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A novel biomimetic modular polymer design is reported to address the challenge in polymer science to design polymers that combine desired mechanical properties such as tensile strength, fracture toughness, and elasticity into one structure. The excellent correlation between the single-molecule and the bulk properties successfully demonstrates biomimetic concept of suing modular domain structure to achieve advanced polymer properties.

The triad of central nervous system symptoms, visual disturbance and hearing impairment is an oft-encountered clinical scenario. A number of immune-mediated diseases should be considered among the differential diagnoses including: Susac syndrome, Cogan syndrome or Vogt-Koyanagi-Harada disease; demyelinating conditions such as multiple sclerosis or neuromyelitis optica spectrum disorder; systemic diseases such as systemic lupus erythematosus, Sjögren syndrome or Behcet disease and granulomatous diseases such as sarcoidosis. In this article, we coin the term 'BEE syndromes' to draw attention to the various immune-mediated diseases that affect the brain, eye and ear. We present common disease manifestations and identify key clinical and investigation features. [ABSTRACT FROM AUTHOR]

The diagnosis of interstitial lung disease (ILD) requires meticulous evaluation for an underlying connective tissue disease (CTD), with major implications for prognosis and management. CTD associated ILD (CTD-ILD) occurs most commonly in the context of an established CTD, but can be the first and/or only manifestation of an occult CTD or occur in patients who have features suggestive of an autoimmune process, but not meeting diagnostic criteria for a defined CTD--recently defined as "interstitial pneumonia with autoimmune features" (IPAF). The detection of specific autoantibodies serves a critical role in the diagnosis of CTD-ILD, but there remains a lack of data to guide clinical practice including which autoantibodies should be tested on initial assessment and when or in whom serial testing should be performed. The implications of detecting autoantibodies in patients with IPAF on disease behaviour and management remain unknown. The evaluation of CTD-ILD is challenging due to the heterogeneity of presentations and types of CTD and ILD that may be encountered and thus it is imperative that immunologic tests are interpreted in conjunction with a detailed rheumatologic history and examination and multidisciplinary collaboration between respiratory physicians, rheumatologists, immunologists, radiologists and pathologists. [ABSTRACT FROM AUTHOR]

Case: A 39-year-old man with thymoma-associated acetylcholine receptor antibody myasthenia gravis (MG) presented with fevers, night sweats, abdominal pain and weight loss. Marked splenomegaly and intra-abdominal lymphadenopathy were found. Biopsies confirmed disseminated Mycobacterium genavense infection. Despite antimicrobials and reduced immunosuppressive medications, he worsened. We suspected a thymoma-associated cytokine inhibitory antibody. The addition of subcutaneous interferon-gamma (IFN-γ) induced clinical and radiological improvement. His antimicrobials were able to be ceased. MG remained stable. Subsequent testing demonstrated an endogenous interleukin-12 (IL-12) inhibitor, likely inhibiting the IL-12/IFN-γ axis crucial for defence against mycobacterial infections., Discussion: This case illustrates the autoimmune manifestations that can occur with thymoma. It illustrates the benefit of exogenous IFN-γ in overcoming the immune deficit. In this case, its use did not exacerbate existing autoimmune disease or trigger others. We raise awareness of the need to consider cytokine pathway defects as a contributing factor to refractory atypical infections in patients with thymoma-associated MG., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Disease behaviour in interstitial lung disease (ILD) is highly variable and accurate clinical tools to predict prognosis and guide management decisions remain unsatisfactorily elusive. Accurate disease stratification would allow clinicians to better distinguish patients at risk of rapid progression requiring urgent treatment, from those indolent disease where potentially toxic drug therapy could be minimised or avoided. Several serum biomarkers have demonstrated potential utility for diagnosis and prognosis of ILD in small retrospective studies, and the hope is future multicentre prospective trials focussed on the markers with most potential will see translation to clinical practice. Two important and contrasting fibrotic lung diseases with high mortality are idiopathic pulmonary fibrosis (IPF) and systemic sclerosis associated ILD (SSc-ILD). In this era where anti-fibrotics for IPF have proven benefit, there are increasing biologic and non-biologic options for the treatment of connective tissue disease ILD (CTD-ILD), and the incidence of both is increasing, there is an urgent need to improve the diagnostic and prognostic accuracy in these complex patients. This comprehensive literature review will summarise and discuss the current evidence for the major candidate serum biomarkers in IPF and SSc-ILD. Biomarkers will be categorised by the following major mechanistic pathways (1) alveolar epithelial cell damage; (2) aberrant fibrogenesis, fibroproliferation and matrix remodelling; (3) immune dysregulation; and (4) vascular and endothelial damage. The aim is to review the rationale, potential and limitations of current candidate biomarkers and their utility in IPF and SSc-ILD to help direct future research and translation to clinical practice., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)