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Aim of the work: Measuring serum endocan level to determine its potential role in detecting subclinical cardiovascular involvement in psoriatic patients with or without arthritis. Patients and methods: This work included 14 psoriatic arthritis (PsA) patients, 14 psoriasis only (PsO) patients, and 14 age and sex matched controls. The psoriasis area severity index was evaluated. Serum endocan level was measured, subclinical atherosclerosis was assessed using brachial artery flow-mediated vasodilation (FMD), and echocardiography: standard and tissue Doppler imaging (TDI) was performed. Results: The mean age of PsA patients was 38.3 ± 9.9 years and for PsO was 37.9 ± 8 years. They were 3 males and 11 females in both groups with a comparable psoriasis duration (11 ± 4.9 vs 8 ± 6.3 years; p = 0.17). PsA patients had significantly increased endocan level (618 ± 227.8 ng/L) compared to those with PsO or controls (359 ± 185.7 and 130.6 ± 38.2 ng/L respectively; p

Aim of the work To describe musculoskeletal ultrasound (MSUS) findings in patients with systemic sclerosis (SSc) and to study their relation with cardiopulmonary and skin affection. Patient and methods In 50 SSc patients, hands, wrists and six entheses sites were evaluated by MSUS. Entheses were scored using the Madrid Sonography Enthesitis Index (MASEI). The modified Rodnan skin score (mRSS) was assessed. Results They were 42 females/8males with a mean age 36.2 ± 11.6 years, disease duration 3.5 ± 4.2 years, 27 had limited skin affection and 23 diffuse and the mRSS was 4.1 ± 15.3. 54% had arthritis, 10% tendon friction rub, 16% joint contractures and 10% calcinosis. 18% had left ventricular hypertrophy, 34% had pulmonary hypertension, 20% had restrictive pulmonary function test (PFT) and 24% had interstial lung disease (ILD). Synovitis was detected in 58% and was significantly related to mRSS, left ventricular hypertrophy, PFT, pulmonary hypertension and ILD (p = 0.023, p = 0.03, p = 0.006, p = 0.026 and p = 0.039 respectively). Common extensor tenosynovitis was detected in 82% and was significantly related to mRSS, PFT and ILD (p = 0.019, p = 0.043 and p = 0.032 respectively). Joint erosions were detected in 36% and were significantly related to age and C-reactive protein (CRP) (p = 0.01 and p = 0.034). Enthesopathy showed a significant relation with erythrocyte sedimentation rate (ESR), CRP and mRSS (p = 0.014, p = 0.013, p = 0.025, respectively). Conclusion Articular involvement is common in SSc and underestimated by clinical examination. Synovitis is associated with cardiovascular complication in SSc. Tenosynovitis is clinically related to restrictive pulmonary function. Enthesopathy should be kept in mind in symptomatic patients with systemic sclerosis.

Aim of the work: To evaluate the frequency of anti-carbamylated protein (anti-CarP) antibodies positivity in female rheumatoid arthritis (RA) patients; to study their association with different disease aspects clinically and radiologically and to assess their potential predictive role of RA disease compared to other autoantibodies. Patients and methods: Fifty-one RA female patients and 44 age-matched controls were studied. Duration of morning stiffness, disease activity score (DAS28) and health assessment questionnaire (HAQ) were assessed. Laboratory investigations included acute phase reactants, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and anti-CarP antibodies. Conventional radiography of both hands and feet was performed and assessed by a simple erosion narrowing score (SENS). All patients were evaluated by ultrasound 7 (US7) score. Results: The mean age of patients was 46.9 ± 8.6 years with disease duration of 6.2 ± 5.3 years. Anti-CarP antibody was positive in 52% and 54.5% of patients seronegative for anti-CCP and RF respectively. RF was positive in 40 (78.4), anti-CCP was positive in 26(51%), and anti-CarP in 21 (41.2%) patients. Anti-CarP antibodies were significantly associated with radiological damage, DAS28, HAQ and acute phase reactants. The sensitivity and specificity were 41.2% and 88.6%, respectively for anti-CarP, 51% and 93.2% for anti-CCP and 78.4% and 90.9% for RF to diagnose RA. Conclusions: An association between anti-CarP antibody positivity and the disease activity, severity, structural damage and hence poor disease outcome has been demonstrated. Testing anti-CarP antibodies could be a useful marker for the assessment of disease activity as well as the expectation of prognosis in RA patients.

Background: Behçet’s disease (BD) is a chronic, relapsing, multisystemic vasculitis with varying frequency of gastrointestinal manifestations. Pancreatitis is a rare manifestation of BD. Case presentation: A 31-year-old man diagnosed with Behçet’s disease with a fiveyear history of recurrent orogenital ulcers, ocular involvement and pseudofolliculitis presented with severe epigastric pain radiating to back that worsens after meals and weight loss (10 kg in 3 months). He denied history of abdominal trauma, drug abuse or alcohol consumption. He was found to be hypertensive. Laboratory investigations revealed presence of leukocytosis, thrombocytosis, high inflammatory markers, low serum albumin, impaired renal functions, hyperglycemia and elevated serum amylase. Post contrast triphasic computed tomography scan showed a picture of necrotizing hemorrhagic pancreatitis. Bile and pancreatic ducts were normal. CT mesenteric angiography showed no evidence of aortic, celiac or superior mesenteric artery aneurysms, also splenic artery and veins were patent with no evidence of occlusion. After exclusion of other causes of acute pancreatitis, the condition has been attributed to BD. High dose of oral corticosteroids was started (60 mg/day) in addition to proper hydration, antihypertensive medications, intravenous antibiotics and insulin to control elevated blood sugar. Cystogastrostomy through endoscopic ultrasound was done to relieve the patient’s pain. Unfortunately, three months after the onset of pain, the patient developed systemic inflammatory response syndrome and passed away. Conclusion: Although acute pancreatitis is a rare gastrointestinal manifestation of BD, it is a possibly fatal one.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with heterogeneous manifestations and intricate pathophysiology. Driven by its complicated diagnostic framework, an interest in innovative diagnostic approaches has been steadily growing. Circular RNAs (circRNAs) are novel class of noncoding RNAs involved in the development of various diseases including SLE. Aim of the work: To investigate circPTPN22, microRNA-200a-3p (miR-200a-3p) and interleukin-2 (IL-2) in SLE patients and study their diagnostic potential. Patients and methods: The study included 45 patients and 45 control. The expression of circPTPN22 and miR-200a-3p were evaluated using quantitative reverse transcription polymerized chain reaction PCR. In addition, plasma IL-2 levels were determined by ELISA. The SLE disease activity index (SLEDAI) was assessed. Results: The patients were 42 females and 3 males, and their mean age was 33.6 ± 7.9 years and disease duration 11 ± 6.5 years. The expression of circPTPN22 and IL-2 were significantly lower in patients (0.33 ± 0.18 and 35.7 ± 22.02 pg/ml) compared to control (1 ± 0.1 and 147 ± 153.3 pg/ml respectively; p

Background: Cervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been the modality of choice in assessing CS in RA. Aim of the work: To evaluate CS in RA using MRI and detect the risk factors for its involvement. Patients and methods: Forty RA patients with neck pain were assessed using disease activity score (DAS28), Ranawat classification of rheumatoid myelopathy, simple erosion narrowing score (SENS), bilateral hand and wrist musculoskeletal ultrasound (MSKUS) for early erosion detection and CS MRI. Results: The mean age of patients was 44.3 ± 10.1 years, disease duration 7.9 ± 6.6 years and the DAS28 was 4.8 ± 1.6. 70% of patients were in Ranawat class I, 30% in class II, and none in class III. 70% of patients had CS lesions where synovitis occurred in 67.5% of patients, odontoid erosions in 15%, atlanto-axial marrow edema in 5%, atlanto-occipital marrow edema in 5% and none had atlanto-axial subluxation (AAS), subaxial subluxation (SAS), spinal cord/brain stem compression. CS involvement was significantly related to peripheral joint erosion, high SENS and positive RF (p = 0.01, p

