.001 for RBDSSS-PT; r=0.639, P<0.001 for RBDSSS-BP). Factor analysis confirmed both single-factor structure for RBDSSS-PT and RBDSSS-BP.RBDSSS-PT showed χ2/ df=3.930, CFI=0.954, TLI=0.937, and RMSEA=0.093; RBDSSS-BP showed χ2/ df=8.300, CFI=0.975, TLI=0.966, and RMSEA=0.079. These results indicated adequate model fit. Conclusion:RBDSSS-C has good reliability and validity, and can be used as a reliable and effective tool to evaluate the severity of symptoms in Chinese RBD patients.

Objective:To sinicize the English version of the rapid eye movement sleep behavior disorder symptom severity scale (RBDSSS) and to evaluate the reliability and validity of the Chinese version of RBDSSS (RBDSSS-C) among Chinese patients with rapid eye movement sleep behavior disorder (RBD).Methods:RBDSSS-C was ultimately formed through translation, back translation and revision according to the Brislin's translation model, including patient version (RBDSSS-PT) and bedpartner version (RBDSSS-BP). A questionnaire survey was conducted among 120 RBD patients to test the reliability and validity of the RBDSSS-C, using Cronbach’s α coefficient, Spearman-Brown coefficient, Spearman correlation analysis, content validity index and factor analysis. The correlation between RBDSSS-C and RBDQ-HK was examined.Results:For the Chinese version of RBDSSS-PT, the Cronbach’s α was 0.795, the split-half reliability was 0.756, and the test-retest reliability was 0.940. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, and the scale-level CVI (S-CVI) was 0.937.For the Chinese version of RBDSSS-BP, the Cronbach’s α was 0.712, the split-half reliability was 0.813, and test-retest reliability was 0.950, with both I-CVI and S-CVI at 1.000.The scores of Chinese version of RBDSSS-PT and RBDSSS-BP were both significantly correlated with RBDQ-HK scores ( r=0.638, P<0.001 for RBDSSS-PT; r=0.639, P<0.001 for RBDSSS-BP). Factor analysis confirmed both single-factor structure for RBDSSS-PT and RBDSSS-BP.RBDSSS-PT showed χ2/ df=3.930, CFI=0.954, TLI=0.937, and RMSEA=0.093; RBDSSS-BP showed χ2/ df=8.300, CFI=0.975, TLI=0.966, and RMSEA=0.079. These results indicated adequate model fit. Conclusion:RBDSSS-C has good reliability and validity, and can be used as a reliable and effective tool to evaluate the severity of symptoms in Chinese RBD patients.

Non-ketotic hyperglycemic hemichorea associated with non-ketotichy perglycemia(HC-NH)is a syndrome of poorly controlled diabetes mellitus without diabetic ketoacidosis and cerebrovascular disease that manifests as involuntary choreographic movements of the lateral limbs.This article reports a middle-aged case of HC-NH.

Extramedullary plasmacytoma(EMP)is a malignant neoplasm characterized by monoclonal plasma cell proliferation originating outside the bone marrow and hematopoietic tissues.The co-occurrence of multiple myeloma(MM)with mammary EMP is clinically rare.This case report describes the diagnostic and therapeutic management of a middle-aged female patient with MM and mammary EMP,accompanied by a litera-ture review.The patient presented with persistent fever and was found to have a right breast mass via PET/CT during routine follow-up for MM.The lesion was biopsy-confirmed as mammary EMP,and the patient subse-quently underwent chemotherapy.This case highlights the critical importance of differential diagnosis between breast cancer and rare hematologic metastatic tumors in early prevention of disease progression.

Objective:Chimeric antigen receptor T-cell(CAR-T)immunotherapy has made major breakthroughs in the treatment of blood tu-mors.However,current CAR-T therapies face several limitations:they require autologous cells,involve a lengthy and costly production pro-cess,and use lentiviral transduction that carry risk of insertional carcinogenesis due to random integration.Therefore,there is an urgent need to develop a universal cost-effective cancer immunotherapy method generating CAR-T cells for in vivo cancer immunotherapy.Meth-ods:This study successfully established an exosome-mediated,T-cell targeted delivery system,demonstrating both precise design and func-tional efficacy for biomedical applications.To optimize CAR-T cell generation the transfection dose was adjusted,and the kinetics of CAR-T cell percentage were recorded.The cytotoxicity of the resulting CAR-T cells was evaluated in vitro by calcein-AM release.To test the tumor-killing in vivo of engineered exosomes,human PBMCs were injected into NPG mice via the tail vein to establish humanized mice,followed by intravenous injection of tumor cells to induce cancer.Results:To overcome the limitations of conditional autologous CAR-T cells,we de-veloped a T cell-targeted exosome system capable of specifically targeting human CD3+,CD4+,and CD8+T cells.CAR-T production was dose-dependent,with transfection efficiency reaching upto 97.8%at 106 particles/cell.Both in vitro cytotoxicity assays and in vivo animal experi-ments demonstrated that exosome-incubated CAR-T cells effectively eliminated CD19-positive Raji cells,highlighting their specificity and therapeutic potential in antigen-directed applications.Conclusions:We successfully established a CD8-targeting exosome delivery system for CAR-T cell production capable of transforming CD8+T cells into functional CAR-T cells,which showed significant tumor-killing ability in vitro and in mice.Compared with the traditional lentiviral vector for the preparation of CAR-T cells in vitro,in vivo-reprogrammed CAR-T cells us-ing our CD8-targeted exosome delivery system,with higher transfection efficiency,shorter production period,lower cost,and eliminated the risk of insertion carcinogenesis.This strategy promises to bring a new era of universal CAR-T medicine,which can improve cancer immuno-therapy and may hold promise as a therapeutic platform to treat various diseases.

To conduct a systematic analysis of a clinical surgery theoretical examination based on knowledge points, thereby providing a reference for establishing a scientific and comprehensive test paper analysis system.

Objective To investigate the effects of long non-coding RNA 00894(LINC00894)gene on prolifera-tion and metastasis of human gastric cancer cells,and to verify the regulatory relationship of LINC00894,miR-205-5p and ZEB1 in gastric cancer.Methods The expression level of LINC00894 in gastric cancer cell lines,normal gastric lines,clinical gastric cancer and normal gastric tissue samples were determined by RT-qPCR.Through fol-low-up,the relationship between the expression level of LINC00894 and the prognosis of gastric cancer patients was explored.LINC00894 knockdown cell lines and overexpression cell lines were constructed,and the knockdown and overexpression efficiency was detected by RT-qPCR.Cell proliferation and metastatic capacity were determined by CCK 8,clone formation and Transwell assays.Dual-luciferase reporter assays,RT-qPCR assays and Western blot assays were used to examine the targeted regulatory relationships of LINC00894,miR-205-5p and ZEB1.Results The expression of LINC00894 gene in gastric cancer tissues or cells was significantly higher than that in normal gas-tric tissues or cells,moreover,gastric cancer patients with high LINC00894 gene expression had a worse prognosis.The knockdown of LINC00894 inhibited the viability,clonogenesis,migration and invasion ability of gastric cancer cells,and conversely,the overexpression of LINC00894 obtained the opposite results.LINC00894 promoted ZEB1 expression by targeted downregulation of miR-205-5p expression.LINC00894 promoted the expression of ZEB1 by targeting miR-205-5p and down-regulating its expression.Conclusion LINC00894 serves as an oncogene in gastric cancer and may promote proliferation and metastasis of gastric cancer cells via regulating miR-205-5p/ZEB1 axis.