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:To investigate role of miR-4738-3p in targeting tryptophan 2,3-dioxygenase 2(TDO2)to regulate energy metabolism and inhibit immune escape in thyroid cancer cells.Methods:A total of 68 cases of thyroid cancer tissues and their corresponding adjacent non-cancerous tissues were collected,expressions of miR-4738-3p and TDO2 in tissues and cell lines were de-tected by qRT-PCR,relationship between miR-4738-3p expression and clinicopathological characteristics was analyzed.Effects of miR-4738-3p and TDO2 on proliferation,migration,invasion,energy metabolism and immune escape of TPC-1 and BCPAP cells were examined through CCK-8,clone formation,wound healing,Transwell experiments,biochemical analyses,ELISA and NK cell co-culture experiments,targeting relationship between miR-4738-3p and TDO2 was validated by dual luciferase reporter gene assay.In vivo xenograft experiments and immunohistochemical detections were conducted to observe effects of miR-4738-3p on tumorigenesis and expression of immune escape-related proteins in TPC-1 and BCPAP cells.Results:miR-4738-3p was lowly expressed(P<0.05),while TDO2 was highly expressed in thyroid cancer(P<0.05).Tumor size,lymph node metastasis and TNM staging were correlated with expression of miR-4738-3p(P<0.05).Compared with miR-NC group,miR-4738-3p mimics group exhibited decreased prolifera-tion,clone formation,migration,invasion ability,glucose uptake,lactate production,ATP/ADP ratio,TDO2 mRNA and protein expressions,tumor volume,mass,Ki-67,TDO2 and PD-L1 expressions(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were increased(P<0.05).miR-4738-3p inhibitor group showed increased proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production,ATP/ADP ratio,TDO2 mRNA and protein expressions(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were decreased(P<0.05).Binding sites were identified between miR-4738-3p and TDO2,and their expression were negatively correlated(r=-0.485 3,P<0.001).Compared with sh-NC group,proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production and ATP/ADP ratio were decreased in sh-TDO2 group(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were increased(P<0.05).Compared with Scrambled group,proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production and ATP/ADP ratio were increased in TDO2 group(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were decreased(P<0.05).Conclusion:miR-4738-3p targets TDO2 to regulate energy metabolism,inhibiting thyroid cancer cell proliferation,metastasis and immune escape.

Objective:To investigate the application effect of BOPPPS+team-based learning (TBL) based on the concept of outcome-based education (OBE) in the teaching of infectious rash and fever illnesses in children.Methods:A total of 199 undergraduate students of the class 2019 in the five-year program of Department of Pediatrics in Chongqing Medical University were selected as subjects, and they were divided into experimental group with 99 students and control group with 100 students using a random number table. The students in the experimental group received BOPPPS+TBL teaching based on the OBE concept, while those in the control group received traditional teaching. After the end of the curriculum, scores were compared between the two groups, and a questionnaire survey was conducted for self-evaluation of teaching and learning effectiveness and the acceptance of teaching models. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:The experimental group had a significantly higher score of the course than the control group [(88.08±5.31) vs. (85.62±8.44), P=0.014]. The questionnaire survey showed that compared with the control group, the experimental group had significantly higher scores of the self-evaluation of teaching effectiveness [(4.40±0.75) vs. (3.36±1.13), P<0.001] and learning effectiveness [(4.31±0.84) vs. (3.35±1.19), P<0.001]. In the experimental group, 96.96% (96/99) of the students believed that BOPPPS+TBL teaching based on the OBE concept could help students to master and understand the knowledge points, and 93.93% (93/99) of the students were willing to use this teaching model in future learning. Conclusions:BOPPPS+TBL teaching based on the OBE concept can help to achieve teaching objectives and significantly improve student satisfaction and learning outcomes.