Aim of the work: To assess urinary soluble CD163 (sCD136) in systemic lupus erythematosus (SLE) patients compared to healthy controls. In addition to determine its association with different SLE clinical features, laboratory investigations and pathological indices focusing on those suggest renal disease activity. Patients and methods: The study included 58 SLE patients and 30 controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into active lupus nephritis (ALN) (renal SLEDAI ≥ 4) and no-renal activity (NRA) SLE patients (renal SLEDAI = 0). Urinary sCD163 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). Urine values were normalized to urinary creatinine excretion. Renal biopsies were performed in 21 ALN patients. Results: They were 54 females and 4 males with a mean age 31.8 ± 9.1 years and disease duration 6.2 ± 4.8 years. They were 31 with ALN and 27 NRA SLE patients. Urinary sCD163 level was significantly higher in SLE patients (1.85 ± 0.3) than controls (0.5 ± 0.36, p 0.82 with sensitivity of 90.3%, specificity of 88.89%, p

Background Inappropriate and excessive activation of type I interferon (IFN) system is a key feature of systemic lupus erythematosus (SLE), and its targeting has led to important achievements in the development of novel drugs for SLE. Aim of the work To evaluate the serum levels of interferon lambda IFNλ3 (IL28B) in Egyptian patients with SLE and investigate its potential relation with different clinical and laboratory parameters. Patients and methods The study included 40 SLE patients and 40 controls. The SLE disease activity index (SLEDAI) was assessed. The measurement of serum levels of IFNλ3 was performed in all participants using enzyme linked immunosorbent assay (ELISA). Results The mean age of the patients was 26.8 ± 7.8 years with disease duration 5.1 ± 4.5 years and they were 35 females and 5 males. The serum levels of IFNλ3 were significantly higher in SLE patients (9.7 ± 12.47 pg/mL) compared to the control (5.13 ± 1.63 pg/mL)(p = 0.02). Significant correlations were observed between serum IFNλ3 and serositis (r = 0.35,p = 0.03), C3 consumption (r −0.33, p = 0.04) and SLEDAI (r 0.34, p = 0.03). On multivariate regression analysis, serositis and SLEDAI (but not C3) were significant independent predictors of IFNλ3 levels (β = 0.08, p = 0.037 and β = 0.06, p = 0.014 respectively). Conclusion The results support a possible role of IFNλ3/IL28B in the immunopathogenesis of SLE. The significant association of serum IFNλ3 with disease activity highlights the utility of IFNλ3 as a novel biomarker for monitoring disease activity and predicting severity in SLE. Further studies on IFNλ3 in SLE could be promising in the development of personalized therapy for lupus patients.

Background Dysregulation of BZRAP1‐AS1 was associated with immune statuses of cancer or Alzheimer's disease patients, yet little is known about its role in rheumatoid arthritis. Methods RT‐qPCR and western blot were applied to assess the expression of indicated expression. CCK‐8 and BrdU proliferation assays were used to measure the proliferation of RA‐HFLS. Apoptosis in RA‐HFLS was evidenced by the alteration of caspase‐3 activity and apoptosis‐related factors. ELISA was performed to detect IL‐6, IL‐1β, and TNF‐α level. Luciferase reporter, RIP, and pull‐down assays were used to confirm the BZRAP1‐AS1/miR‐1286/COL5A2 cascade predicted by bioinformatics analysis. Results BZRAP1‐AS1 and COL5A2 were downregulated in RA tissues and RA‐HFLS while miR‐1286 was amplified. Overexpression of BZRAP1‐AS1 reduced the RA‐HFLS proliferation, IL‐6, IL‐1β, and TNF‐α level and induced cell apoptosis while BZRAP1‐AS1 silence produced an opposite effect. Overexpression of BZRAP1‐AS1 reduced the miR‐1286 expression which in turn increased the COL5A2 expression, thereby relieving the excessive proliferation and limited apoptosis in RA‐HFLS. Conclusion Our findings suggested that BZRAP1‐AS1 sequestered miR‐1286 and reshaped the COL5A2 expression, thereby suppressed RA‐HFLS proliferation and inflammation, and triggered cell apoptosis, resulting in the attenuation of RA progression.

Introduction Mast cells are regarded as a kind of classical anaphylaxis cells. However autoimmune diseases and allergic reactions have many similarities or overlaps. A large number of papers have proved that mast cells play a significant role in the pathogenesis of systemic lupus erythematosus (SLE). It is speculated that IgE, anti‐IgE antibodies, FcεRI, and anti‐FcεRI antibodies activate mast cells through autoimmune pathways and participate in the disease process of SLE. Naturally occurring protein molecules not only exist in monomer form, but also in polymer of protein molecules. Therefore, whether IgE, FcεRIα, anti‐IgE antibodies, and anti‐FcεRI antibodies also exist in polymeric forms in the natural state is worthy of further investigation. Methods The serum samples and clinical data of 131 patients with SLE were collected from Qilu Hospital (Qingdao). Sixty healthy individuals were collected as the control group. Serum FcεRIα, anti‐IgE, and anti‐FcεRI were detected by enzyme‐linked immunosorbent assay. Serum IgE was detected by rate scatter nephelometry. A Chinese hamster ovarian cancer cell line CHO3D10 transfected with human FcεRIα was cultured and the cell protein extract was prepared. The existence forms of FcεRIα in the cell protein extract were detected by the native‐page method. Results The serum FcεRIα in SLE patients was significantly higher than that in control group (3.52 [2.18, 4.71] µg/ml and 1.87 [1.52, 2.33] µg/ml, respectively; p, First, as autoimmune diseases and allergic reactions have many similarities or overlaps, we compared the differences in serum IgE, FcεRIα, anti‐IgE, and anti‐FcεRI levels of systemic lupus erythematosus group and healthy control group for the first time. The serum FcεRIα in SLE patients is significantly higher than that in the control group and anti‐IgE is significantly lower than that in the control group, which provides a new reference basis for the understanding and further discussion of the inflammatory mechanism of the disease. Second, this study has revealed that the FcεRIα has one kind of monomer and two kinds of polymers in the degeneration conditions, which is worthy of further investigation.

Background Although population studies have implicated emotional burden in asthma severity, the underlying genetic risk factors are not completely understood. We aimed to evaluate the genetic influence of a functional single-nucleotide polymorphism (SNP) in the stress-related μ-opioid receptor gene (OPRM1; A118G SNP, rs1799971) on asthma severity. Methods We initially assessed disease severity in asthmatic outpatients carrying A118G. Using an ovalbumin-induced experimental asthma rodent model harboring the functionally equivalent SNP, we investigated the mechanism by which this SNP influences the allergic immune response. Results Among 292 outpatients, 168 underwent airway hyperresponsiveness (AHR) to methacholine testing. Compared with patients carrying the AA and AG genotypes, those carrying the GG genotype exhibited enhanced AHR. The stress levels were presumed to be moderate among patients and were comparable among genotypes. Compared with Oprm1 AA mice, GG mice demonstrated aggravated asthma-related features and increased pulmonary interleukin-4+CD4+ effector and effector memory T cells under everyday life stress conditions. Intraperitoneal naloxone methiodide injection reduced effector CD4+ T cell elevation associated with increased eosinophil numbers in bronchoalveolar lavage fluid of GG mice to the levels in AA mice, suggesting that elevated Th2 cell generation in the bronchial lymph node (BLN) of GG mice induces enhanced eosinophilic inflammation. Conclusions Without forced stress exposure, patients with asthma carrying the OPRM1 GG genotype exhibit enhanced AHR, attributable to enhanced Th2 cell differentiation in the regional lymph node. Further research is necessary to elucidate the role of the OPRM1 A118G genotype in the Th2 cell differentiation pathway in the BLN.

