A 51-year-old male presented with nasal obstruction, followed by progressive hearing loss and blurred vision. Imaging identified space-occupying lesions in the paranasal sinuses, orbits, and paraspinal regions, while laboratory tests confirmed positive anti-proteinase 3 anti-neutrophil cytoplasmic antibody(PR3- ANCA) immunoglobulin G (IgG)and markedly elevated serum IgG4. Despite treatment with corticosteroids, immunosuppressants, and radiotherapy, the patient exhibited steroid dependency with relentless disease progression. Following multidisciplinary consultation, a diagnosis of inflammatory myofibroblastic tumor (IMT) coexisting with ANCA- associated vasculitis (AAV) was favored, though IgG4-related disease remained a critical differential. Ultimately, profound immunosuppression precipitated a severe herpesvirus infection, leading to disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case underscores the rarity and diagnostic complexity of concurrent IMT and AAV, highlights the therapeutic dilemma of balancing primary disease control against fatal opportunistic infections, and emphasizes the critical role of multidisciplinary collaboration in the diagnosis and treatment of complex diseases.

Objective: The heart contains a pool of c-kit+ progenitor cells which is believed to be able to regenerate. The differentiation of these progenitor cells is reliant on different physiological cues. Unraveling the underlying signals to direct differentiation of progenitor cells will be beneficial in controlling progenitor cell fate. In this regard, the role of the mitochondria in mediating cardiac progenitor cell fate remains unclear. Specifically, the association between changes in mitochondrial morphology with the differentiation status of c-kit+ CPCs remains elusive. In this study, we investigated the relationship between mitochondrial morphology and the differentiation status of c-kit+ progenitor cells. Methods: and Results: c-kit+ CPCs were isolated from 2-month-old male wild-type FVB mice. To activate differentiation, CPCs were incubated in α-minimal essential medium containing 10 nM dexamethasone for up to 7 days. To inhibit Drp1-mediated mitochondrial fragmentation, either 10 μM or 50 μM mdivi-1 was administered once at Day 0 and again at Day 2 of differentiation. To inhibit calcineurin, either 1 μM or 5 μM ciclosporin-A (CsA) was administered once at Day 0 and again at Day 2 of differentiation. Dexamethasone-induced differentiation of c-kit+ progenitor cells is aligned with fragmentation of the mitochondria via a calcineurin-Drp1 pathway. Pharmacologically inhibiting mitochondrial fragmentation retains the undifferentiated state of the c-kit+ progenitor cells. Conclusions The findings from this study provide an alternative view of the role of mitochondrial fusion-fission in the differentiation of cardiac progenitor cells and the potential of pharmacologically manipulating the mitochondria to direct progenitor cell fate.

Objective? To explore the changes of lipid metabolism in schizophrenics with long-term use of antipsychotics. Methods? The waist circumference, hip circumference, weight, years of using psychiatric drugs and blood lipid of 1 077 schizophrenic patients hospitalized in a Class Ⅲ Grade A psychiatric specialized hospital in Beijing from January to December 2017 were collected. Patients with normal blood lipid without taking lipid-lowering agents were assigned into N1 group (n=437). Patients with normal blood lipid taking lipid-lowering agents were assigned into N2 group (n=331). Patients with high blood lipid without taking lipid-lowering agents were assigned into N3 group (n=148). Patients with high blood lipid taking lipid-lowering agents were assigned into N4 group (n=161). The lipid metabolism was compared among the four groups. Results? There were significant differences in the years of taking antipsychotic drugs, waist circumference, hip circumference, weight, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein (P＜0.01). The results of pairwise comparison showed that between the two groups without taking lipid-lowering drugs, there was no statistical significance in the difference in apolipoprotein A (apoA) and apolipoprotein B (apoB) (P＞0.05), otherwise the differences in other indexes were statistically significant (P＜0.01). Between the two groups taking lipid-lowering agents, besides of other indexes (P＜0.01), there was no statistical significance in the differences in years of taking antipsychotic drugs, total cholesterol, apoA and apoB (P＞ 0.05). The further correlation analysis showed that the years of taking antipsychotic drugs was positively correlated with the waist circumference and apo A (P＜0.01). The waist circumference was positively related to the hips, weight, triglycerides (P＜0.01), and negatively related with high density lipoprotein and apolipoprotein A (P＜0.01). The hip circumference was positively correlated with weight, triglyceride, low density lipoprotein (P＜0.05), and negatively correlated with high density lipoprotein (P＜0.01). Weight was positively related with triglyceride (P＜0.05), and negatively correlated with high-density lipoprotein and apoA (P＜0.01). Conclusions? During the period of drug use, especially in the early period of drug use, the patients with schizophrenia must be monitored for blood lipid regularly. It is suggested to take the combined medication actively, guide the patients correctly, encourage more participation in recreational activities, help them improve the diet structure, control the weight, and prevent the occurrence of cardiovascular and cerebral blood tube diseases.