Objective:To investigate role of miR-4738-3p in targeting tryptophan 2,3-dioxygenase 2(TDO2)to regulate energy metabolism and inhibit immune escape in thyroid cancer cells.Methods:A total of 68 cases of thyroid cancer tissues and their corresponding adjacent non-cancerous tissues were collected,expressions of miR-4738-3p and TDO2 in tissues and cell lines were de-tected by qRT-PCR,relationship between miR-4738-3p expression and clinicopathological characteristics was analyzed.Effects of miR-4738-3p and TDO2 on proliferation,migration,invasion,energy metabolism and immune escape of TPC-1 and BCPAP cells were examined through CCK-8,clone formation,wound healing,Transwell experiments,biochemical analyses,ELISA and NK cell co-culture experiments,targeting relationship between miR-4738-3p and TDO2 was validated by dual luciferase reporter gene assay.In vivo xenograft experiments and immunohistochemical detections were conducted to observe effects of miR-4738-3p on tumorigenesis and expression of immune escape-related proteins in TPC-1 and BCPAP cells.Results:miR-4738-3p was lowly expressed(P<0.05),while TDO2 was highly expressed in thyroid cancer(P<0.05).Tumor size,lymph node metastasis and TNM staging were correlated with expression of miR-4738-3p(P<0.05).Compared with miR-NC group,miR-4738-3p mimics group exhibited decreased prolifera-tion,clone formation,migration,invasion ability,glucose uptake,lactate production,ATP/ADP ratio,TDO2 mRNA and protein expressions,tumor volume,mass,Ki-67,TDO2 and PD-L1 expressions(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were increased(P<0.05).miR-4738-3p inhibitor group showed increased proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production,ATP/ADP ratio,TDO2 mRNA and protein expressions(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were decreased(P<0.05).Binding sites were identified between miR-4738-3p and TDO2,and their expression were negatively correlated(r=-0.485 3,P<0.001).Compared with sh-NC group,proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production and ATP/ADP ratio were decreased in sh-TDO2 group(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were increased(P<0.05).Compared with Scrambled group,proliferation,clone formation,migration,invasion ability,glucose uptake,lactate production and ATP/ADP ratio were increased in TDO2 group(P<0.05),NAD+/NADH ratio,IFN-γ,TNF-α levels and NK cell killing rate were decreased(P<0.05).Conclusion:miR-4738-3p targets TDO2 to regulate energy metabolism,inhibiting thyroid cancer cell proliferation,metastasis and immune escape.

Objective:To investigate the application effect of BOPPPS+team-based learning (TBL) based on the concept of outcome-based education (OBE) in the teaching of infectious rash and fever illnesses in children.Methods:A total of 199 undergraduate students of the class 2019 in the five-year program of Department of Pediatrics in Chongqing Medical University were selected as subjects, and they were divided into experimental group with 99 students and control group with 100 students using a random number table. The students in the experimental group received BOPPPS+TBL teaching based on the OBE concept, while those in the control group received traditional teaching. After the end of the curriculum, scores were compared between the two groups, and a questionnaire survey was conducted for self-evaluation of teaching and learning effectiveness and the acceptance of teaching models. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:The experimental group had a significantly higher score of the course than the control group [(88.08±5.31) vs. (85.62±8.44), P=0.014]. The questionnaire survey showed that compared with the control group, the experimental group had significantly higher scores of the self-evaluation of teaching effectiveness [(4.40±0.75) vs. (3.36±1.13), P<0.001] and learning effectiveness [(4.31±0.84) vs. (3.35±1.19), P<0.001]. In the experimental group, 96.96% (96/99) of the students believed that BOPPPS+TBL teaching based on the OBE concept could help students to master and understand the knowledge points, and 93.93% (93/99) of the students were willing to use this teaching model in future learning. Conclusions:BOPPPS+TBL teaching based on the OBE concept can help to achieve teaching objectives and significantly improve student satisfaction and learning outcomes.

Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. Methods The Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.