Aim of the work It is to identify the classification characteristics of diagnostic criteria in the early (≤3 year) and advanced stage (>3 year) of palindromic rheumatism (PR). Patients and methods 269 patients of PR were selected out of those with recurrent intermittent arthritis and were divided into two groups with ≤3 year (n = 99) and >3 year (n = 170) disease duration. The clinical characteristics and the positive incidence according to 3 classification criteria: Pasero and Barbieri (1986); Hannonen et al. (1987) and Guerne and Weisman (1992) were compared. Furthermore, the positive incidences of each criterion were calculated. Results The mean age of the patients was 39.2 ± 10.8 years and M:F 1.2:1. The agreement of the Hannonen et al. (1987) and Guerne and Weisman (1992) criteria was the highest with 0.63 of κ value. When the positive incidences by each criteria were compared between groups of the ≤3 year and >3 year, both Hannonen et al criteria (76.8% and 91.2%) and Guerne and Weisman (62.6% and 85.8%) were significantly different (p = 0.001). The criterion that showed the obvious difference between early and advanced stages were as follow: (Pasero and Barbieri) >5 attacks in the last 2 years and ≥3 joints involved in different attacks; (Hannonen et al.) subsequent attacks in at least three different joints and for (Guerne and Weisman) six-month history of brief-sudden-onset and recurrent episodes of monoarthritis and ≥3 joints involved in different attacks. Conclusions The individual PR criteria showed different classification characteristics in ≤3 year and >3 year.

Background The overlap of systemic lupus erythematosus (SLE) and anti-neutrophil cytoplasmic antibody (ANCA) associated-vasculitis (AAV) is a rare entity. Aim of the work. To report a rare case of overlap SLE and AAV complicated by small bowel perforations and nephritis. Case presentation An 81-years-old Chinese woman presented with a two-weeks history of progressive bilateral lower limb weakness and dysuria. An incidental uterine mass was found, and a total hysterectomy was performed with extensive small bowel adhesion and multiple enteric perforations discovered intra-operatively. SLE was diagnosed based on the presence of cutaneous vasculitis, positive antinuclear antibody, anti-double stranded deoxyribonucleic acid, consumed complements, thrombocytopenia, nephritis, and pleural effusion. Positive perinuclear-ANCA and histological findings of the resected small bowel led to evidence of co-existing AAV. Hence, these findings have led to a diagnosis of overlap SLE and microscopic polyangiitis (MPA). The patient received daily hydroxychloroquine (200 mg), azathioprine (50 mg) followed by intravenous (IV) hydrocortisone (200 mg/8 h) and cyclophosphamide (750 mg/m2). The patient’s condition deteriorated with respiratory failure and hypotension and was eventually intubated and ventilated. IV immunoglobulin (4 mg/kg/day) was given for 3 days with resolution of the vasculitic lesions. The renal function rapidly declined with hemodynamic and clinical deterioration and the patient died. Conclusion This case demonstrates the diagnostic conundrum and complexity in the management of a late presentation of an overlap syndrome with rare life-threatening complications. To our knowledge, this is the first case diagnosed and managed in Malaysia and the oldest patient diagnosed with overlap SLE/AAV in the literature.

Aim of the work: We assessed the online efficacy of global awareness days (GADs) related to 5 rheumatological conditions: ankylosing spondylitis, fibromyalgia, gout, osteoporosis, and rheumatoid arthritis before and during the COVID-19 pandemic. Methods: Google Trends was used to obtain global relative search volume (RSV) for each condition, for a 41-day period around each GAD, per annum, between the years 2015 and 2020, inclusive. A joinpoint (time-trend) analysis was subsequently used to identify statistically significant perturbations (p

Background Measurement of allergen-specific IgE antibodies to inhaled allergens is important for the diagnosis and risk evaluation of allergic diseases such as asthma and allergic rhinitis. This study aimed to elucidate the prevalence of allergen sensitization among the healthy population in Japan using serum samples stocked in the Japanese Red Cross for blood donation. Methods Age- and gender-stratified serum samples (n = 800) from residents in Tokyo aged 20–59 years were randomly selected from the stocked serum obtained for blood donation in 2005. Total and specific IgE antibodies to 17 inhaled allergens were measured by the ImmunoCAP method. Individuals with positive (≥0.35 UA/mL) specific IgE antibodies to at least one inhaled allergen were defined as atopic. Stocked serums from donors aged 20–29 years in Sapporo, Osaka, Fukuoka, and Okinawa (n = 200 each) were also obtained for the measurement of IgE to six common inhaled allergens, to evaluate regional differences in the rate of positivity. Results Among residents in Tokyo, the prevalence of atopy was 78.0% and highest in men aged 20–29 years (94.0%), which decreased with age. The prevalence of specific IgE antibodies was highest for Japanese cedar pollen (66.8%), followed by cypress pollen (46.8%), Dermatophagoides pteronyssinus (38.3%), and moths (30.1%). Examination of IgE to Japanese cedar pollen, D. pteronyssinus, and moths identified 97.6% of atopic subjects in Tokyo. There were substantial regional differences in the prevalence of pollen IgE positivity. Conclusions This study demonstrated an extremely high prevalence of positivity in inhaled allergen-specific IgE antibodies among healthy adults in Japan.

Background: Behçet’s disease (BD) is a chronic inflammatory disorder with multifactorial cause. Long non-coding RNAs (lncRNAs) perform an essential role in gene regulation, and there is ongoing research in their contribution to autoimmune diseases. Aim of the work: To determine expression levels and diagnostic value of Theiler's Murine Encephalitis Virus Possible Gene1 (TMEVPG1) and TNFα and hnRNPL related immunoregulatory long non-coding RNA (THRIL) in BD, and to assess their role in the clinical characteristics of BD and disease activity. Patients and methods: Study included 30 BD patients (12 females and 18 males) and 30 matched controls. Expression levels of TMEVPG1 and THRIL were detected by real-time polymerase chain reaction. Results: The mean age of patients was 37.5 ± 11.3 years and disease duration was 7.7 ± 6 years. Expression levels of TMEVPG1 and THRIL were upregulated significantly in serum of patients compared with controls (set as 1). TMEVPG1 fold change = 3.0 with interquartile range (0.2–546.9) (p

Background Allergic rhinitis (AR) is a complex disease involving both mucosal and systemic immune compartments. Greater understanding of the immune networks underpinning AR pathophysiology may assist with further refining disease‐specific biomarkers. Objective To compare immune gene expression profiles in nasal mucosa and peripheral blood samples between adults with AR and controls without AR. Methods This cross‐sectional study included 45 adults with moderate‐severe and persistent AR (37.6 ± 12.8 years; mean ± SD) and 24 adults without AR (36.6 ± 10.2). Gene expression analysis was performed using the NanoString nCounter PanCancer Immune profiling panel (n = 730 immune genes) in combination with the panel plus probe set (n = 30 allergy‐related genes) with purified RNA from peripheral blood and cell lysates prepared from combined nasal lavage and nasal brushing. Results One hundred and thirteen genes were significantly differentially expressed in peripheral blood samples between groups (p, A series of genes were differentially expressed in both peripheral blood and nasal mucosal samples from adults with moderate‐severe persistent allergic rhinitis compared with adults without a history of allergic rhinitis.

Introduction Fibrous dysplasia (FD) is a rare genetic disease characterized by development of dysplastic bone tissue leading to pain, deformities and compressive complications. Spinal involvement is rare particularly for the polyostotic form. Case report Herein, we present a case of 52-year-old man presented with isolated low back pain who received non-steroidal anti-inflammatory drugs (NSAIDs) with partial pain relief. On examination, the thoracic and lumbar spines were tender. Lumbar spine movements, attested by Shober’s test and finger-to-floor test, were limited. There was no radicular pain and neurological examination was normal. The erythrocyte sedimentation rate was 20 mm/1st hour, C- reactive protein 2 mg/l and white blood cell count, serum calcium, phosphorus, alkaline phosphatase and parathormone were normal. Plain x-ray lumbar and thoracic spine and hips were normal. X-ray cervical spine and peripheral bone showed no lesions. Computed tomography (CT) and magnetic resonance imaging showed multiple osteolytic lesions with ground-glass opacity and sclerotic rims of thoracic and lumbar (L1 and L2) spine. Investigations to rule out malignancy or infections were negative. CT guided biopsy of a lumbar vertebra was performed and showed the presence of abnormal fibrous matrix surrounding an irregular shaped immature bone. The diagnosis of polyostotic FD of the spine was made. Zoledronic acid infusion was introduced and the patient felt better thereafter with no additional osteolytic lesions or new pain localization reported for 2 years on follow up. Conclusion Thoracic and lumbar spine FD is a rare localization that should be considered in the differential diagnosis of back pain.