Objective To explore the value of retrievable inferior vena cava (IVC) filter placement for prevention of perioperative pulmonary embolism (PE) in patients with lower extremity/pelvic fracture with deep vein thrombosis (DVT).Methods Clinical data of 1 891 lower extremity/pelvic fracture patients combined with DVT were retrospectively analyzed.Totally 411 patients with permanent filters were excluded,and the other patients were divided into filter group (n=843) and control group (n=637) according to whether receiving retrievable IVC filter placement or not.The incidence of perioperative symptomatic PE and mortality were compared between the two groups.Results In filter group,Optease nonpermanent filters were inserted in 218 patients,and the mean indwelling time was (14.3±3.6) days.Celcet filters were inserted in 625 patients,and the filters were successfully removed in 566 out of 578 patients who underwent filter removal surgery (97.92％,566/578),and the mean indwelling time was (15.8±4.1) days.The incidence of PE in filter group (0.12％[1/843]) was significantly lower than that in control group (1.57％ [10/637],P＜0.05).Among the patients who received chemical anticoagulant therapy,the incidence of PE in filter group and control group was 0.14 ％ (1/700) and 1.47％(9/612),respectively (P＜0.05).Conclusion Retrievable IVC filter placement is a safe and effective method for preventing perioperative symptomatic and fatal PE in lower extremity/pelvic fracture patients with DVT.

Objective For the second children diagnosed as ABO hemolytic disease of the newborn(ABO-HDN),we made a comprehensive analysis of the related indicators of prenatal and postpartum,so as to achieve early prevention,early diagnosis and early treatment.Methods Prenatal microcolumn gel assay was used to detect the father and mother's blood type and mother's irregular antibody,mother serum IgG anti A(B)anti-body titer.Microcolumn gel assay was used to detect hemolysis three tests after the production of pregnant women.The results were divided into five groups according to the results of hemolysis three tests:group A[di-rect antiglobulin test(+),free antibodies test(+)and antibody releasing test(+)],group B[direct antiglobu-lin test(-),free antibodies test(+)and antibody releasing test(+)],group C[direct antiglobulin test(+), free antibodies test(-)and antibody releasing test(+)],group D[direct antiglobulin test(-),free antibod-ies test(-)and antibody releasing test(+)]and group E[direct antiglobulin test(+),free antibodies test (-)and antibody releasing test(-)].Total bilirubin,unbound bilirubin,hemoglobin,reticulocyte percentage and lactate dehydrogenase were detected by automatic analyzer.Results ABO-HDN children hemolysis three tests,in the 5 groups,the higher the titer of the mother's IgG anti A(B)antibody,the more serious the child' s condition was,the difference was statistically significant(P<0.05).Reticulocyte percentage and lactate de-hydrogenase in the five groups,the difference was statistically significant(P<0.05).Conclusion A combina-tion of antenatal and postnatal multiple laboratory test parameters is more accurate in predicting the second child ABO-HDN.At the same time,it helps to master the state of the disease and reduce the occurrence of complications and sequelae.