Objective To investigate the relationship between circular RNA homeodomain interacting protein ki-nase 3 (circHIPK3) and the activation of rat microglia (RM) cells.Methods In vitro, RM cells were cultured and randomized into normal and oxygen-glucose deprivation/reperfusion (OGD/R) groups, and the expression lev-el of circHIPK3 in each group was detected by RT-qPCR.The circHIPK3 lentiviral vector with puromycin resist-ance was constructed, and the overexpression (OE) group and negative control (NC) group were set up.The opti-mal multiplicity of infection (MOI) for RM cells was determined based on fluorescence expression, and puromycin was used to screen RM cells stably expressing circHIPK3 .The cells of OE and NC groups were treated with OGD/R, and the expression levels of ionized calcium binding adaptor molecule 1 (Iba-1) and eukaryotic tumor necrosis factor receptor superfamily (CD40) were detected by Western blot.The circHIPK3 translational protein potential was analyzed by the circRNAdb database, while the potential binding microRNAs on circHIPK3 were predicted by circBank and Starbase databases.Results OGD/R down-regulated circHIPK3 in RM cells (P <0.0001).The sequencing results were accurate and the lentiviral vector of circHIPK3 was constructed successfully.The optimal MOI of RM cells was 80 , puromycin at a concentration of 2μg/ml was used to screen RM cell lines stably express-ing circHIPK3 .RT-qPCR results showed that the expression level of circHIPK3 was significantly higher in the OE group compared with the NC group (P<0.01) .Western blot results revealed that the expression levels of Iba-1 and CD40 in the OE group were markedly lower than those in the NC group (P<0.05) .Protein translation analy-sis showed that circHIPK3 encoded a polypeptide of 404 amino acids with two internal ribosome entry sites (IRES) and an open reading frame (ORF) .Database analysis uncovered that circHIPK3 could target eight specific miR-Nas, namely hsa-miR-3529-5p, hsa-miR-379-5p, hsa-miR-506-3p, hsa-miR-33, hsa-miR-450b-5p, hsa-miR-551b-3p, hsa-miR-193, and hsa-miR-508-3p.Conclusion The overexpression of circHIPK3 effectively suppres-ses OGD/R-induced activation of RM cells.It has the potential to encode peptides and may act as a miRNA sponge.These findings provide a foundation for further study of circHIPK3 functions.

Objective To investigate the status of occult hepatitis B virus infection(OBI)among blood donors in Quzhou,Zhejiang,and to analyze the mutation of S region in blood donors with anti-HBc+alone and non anti-HBc+alone.Methods The OBI samples were screened by ELISA and NAT;the HBV DNA was amplified and sequenced;20 anti-HBc+alone and 25 not anti-HBc+alone samples were obtained.Results The detection rate of OBI in Quzhou was 0.10%(155/161 045),and the positive rate of anti-HBc was 74.19%(115/155).The detection rate of OBI increased with the age of blood donors(P＜0.05),but was not related to gender.The positive rate of anti-HBc+alone was 22.58%(35/155),and that of not anti-HBc alone was 51.61%(80/155).Among the 45 OBI sequencing samples,the proportion of B and C geno-type was73.33%(33/45)and 20.00%(9/45),respectively.The mutation sites of blood donors in the anti-HBc+alone group were more than those in the not anti-HBc+alone group,and the mutation rates of S114T and V168A on MHR were significantly different(P＜0.05).Conclusion The genotype of OBI infection in Quzhou is mainly type B.The mutation sites of blood donors with anti-HBc+alone are higher than those with not anti-HBc+alone,which may be more suitable as one of the OBI screening indicators.

Objective:To explore the incidence of hepatitis B virus (HBV) reactivation in the population with HBV associated liver cancer after receiving programmed death receptor 1 (PD-1) inhibitors combined with targeted therapy, and the prognostic differences between HBV reactivation and non reactivation populations during this treatment.Methods:A retrospective analysis was conducted on patients with primary liver cancer who received PD-1 inhibitor combined with targeted drugs treatment at the Zhongshan Hospital, Fudan University (Xiamen Branch) from January 2019 to June 2021. Clinical data such as age, sex, liver function status, cirrhosis, HBV DNA level, alpha fetoprotein, tumor stage, anti-tumor program and anti HBV program, tumor treatment response, progression free survival (PFS), and total survival (OS) were collected for t test, χ 2 test and Kaplan-Meier survival analysis. Results:A total of 66 enrolled patients were enrolled, of which 17 cases experienced HBV reactivation, with an incidence rate of 25.76%; The rates of HBV reactivation at 3 months, 6 months, 1 year, 2 years, and 3 years were 6.06%(4/66), 12.12%(8/66), 19.70%(13/66), 22.73%(15/66), and 25.76%(17/66), respectively. There was no significant difference between the HBV reactivation group and the non HBV reactivation group in age, sex, liver function status, cirrhosis, HBV DNA level, alpha fetoprotein, tumor stage, anti-tumor and anti HBV programs, objective response rate (ORR) and disease control rate (DCR) (all P>0.05). However, the PFS and OS of the HBV reactivation group were significantly lower than those of the non HBV reactivation group, at 4.00 months vs 8.50 months ( P=0.002) and 12.90 months vs 19.77 months ( P=0.014), respectively. Conclusions:Patients with primary live cancer who receive PD-1 inhibitor combined with targeted therapy are at risk of HBV reactivation, and those who experience HBV reactivation have significantly poorer tumor progression and survival prognosis compared with non HBV reactivated patients.