Introduction The aim of this study was to investigate the improvements in laboratory testing procedures and the quality and safety management for large‐scale population screening for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods Because of epidemic prevention and control needs in Hebei Province, on January 7, 2021, the Health Commission of Zhejiang Province sent a medical team to Hebei Province, to carry out SARS‐CoV‐2 nucleic acid testing. Screening for the SARS‐CoV‐2 nucleic acid test was performed using reverse‐transcription polymerase chain reaction (RT‐PCR). Practical tests and repeated process optimization were adopted to explore the optimal solution for improving laboratory testing procedures and the quality of and safety management for large‐scale population screening for SARS‐CoV‐2. Results The Zhejiang medical team completed 250,000 pooled SARS‐CoV‐2 nucleic acid samples in 24 days in Shijiazhuang, with a peak daily testing capacity of 40,246 samples testing. There were no false‐negative or false‐positive results, and no laboratory personnel was infected with SARS‐CoV‐2. Significant achievements have been made in SARS‐CoV‐2 prevention and control. Conclusions This report summarizes the effort of the medical team regarding their management of the quality and safety of laboratory tests and proposes corresponding empirical recommendations to provide a reference for future large‐scale population screening SARS‐CoV‐2., The Health Commission of Zhejiang Province of china sent a medical team to Hebei Province, to carry out SARS‐CoV‐2 nucleic acid testing. The Zhejiang medical team completed 250,000 pooled more than two million peoples' SARS‐CoV‐2 nucleic acid samples in 24 days in Shijiazhuang, with a peak daily testing volume of 40,246 pooled samples using reverse‐transcription polymerase chain reaction (RT‐PCR). There were no false‐negative or false‐positive results, and no laboratory personnel was infected with SARS‐CoV‐2. Layout recommendations for temporary laboratories for large‐scale nucleic acid screening operation process and experience sharing of each link of nucleic acid detection.

Background Natto (fermented soybeans)-induced hypersensitivity is characterized by delayed symptom onset that hampers diagnosis. We aimed to clarify the clinical utility of the basophil activation test (BAT) in the diagnosis of natto-induced hypersensitivity. Methods Five patients with a history of anaphylaxis and chronic urticaria suspected of natto-induced hypersensitivity and seven with chronic spontaneous urticaria clinically unrelated to natto were enrolled in the patient and control groups, respectively. The BAT was performed with two incubation times, 15 min and 1 h, in combination with various concentrations of natto-mucilage extract. Results In controls, CD203c levels in basophils remained low in the 15-min incubation but were significantly increased in the 1-h incubation. In the patient group, in the 15-min condition, basophil CD203c was significantly upregulated by natto mucilage but not by soybean vs controls (P = 0.001). Low concentrations of natto mucilage were sufficient to upregulate basophil CD203c in the anaphylaxis cases, but high concentrations were required to induce the same effect in the urticaria cases. Finally, the dose-dependent pattern of the BAT results differed significantly between the anaphylaxis and urticaria cases (P = 0.006). Thus, a strong background reaction was observed in the BAT with 1 h incubation; 15 min of incubation was sufficient to identify patients with natto-induced hypersensitivity and may distinguish the clinical phenotype of natto-induced hypersensitivity, i.e., anaphylaxis or urticaria. Conclusions The BAT with a 15-min incubation period is useful in diagnosing natto-induced hypersensitivity.

Aim of the work To assess serum interleukin-6 (IL-6) level in primary fibromyalgia syndrome (FMS) patients and to study its relation to disease burden parameters Patients and methods Forty primary FMS patients and 40 age and sex matched controls were studied. Patients answered multiple questionnaires. Fatigue was assessed by multidimensional fatigue inventory (MFI-20), pain severity by visual analogue scale (VAS-pain) and sleep quality by sleep quality numerical rating scale (NRS). The 36-Item Short Form (SF-36) was used to assess quality of life and fibromyalgia Impact Questionnaire (FIQ) was used to evaluate patient status, progress and outcomes. Results The patients mean age was 36.5 ± 7.1 years and disease duration 5.3 ± 2.95 years and they were 38 females and 2 males. The mean serum IL-6 level was significantly higher in patients (134.9 ± 67.3 pg/ml) than control (41.1 ± 8.5 pg/ml)(p = 0.001). The mean VAS-pain was 6.2 ± 1.3 (4–8), FIQ was 58 ± 6.1 (50–70), SF-36 47 ± 10.2 (30–60), MFI20 was 76.5 ± 10.6 (60–95) and sleep quality NRS was 6.9 ± 1.2 (5–9). The values of the studied parameters and scores were significantly different from the control 1.4 ± 0.5; 14.4 ± 6.5; 93.9 ± 3.5 10 ± 5.2 and 0.9 ± 0.8 respectively; p = 0.001 for all). There was a significant correlation between serum IL-6 levels and VAS-pain (r = 0.72, p = 0.001), FIQ (r = 0.58, p = 0.001), SF-36 (r = 0.78, p = 0.001), MFI-20 (r = 0.74, p = 0.001) and sleep NRS (r = 0.78,p = 0.001). On regression, IL-6 level had a greater impact on sleep NRS (p = 0.001), SF-36 (p = 0.005) and MFI20 (p = 0.01). Conclusions Serum IL-6 level is high in primary FMS patients. Also, serum IL-6 is significantly related to the parameters of fatigue, functional status, sleep quality and pain.

Atopic dermatitis (AD) is characterized by chronic, eczematous, severe pruritic skin lesions. The knowledge on the pathogenesis of AD is driving the development of new drugs. From the research results, it has been revealed that Th2 cell-mediated immunity, skin barrier dysfunction, and pruritus cause a vicious cycle of AD. On the other hand, the Janus kinase (JAK)/signal transducers and activators of transcription (STAT) pathway are one of the essential signaling pathways in various inflammatory diseases including AD. In particular, TSLP, IL-4, IL-13 and IL-22 occupy an important position for Th2 cell-mediated immune reaction. Moreover, experimentally pan-JAK inhibitor suppress the STAT3 activation and improved the skin barrier function. Furthermore TSLP, IL-4, IL-13 and IL-31 contribute a lot to chronic pruritus of AD, and transmitted via JAK-STAT pathway. Therefore, JAK inhibitors are promising candidates for the treatment of severe AD. Here we review clinical trials of topical dergocitinib; a pan-JAK inhibitor, ruxolitinib; a JAK1 and JAK2 inhibitor, and tofacitinib; a JAK1, JAK2, and JAK3 inhibitor and oral baricitinib; a JAK1 and JAK2 inhibitor, abrocitinib and upadacitinib; JAK1 inhibitor. Significant improvements in the symptoms were obtained by each drug with low frequency of adverse events. In particular, oral JAK inhibitors have the ability to improve the pruritus and skin symptoms quickly. Therefore, the emergence of these topical and oral JAK inhibitors would be regarded as an innovation in the treatment of atopic dermatitis.

Aim of the work To determine the clinical characteristics of ankylosing spondylitis (AS) in rheumatology wards in Togo. Patients and methods: The medical records of AS patients in four rheumatology wards in Togo were recorded from January 2000 to December 2019. Results: The study included 37 AS cases out of 35,304 rheumatic diseases patients’ files that were investigated over the preceding 20 years; accounting for 0.1% of hospital cases. Male predominance was noticed with a M:F ratio of 4.3. The mean age at disease onset was 29.6 ± 10.3 years and the mean duration of the symptoms was 9.5 ± 9.2 years. The clinical findings were dominated by spinal pain (91.9%). The main peripheral joints involvements were knees (48.6%) and ankles (35.1%) and the most frequent extra-articular features were ocular with conjunctivitis (13.5%) and uveitis (8.1%) respectively. Plain radiographs of the spine revealed syndesmophytes (45.9%) with bony ankylosis and bamboo spine (21.6%); and that of the pelvis showed sacroiliitis in 89.2%. The human leucocytic antigen (HLA B27) was positive in four cases. Non-steroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine were the most commonly used drugs, respectively in 89.2% and 67.6% of patients. One patient was receiving biologic therapy. Conclusion: Ankylosing spondylitis is relatively rare in Togo. There is no particularity in the clinical features or imaging and laboratory findings. The diagnostic delay reflects the importance of the plain radiograph structural changes. NSAIDs and disease modifying anti-rheumatic drugs (DMARDs) are the cornerstone of the treatment due to their accessibility in Togo.