Objective To investigate the distribution and antibiotic resistance of clinical Pseudomonas aeruginosa in Yunnan provincal of China in 2014.Methods Pseudomonas aeruginosa were collected from 28 hospitals in Yunnan surveillance of China.All hospitals were carried with the unified solution for bacteria culture,isolation,identification and antibiotic sensitivity tests according to CLSI M100-S24.The data of 2 873 strains pseudomonas aeruginosa were analyzed by WHONET5.6 software.Results 2 873 clinical strains of non-repetitive Pseudomonas aeruginosa isolates,90.36%were isolated from hospitalized patients and 60.32% from sputum,8.42% from urine,8.11% from secretion,4.70% from abscess,2.92% from blood,etc.The sensitive rates of common antimicrobial agents of Pseudomonas aeruginosa in top five were turn amikacin (88.7%),piperacillin/he azole temple (85.0%),tobramycin (83.1%),piperacillin (80.3%) and cefepime (80.1%).59.0% of the Pseudomonas aeruginosa strains were resistant to Aztreonam.20.9%-29.7% of the Pseudomonas aeruginosa strains were resistant to Imipenem,Ceftazidime,Meropenem,Ciprofloxacin and Levofloxacin.The Pseudomonas aeruginosa isolates showed the lowest resistance rate (10.3%-19.9%) to Piperacillin,Gentamicin,Cefepime,Tobramycin,Piperacillin/Tazobactam and Amikacin.Conclusion The antimicrobial susceptibility pattern varies widly with Pseudomonas aeruginosa isolated in Yunnan of China in 2014.Antimicrobial resistance sur-Monitoring the antibiotic resistant trend of Pseudomonas aeruginosa and implementing the nosocomial infection control policy become more important in hospital management setting.

Objective To investigate the effect of magnesium sulfate on epidural labor analgesia with ropivacaine in the patients with preeclampsia. Methods Seventy nulliparous parturients with pre?eclampsia, aged 23-34 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, weighing 63-81 kg, with a singleton fetus in vertex presentation, without contradications to neuraxial anesthesia, waiting for vaginal delivery, received epidural analgesia for labor. The patients were divided into magnesi?um sulfate group and control group using a random number table, with 35 patients in each group. In magne?sium sulfate group, magnesium sulfate 50 mg∕kg ( 30 ml) was infused intravenously over 15 min when their cervical dilation was 3 cm, while the equal volume of normal saline was given in control group. Epi?dural labor analgesia was performed with ropivacaine. The up?and?down sequential allocation was used to determine the median effective concentration of epidural ropivacaine ( EC50 ) . The severity of pain was as?sessed with visual analogue scale score. Effective analgesia was defined as visual analogue scale score of≤1. The initial concentration of ropivacaine was 0.15%. Each time the concentration was increased∕decreased according to whether or not analgesia was effective, and the ratio between the two successive concentrations was 0.9. The EC50 and 95% confidence interval ( CI) of ropivacaine for epidural labor analgesia was calcu?lated. Results The EC50 (95% CI) of ropivacaine for epidural labor analgesia was 0.066% (0.062%-0.071%) in magnesium sulfate group. The EC50 (95% CI) of ropivacaine for epidural labor analgesia was 0.078% (0.072%-0.085%) in control group. The EC50 of ropivacaine was significantly lower in magnesi?um sulfate group than in control group ( P<0.05) . Conclusion Magnesium sulfate can enhance the effica?cy of ropivacaine for epidural labor analgesia in the patients with preeclampsia.

Objective To study the changes and clinical significance of serum interleukin-2 (IL-2) ,interleukin-6 (IL-6) ,interleu-kin-10 (IL-10) ,cholinesterase (ChE) and hyaluronic acid (HA) in the patients with chronic hepatitis B (CHB) and liver cirrhosis (LC) .Methods The serum concentrations of IL-2 ,IL-6 ,IL-10 ,ChE and HA were detected in 92 cases of CHB(CHB group) ,63 cases of LC (group LC) and 46 cases of healthy populations (control group) .Results The serum concentrations of IL-2 ,IL-6 and HA in the CHB group and the LC group were higher than those in the control group ,while the serum concentrations of IL-10 and ChE were lower than those in the control group ,the differences had statistical significance (P<0 .05) .The serum concentrations of IL-2 ,IL-6 and HA in the patients with HBV DNA copy number of 6 .0-6 .9 log10 copy/mL were higher than those with the copy number of 3 .0-4 .9 log10 copy/mL and 5 .0 -5 .9 log10 copy/mL ,while the serum concentrations of IL-10 and ChE were lower than those with HBV DNA copy number of 3 .0-4 .9 log10 copy/mL and 5 .0-5 .9 log10 copy/mL ,the differences had statistical significance(P<0 .05) .The serum concentrations of IL-2 ,IL-6 and HA in the LC patients with the Child-Pugh grade C were higher than those with the Child-Pugh grade A and B ,while serum concentrations of IL-10 and ChE were lower than those with the Child-Pugh grade A and B ,the differences were statistically significant (P<0 .05) .Conclusion The simultaneous detection of serum IL-2 ,IL-6 ,IL-10 ,ChE and HA concentration changes can provide certain clinical reference value for the evaluation of severity and prognosis in the patients with CHB and LC .