Aim of the work: To assess serum collagen triple helix repeat containing 1 (CTHRC1) protein level in rheumatoid arthritis (RA) patients and compare it with healthy controls. In addition, to evaluate the relation of its level with RA activity and severity Patients and methods: The study included 60 adult RA patients and 60 matched controls. Disease activity score (DAS28), modified health assessment questionnaire (MHAQ) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. Serum CTHRC1 levels were measured in patients and controls by enzyme linked immunosorbent assay (ELISA) Results: They were 49 females and 11 males patients with a mean age of 43.6 ± 10.8 years and disease duration of 8.8 ± 0.9 years. The mean of DAS28 was 4.9 ± 2 (1.95–8.6). Serum CTHRC1 levels were significantly higher in patients than controls (1009.5 ± 79.4 vs. 470.7 ± 8.2 ng/ml, p 583.5 ng/ml with sensitivity of 98.3% and specificity of 100%. CTHRC1 significantly correlated with DAS28 (r = 0.81, p

Aim of the work To evaluate the demographic, clinical presentation, and laboratory findings of the juvenile idiopathic arthritis (JIA) subtypes in Sudanese patients attending the Pediatric Rheumatology Clinic. Patients and methods This single-center study was conducted at the Rheumatology Clinic of Ahmed Gasim Hospital, Khartoum North. A specially designed data collection form was used. Full medical history and physical examination of patients was done. The initial investigation was collected from the patients' records. Results Eighty-one patients were enrolled in the study. Females were 54 and 27 males (F: M was 2:1). The mean age of the patients was 10.8 ± 3.6 years, 58% were above 10 years; disease duration 5.8 ± 2.4 years and age at onset 9 ± 3.8 years, the commonest age at onset was between 5 and 10 years. Half of the patients were from rural areas. There was a positive family history in 7.4%. Morning stiffness was the commonest presenting symptom (98.8%) and uveitis was present in 8.6%. The knee was the most affected joint (82.7%). The polyarticular subtype was found in 51 (63%), systemic-onset in 18 (22.2%), oligo articular in 10 (12.3%) and spondyloarthritis in 2 (2.5%). Seven patients (8.6%) had uveitis. Rheumatoid factor (RF) and antinuclear antibody (ANA) were positive among 30.9% and 46.9% of the participants respectively. Conclusion Females predominate and half of the patients are from rural areas. Polyarticular is the commonest subtype. Morning stiffness is the presenting symptom. The knee joint was the most affected. Positive RF was found in one-third of patients, ANA in about half of them.

Aim of the work To analyze the relationship between miRNA-146a rs2910164 and rheumatoid arthritis (RA) susceptibility and clarifying its association with disease activity and extra-articular involvement. Patients and methods The study enrolled 50 RA patients and 40 controls. DNA extraction from whole blood was done. Genotyping was performed by real-time polymerase chain reaction. The selected single nucleotide polymorphism was rs2910164 in the miRNA-146a gene. Genotyping was performed on genomic DNA samples by allelic discrimination assay. Disease activity score (DAS28) and health assessment questionnaire-disability index (HAQ-DI) were assessed. Results The mean age of patients was 44.8 ± 9.9 years while age at onset was 37.2 ± 9.8 years. Female:male was 5.3 vs 1. Females had significantly higher DAS28, visual analogue scale and rheumatoid factor (RF) than males (p = 0.04, p = 0.009, p = 0.03). The frequency of GC genotype was more in both males and females (62.5 vs 47.6%). GC genotype and G allele were the most frequent in patients. No significant difference in the frequency distribution of genotypes and alleles was observed between patients and controls. There was a significant difference in the number of swollen joints (p = 0.04) and sicca symptoms (p = 0.01) being higher in those with CC genotype with a tendency of increased DAS28, HAQ-DI, deformities and rheumatoid nodules with CC genotype and interstitial pulmonary fibrosis and RF with GG genotype. Conclusions CC genotype was associated with sicca symptoms and swollen joints, deformities, disease activity and functional disability. miRNA-146a may be a potential biomarker for extra-articular manifestations of RA that need more attention and warrant aggressive therapy.

Background The effects of bronchial thermoplasty (BT) on smooth muscle (SM) and nerves in small airways are unclear. Methods We recruited 15 patients with severe refractory asthma, who received BT treatment. Endobronchial optical-coherence tomography (EB-OCT) was performed at baseline, 3 weeks' follow-up and 2 years' follow-up to evaluate the effect of BT on airway structure. In addition, we divided 12 healthy beagles into a sham group and a BT group, the latter receiving BT on large airways (inner diameter >3 mm) of the lower lobe. The dogs’ lung lobes were resected to evaluate histological and neuronal changes of the treated large airways and untreated small airways 12 weeks after BT. Results Patients receiving BT treatment had significant improvement in Asthma Control Questionnaire (ACQ) scores and significant reduction in asthma exacerbations. EB-OCT results demonstrated a notable increase in inner-airway area (Ai) and decrease in airway wall area percentage (Aw%) in both large (3rd-to 6th-generation) and small (7th-to 9th-generation) airways. Furthermore, the animal study showed a significant reduction in the amount of SM in BT-treated large airways but not in untreated small airways. Protein gene product 9.5 (PGP9.5)–positive nerves and muscarinic receptor 3 (M3 receptor) expression in large and small airways were both markedly decreased throughout the airway wall 12 weeks after BT treatment. Conclusions BT significantly reduced nerves, but not SM, in small airways, which might shed light on the mechanism of lung denervation by BT.

Introduction: The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has long affected millions of individuals across the globe. Historically, the prevalence of this disease is particularly noted within the African continent. Before the coronavirus disease 2019 (COVID‐19) pandemic, many African countries struggled to effectively manage the increasing burden associated with HIV/AIDS. There is now a need to reassess this in a COVID‐19 pandemic context so that the impact of COVID‐19 on HIV/AIDS healthcare within Africa can be adequately evaluated. Methods: Data collection was performed on the PubMed, Ovid MEDLINE and Embase bibliographical databases with a predefined search strategy. Searches were performed in blind duplicate and all articles considering COVID‐19 and HIV/AIDS within African healthcare were considered. Results: The COVID‐19 pandemic has severely exacerbated the many issues surrounding HIV/AIDS care within many African countries. These impacts are noticeable in medical, psychological, and socio‐political contexts. Conclusions: Before efforts are made to improve the provision of HIV/AIDS and COVID‐19 care within Africa, it is important that this issue is brought to the attention of the scientific and clinical community so that the continent can receive the necessary support and aid.

Aim of the work To evaluate the relationship between medication adherence, serum uric acid (SUA) levels, and diet, with recurrent gout attacks. Patients and methods This study included 89 patients being followed up for gouty arthritis. A self-administered, structured questionnaire was used to collect socio-demographic data, gout attacks frequency, history of acute intake of purine rich foods prior to the gouty attack, and adherence to urate-lowering therapies (ULT). Results 89 patients were studied, 84 males and 5 females with a mean age of 55.4 ± 13.7 years, disease duration 12.22 ± 9.2 years and body mass index 24.67 ± 5.01. 71.9% were Malays, 20.2% Chinese, 6.7% Indians and 1.1% others. 61.8% had at least one episode of gout flare in the past 6 months. Of the 86 taking ULT, 65 (75.6%) were adherent. There was no difference in clinical characteristics between those who had high versus low adherence. High adherence to ULT was not associated with lower SUA or not having recurrent gout attacks. Having a high SUA level [OR = 2.86 (95%CI:1.52–5.39)], acute intake of purine-rich foods [OR = 2.01 (95%CI:1.09–3.73)] and obesity [OR = 1.58 (95%CI:1.09–2.32)] were significantly associated with recurrent gout attacks. Conclusions Although three-quarters of patients were adherent to their ULT, it was not associated with a reduction in recurrent gout attacks or lower SUA levels. Recurrent gout attacks were associated with a high SUA and an acute intake of purine-rich foods. To reduce the burden of recurrent gout attacks, ULT may need to be intensified even in adherent patients, as well as avoiding dietary indiscretions.

Aim of the work: To compare clinical aspects, disease activity, spinal mobility, and radiographic findings between ankylosing spondylitis (AS) and axial psoriatic arthritis (axPsA) patients Patients and methods: Fifty-eight AS and 42 axPsA patients were enrolled. Patients were assessed by clinical examination, spinal mobility measurements, and conventional radiographs of the sacroiliac joints, lumbosacral and cervical spines. Bath.AS Metrology Index (BASMI) and modified Stoke AS Spinal Score (mSASSS) were measured. Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index score and AS Disease Activity Score (ASDAS) were assessed. Results: The mean age of AS and AxPsA patients were comparable (37.2 ± 11.2 years vs 39.6 ± 13.3 years;p = 0.33) and male:female was 2.63 vs 0.24:1 (p

Introduction: The Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) syndrome is a rare autoinflammatory disease. The clinical presentation is heterogeneous, hence the difficulty of making the diagnosis. Aim of the work: To assess clinical, laboratory parameters and radiological features, and to detail the therapeutic options of SAPHO syndrome. Patients and methods: Patients diagnosed with SAPHO syndrome were retrospectively studied from two rheumatology centres in Tunisia. The epidemiological, clinical, radiological, and therapeutic data were collected from patients’ medical records. Results: Twenty-three patients were enrolled. The mean age was 44.7 ± 16.9 years (14–76 years). Skin involvement was found in a third of patients. Osteoarticular manifestations involved anterior chest wall damage in 56% of cases and axial skeletal lesions in 93% of patients. Ten (43%) patients had peripheral joint involvement, and one reported bone pain in the forearm. HLA-B27 was positive in a third of the patients. All patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) with variable clinical responses. Antibiotic therapy with doxycycline was prescribed in 3 cases, with no clinical improvement. Sulfasalazine was used in 4 cases after therapeutic failure of NSAIDs. Methotrexate was prescribed in 4 cases. Tumor necrosis factor (TNF) inhibitors (Etanercept) were provided for 2 with a good clinical response, and were planned for two others. Pamidronate was given to a patient with bone involvement with pain relief and clinical improvement. Conclusion: Patients with SAPHO were relatively young. Skin lesions were not common. The involvement of the anterior chest wall and the axial skeleton was predominant.

Atopic dermatitis (AD) is a heterogenous disorder and can be classified into different types. Stratification of subtypes may enable personalized medicine approaches. AD can be categorized into the IgE-high, extrinsic subtype and the IgE-normal, intrinsic subtype. While extrinsic AD is the major subtype possessing skin barrier impairment (high incidence of filaggrin mutations), intrinsic AD occupies about 20% of AD with female dominance and preserved barrier. Extrinsic AD exhibits protein allergy and food allergy, but intrinsic AD shows metal allergy possibly in association with suprabasin deficiency. In particular, accumulated knowledge of food allergy has more clearly characterized extrinsic AD. European American (EA) and Asian AD subtypes have been also proposed. Asian patients with AD are characterized by a unique blended immune dysregulation and barrier feature phenotype between EA patients with AD and those with psoriasis. In another ethnic study, filaggrin loss-of-function mutations are not prevalent in African American patients with AD, and Th1/Th17 attenuation and Th2/Th22 skewing were seen in these patients. Recent endotype classification provides new insights for AD and other allergic disorders. Endotype is defined as the molecular mechanisms underlying the visible features/phenotype. Endotype repertoire harbors activation of type 2 cytokines, type 1 cytokines, and IL-17/IL-22, impairment of epidermal barrier, and abnormalities of intercellular lipids. Classification of endotype has been attempted with serum markers. These lines of evidence indicate a need for personalized or precision medicine appropriate for each subtype of AD.

Second-generation COVID-19 vaccines could contribute to establish protective immunity against SARS-CoV-2 and its emerging variants. We developed COH04S1, a synthetic multiantigen modified vaccinia Ankara-based SARS-CoV-2 vaccine that co-expresses spike and nucleocapsid antigens. Here, we report COH04S1 vaccine efficacy in animal models. We demonstrate that intramuscular or intranasal vaccination of Syrian hamsters with COH04S1 induces robust Th1-biased antigen-specific humoral immunity and cross-neutralizing antibodies (NAb) and protects against weight loss, lower respiratory tract infection, and lung injury following intranasal SARS-CoV-2 challenge. Moreover, we demonstrate that single-dose or two-dose vaccination of non-human primates with COH04S1 induces robust antigen-specific binding antibodies, NAb, and Th1-biased T cells, protects against both upper and lower respiratory tract infection following intranasal/intratracheal SARS-CoV-2 challenge, and triggers potent post-challenge anamnestic antiviral responses. These results demonstrate COH04S1-mediated vaccine protection in animal models through different vaccination routes and dose regimens, complementing ongoing investigation of this multiantigen SARS-CoV-2 vaccine in clinical trials.

Background Higher prevalence of fibromyalgia (FM) among chronic hepatitis-C virus (HCV) suspects virally-mediated pathway. Aim of the work To determine the frequency and clinical characteristics of FM in Egyptian patients with chronic HCV and to evaluate its relationship to viral load. Patients and methods 150 Egyptian patients with chronic HCV and 150 controls were included. Liver function tests, thyroid stimulating hormone (TSH), HCV antibodies, HCV-ribonucleic acid (RNA) and abdominal ultrasonography were done. FM was diagnosed according to 2010 American College of Rheumatology (ACR) classification criteria. Results The mean age of the patients was 54.1 ± 8.4 years and they were 94 females: 56 males; and the mean duration of HCV was 6.9 ± 3.2 years. Fatigue, arthralgia, arthritis, morning stiffness, weakness, sicca-like symptoms, depression, cognitive, sleep disturbances and irritable bowel syndrome (IBS) were significantly more frequent in HCV patients. Twenty six patients with HCV (17.3%) and 4 (2.7%) of the controls had FM. HCV patients with FM had significantly higher widespread pain index, symptom severity score, visual analogue scale (VAS), tender points count and stiffness than controls with FM. HCV patients with FM had significant higher VAS score, fatigue and depression than without FM. Rates of hematological features, autoantibodies, liver enzymes, abdominal US findings, patients with viral load > 800,000 IU/L were comparable. Conclusion There is increased rate of fibromyalgia in chronic HCV patients and is associated with higher pain intensity, tender point count, symptom severity and fatigue. FM in patients with HCV infection is not related to viral load of HCV.

Background Cystic fibrosis (CF) is a genetic condition that affects multiple organ systems. Allergic bronchopulmonary aspergillosis (ABPA) is a well‐recognised problem but other allergic conditions are less well documented in CF. Objective To characterise the allergic profile of a cohort of children with CF, with a focus on those with ABPA. Methods A cohort of children with CF were interviewed and retrospective data were collected regarding their allergic histories and other relevant clinical features. Results The cohort included 37 children with median age of 9 years (interquartile range: 6‐12). There was a history of ≥1 allergic condition(s) in 28/37 children (76%). The most common allergic condition was allergic rhinitis (AR) in 21/37 (57%) and 16 of these 21 children (76%) had another allergic condition. All children with ABPA (8) had another allergic condition. In some children ABPA exacerbations appeared to be seasonal, suggesting possible cross‐sensitisation between Aspergillus fumigatus and aeroallergens associated with seasonal AR. Allergic conditions were also common in children with Pseudomonas aeruginosa infection., “Example allergic timelines for children with CF”

Background The effect of low‐level pretransplant donor‐specific antibody (DSA) on kidney transplant outcomes is not well described. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pretransplant DSA. Methods We retrospectively reviewed all adult kidney transplant recipients who had undergone a transplant at our center between January 2013 and May 2017. Patients were grouped as negative DSA (mean fluorescence intensity, [MFISUM 1000). Rejection, infection, graft, and patient survival were outcomes measured. Results Of 952 patients, 82.1% had negative DSA, 10.7% had low‐level DSA, and 7.1% had positive DSA. The positive DSA group had the highest rate of antibody‐mediated rejection (10.3%), followed by low‐level DSA (7.8%) and the negative DSA group (4.5%) (p = .034). The rate of BK viremia was highest in the positive DSA group (39.7%), followed by the low‐level group (30.4%) and the negative DSA group (25.6%), (p = .025). None of the other outcomes, including graft or patient survival, were different between the groups. Conclusion While low‐level DSA should not prevent proceeding with kidney transplantation, it should not be ignored. Future studies are needed to investigate the long‐term effects of varying levels of pre‐transplant DSA on outcomes., The presence of pretransplant donor‐specific antibody (DSA) represents a significant barrier to kidney transplantation for highly sensitized patients as they are less likely to undergo transplants compared with their nonsensitized counterparts. The goal of this study was to compare outcomes among patients of varying immunologic risk, based on the level of pre‐transplant DSA. The positive DSA group had the highest rate of antibody‐mediated rejection (10.3%), followed by low‐level DSA (7.8%) and the negative DSA group (4.5%) (p = .034). Also, the rate of BK viremia was highest in the positive DSA group (39.7%), followed by the low‐level group (30.4%) and the negative DSA group (25.6%), (p = .025).

Uveitis is the most common ophthalmological disorder in the field of rheumatology, accounting for a significant proportion of visual morbidity, both locally and internationally. Causative factors can be divided into infectious and noninfectious etiologies. The diagnosis of uveitis is a major challenge due to heterogeneity in presentation. The disease course may be acute monophasic, recurrent, or chronic relapsing. Complications include posterior synechiae, secondary cataract, ocular hypertension or glaucoma, macular edema, retinal vascular occlusion, epiretinal membrane, and so on, and ultimately visual loss. Antimicrobial therapy is indicated for infection, whereas noninfectious uveitis warrants a combination of steroids, immunosuppressives, and anti-inflammatory agents. With the advancement of biologics, treatment strategies in chronic, noninfectious uveitis have had multiple breakthroughs, particularly in treatment-resistant cases. This article provides a review of the diagnostic approach to uveitis based on symptomatology and ophthalmological findings, and discussion of relevant treatment modalities and strategies.

Introduction The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram‐negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings. Methods Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends. Results A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: −3.3% [95% confidence interval: −5.0, −1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165). Conclusion These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs., Over a 10‐year period, Gram‐negative rod bacteremia (GNRB) incidence and the proportion of GNRBs treatment time spent outpatient declined significantly. However, among patients with similar posttransplant complications, no decline in outpatient treatment was observed. This suggests that the decline in outpatient antibiotic days may be linked to increased frequency of posttransplant complications.

Introduction Patients with chronic underlying diseases are more susceptible to coronavirus disease 2019 (COVID‐19) complications. Recent studies showed people living with HIV (PLWH) are not at greater risk than the general population. Few studies have reviewed the impacts of COVID‐19 on PLWH. The purpose of this systematic review was to investigate the impact of COVID‐19 on patients infected with HIV. Methods We executed a systematic search using four databases of PubMed, Scopus, Science Direct, and Web of Science and screened the records in two steps based on their title/abstract and full text. This study follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist to elevate the validity and reliability of its results. Results We reviewed 36 studies. The patients' age was above 20 years in all studies. In almost all studies, the inflammatory parameters were reported high. In most of the studies, all HIV patients completely recovered from the COVID 19 infection. Although CD4 count was not recorded in all studies, the minimum level was reported as 12 cells/µl. Conclusion Based on the current review, we concluded that HIV patients at advanced stages (3 or 4) of the disease, whose CD4 counts are low, may show less severe COVID‐19 infection symptoms. Similarly, Interference can reduce the severity of immune reactions and subsequent cytokine storms and consequently mitigate the symptoms. Therefore, in most of the studies, the majority of HIV patients showed no severe symptoms and completely recovered from COVID 19 infection.

Introduction Obesity has been reported as a risk factor for COVID‐19 prognosis. However, the long‐term effects of obesity on patients discharged from the hospital are unclear, and the present study aims to address this issue. Methods A cohort study was conducted using data from patients diagnosed with COVID‐19 who were discharged from Wuhan Union Hospital between February 20, 2020, and March 20, 2020. The 118 patients with COVID‐19 were divided into the non‐obesity group and the obesity group according to their body mass index (BMI). All the patients were invited to fill out a series of scales to assess cardiopulmonary function. Data on population baseline characteristics, clinical manifestations, laboratory examinations, chest computed tomography (CT), and lung function were collected and analyzed. Results The clinical manifestations and pathological changes on CT images of obese patients were more serious after discharge than those of non‐obese patients. In addition, we found significant abnormalities in metabolic indicators such as blood lipids, uric acid, and liver function in obese patients. Most importantly, the antibody titer of COVID‐19 obese patients was inversely correlated with BMI. Conclusion In the long term, obesity affects clinical manifestations, immune function and endocrine metabolism in patients discharged after recovering from COVID‐19., In the long term, obesity affects clinical manifestations, immune function, and endocrine metabolism in patients discharged after recovering from COVID‐19.

Background Recent studies have revealed that circular RNA participates in endometrial carcinoma (EC) progression. Here we investigated the role of circRNA zinc finger protein 124 (circZNF124) in EC genesis and underlying mechanism. Methods The expression levels of circZNF124, microRNA‐199b‐5p (miR‐199b‐5p) and solute carrier family 7 member 5 (SLC7A5) were detected by quantitative real‐time polymerase chain reaction. The expression of SLC7A5 and other indicated marker proteins was determined by western blot analysis. For functional assay, cell proliferation, leucine uptake and metastasis were investigated by total cell number, cell counting kit‐8, cell colony formation, leucine uptake or transwell assay. The interaction between miR‐199b‐5p and circZNF124 or SLC7A5 was predicted by starbase online database, and identified by mechanism assays. The impact of circZNF124 absence on tumor growth in vivo was revealed by xenograft mouse model assay. Immunohistochemistry assay was implemented to detect the positive expression rate of nuclear proliferation marker (Ki67). Results CircZNF124 and SLC7A5 expression were significantly increased, while miR‐199b‐5p was decreased in EC tissues and cells compared with normal endometrial tissues or cells. CircZNF124 expression was closely associated with EC severity and lymph node metastasis. Additionally, circZNF124 depletion repressed cell proliferation, leucine uptake, migration and invasion in both HEC1A and Ishikawa cells. CircZNF124 regulated SLC7A5 expression by binding to miR‐199b‐5p. MiR‐199b‐5p inhibitors or SLC7A5 overexpression attenuated circZNF124 silencing‐mediated EC malignant progression. Furthermore, SLC7A5 absence inhibited tumor growth in vivo. Conclusion CircZNF124 depletion inhibited EC cell malignancy by miR‐199b‐5p/SLC7A5 pathway, which demonstrated that circZNF124 had the potential as a therapeutic target for EC., CircZNF124 expression was related to severity of EC and lymph node metastasis. CircZNF124 silencing inhibited EC tumorigenesis by hindering leucine uptake through miR‐199b‐5p/SLC7A5 axis. This study demonstrates that circZNF124 can be employed as a diagnosis biomarker and circZNF124 inhibitors may be used as an anticancer drug for EC.

Solid organ transplant recipients are at increased risk of acquiring devastating infections with unusual pathogens. Nocardia are aerobic actinomycetes that affect the lungs, brain, skin and soft tissue. Cladophialophora species are dematiaceous fungi that overwhelmingly cause infections in the brain. Both organisms carry a high mortality rate. We present the first reported renal transplant case with Cladophialophora bantiana involving the renal allograft with concurrent invasive nocardiosis involving the lungs and brain.

Introduction Programmed death 1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) inhibitors are proved to be promising and are applied for the treatment of a variety of solid tumors. This retrospective study evaluated the efficacy of PD‐1/PD‐L1 inhibitors in patients with advanced solid tumors and explore the effect of clinical characteristics on it. Materials and Methods From October 2017 to April 2020, a total of 90 patients from Capital Medical University Affiliated Beijing Friendship Hospital were enrolled. Results At a median follow‐up of 10.55 months, objective response was observed in 23 patients and the objective response rate was 25.6%. The median progression‐free survival (PFS) was 5.5 months (95% confidence interval [CI], 3.69–7.37). The 6m‐PFS was 45.8% and 12m‐PFS was 25.1%. The median overall survival (OS) was 16.9 months (95% CI, not reached [NR]‐NR). The 12m‐OS was 58.1% and 18m‐OS was 48.1%. Conclusion The efficacy of PD‐1/PD‐L1 inhibitors in the treatment of advanced solid tumors was comparable to previous studies. ECOG performance status, smoking status, liver metastasis, neutrophil‐to‐lymphocyte ratio were independently correlated with PFS while liver metastasis and lactate dehydrogenase level were independently correlated with OS., we evaluate the efficacy of programmed death 1 (PD‐1)/programmed death‐ligand 1 (PD‐1/PD‐L1) inhibitors in patients with advanced solid tumors and explore the effect of clinical characteristics. ECOG status, smoking status, liver metastasis status, and NLR might predict the recurrence between PD‐1/PD‐L1 inhibitors treatment and liver metastasis, lactate dehydrogenase might predict the survival. This finding has great significance and value of the guidance for the application of immunotherapy.

Objectives The aim of this study was to evaluate the expression of GCDFP15 and GATA‐binding protein 3 (GATA‐3) in extramammary Paget's disease (EMPD) skin and serum samples and to assess their availability as tumor markers for the diagnosis and assessment of disease severity in primary EMPD. Methods Skin samples and serum samples were obtained from 16 patients with primary EMPD (10 cases from male, six cases from female; stage IA six cases, stage IB seven cases, stage III one case, stage IV two cases). By immunohistochemistry, the expression of GCDFP15 and GATA3 was examined in skin specimens. The serum levels of GCDFP15 and GATA3 were quantified by ELISA. Results In our study, eight out of 16 patients showed positive staining for GCDFP15. In contrast, all 16 patients showed positive staining for GATA‐3. Immunohistochemical staining of EMPD skin samples showed that GATA‐3 had a higher positivity rate than GCDFP15. However, there was no correlation between serum levels of GCDFP15 or GATA‐3 and the disease stage. Conclusion Our results indicate that GCDFP15 and GATA‐3 are useful for the diagnosis of primary EMPD, but not for monitoring disease progression, and suggest that GATA‐3 is a more reliable marker than GCDFP15 for the diagnosis of primary EMPD.

Background T helper 17 (Th17) cells actively participate in the tumor immune response in lung cancer. However, the heterogeneity and plasticity of intratumoral Th17 cells in lung cancer remain elusive. In this study, Th17 subpopulations were characterized in a mouse lung cancer model. Methods Urethane was administered to induce lung cancer in interleukin (IL)‐17‐EGFP transgenic mice. Flow cytometry was used to analyze the phenotypes, signaling status, and functions of Th17 subpopulations either in vivo or in vitro. The adoptive transfer assay and real‐time polymerase chain reaction were applied to analyze the plasticity of Th17 subpopulations. Results IL‐6RαhighCD27− Th17 and IL‐6RαlowCD27+ Th17 were identified in intratumoral Th17 cells. The two subpopulations expressed equivalent RORγt. However, the former expressed higher T‐bet but lower Foxp3, more IL‐17A and IFN‐γ but less IL‐10 than the latter. Furthermore, IL‐6RαhighCD27− Th17 moderately inhibited the proliferation of lung cancer cells while IL‐6RαlowCD27+ Th17 could not. IL‐6RαhighCD27− Th17 exhibited weaker Jun N‐terminal kinases (JNK) signaling but stronger signal transducer and activator of transcription 3 (Stat3) signaling than IL‐6RαlowCD27+ Th17. The adoptive transfer assay indicated that both subpopulations downregulated RORγt in recipients' spleens but maintained RORγt in recipients' lungs. Meanwhile, IL‐6RαhighCD27− Th17 expressed higher T‐bet and IFN‐γ than IL‐6RαlowCD27+ Th17 in the recipients. IL‐6RαlowCD27+ Th17 expressed Foxp3 and IL‐10 in recipients' spleens but not lungs. Conclusions This study reveals intratumoral Th17 subpopulations with distinct functional properties and signaling patterns, thus offering valuable insight into Th17 heterogeneity and plasticity in lung cancer., IL‐6RαhighCD27− Th17 and IL‐6RαlowCD27+ Th17 cells differentially express master regulators key to T helper cell polarization, as well as cytokines crucial for tumor immunity.

Objectives It has been known that the use of moisturizers is useful in preventing the onset and maintaining remission of atopic dermatitis (AD). We recently focused on the moisturizing effect of natural mineral dissolved water and have conducted various studies. In this study, we investigated whether the bath treatment using natural mineral dissolved water can improve dry skin in AD patient in prospective nonblind, nonrandomized controlled study. Methods Thirteen adults with almost clear to moderate AD took bath therapy using tap water for 13 days, followed by bath therapy using natural mineral dissolved water for 13 days. Changes in the severity scoring, patient‐oriented eczema measure, pruritus numerical rating scale, transepidermal water loss (TEWL) and hydration were evaluated at day1, 14 and 28. Results Tap water using bath treatment did not change the severity scoring and itch associated score, and it partially decrease TEWL when compared with baseline condition. Bath treatment using natural mineral dissolved water slightly decrease eczema area and severity index (EASI) score and significantly decrease TEWL with respect to baseline condition. Moreover, in relatively severe AD analysis, bath treatment with mineral dissolved water significantly decreased EASI and TEWL. Conclusions Based on these results, bathing with natural mineral dissolved water may be effective in improving the dry skin of atopic dermatitis. Further studies are needed to evaluate its effects more clearly.

Background Milk protein allergy is one of the most common food allergies in infants. We aimed to test whether fecal calprotectin can be used to monitor food allergies in infants by comparing the fecal calprotectin levels in infants with a milk protein allergy before and after an intervention treatment. Methods The study was designed as a prospective case–control trial. Stool samples were collected at follow-up, and the concentration of fecal calprotectin was determined using an enzyme-linked immunosorbent assay. The infant’s weight and length were measured. Results The allergic group comprised 90 milk-allergic infants (41 boys, 49 girls), and the nonallergic group comprised 90 nonallergic infants (51 boys, 39 girls). Compared with the fecal calprotectin level in the nonallergic group (median: 141 μg/g), that in the allergic group (median: 410 μg/g) was significantly higher (z = − 9.335, p p p p p = 0.01 and Spearman’s rho = − 0.193, p = 0.03, respectively). Conclusion The level of fecal calprotectin in infants with a milk protein allergy decreased after dietary intervention and seems to be a promising biological indicator for monitoring intestinal allergies.

Introduction We report the case of a 65‐year‐old Coronavirus disease 2019 (COVID‐19) patient with pneumonia and subsequent end‐stage pulmonary failure who required 63 days of mechanical ventilation (MV) and 62 days of extracorporeal membrane oxygenation (ECMO). Methods On Day 45, a comprehensive interdisciplinary discussion on the best course of treatment resulted in the general consensus that his lungs would not recover. As such, he was evaluated and listed for a lung transplant. Results We performed a bilateral lung transplant, and the patient was weaned off ECMO and MV postoperatively. This is the first report of lung transplants in patients with COVID‐19 in Wuhan. Conclusions We suggest that a lung transplantation may be a viable treatment for patients with end‐stage pulmonary failure secondary to COVID‐19 in selected situations., Lung transplantation provided an opportunity for this very severe selected patient a chance to survival, which is meaningful

The treatment of bone metastases is a thorny issue. Immunotherapy may be one of the few hopes for patients with unresectable bone metastases. Immune checkpoint inhibitors are the most commonly used immunotherapy drugs currently. In this review, the characteristics and interaction of bone metastases and their immune microenvironment were systematically discussed, and the relevant research progress of the immunological mechanism of tumor bone metastasis was reviewed. On this basis, we expounded the clinical application of immune checkpoint inhibitors for bone metastasis of common tumors, including non-small-cell lung cancer, renal cell carcinoma, prostate cancer, melanoma, and breast cancer. Then, the deficiencies and limitations in current researches were summarized. In-depth basic research on bone metastases and optimization of clinical treatment is needed.

Periodontitis is a globally prevalent disease that imposes a functional and aesthetic burden on patients. The oral microbiome influences human health. The aim of this study was at assessing gender variation in the subgingival bacterial microbiome of elderly patients with initial periodontitis and to determine the causes of this variation. Twelve males and twenty females (range 50–68 years old) with initial periodontitis provided subgingival plaque samples. 16S rRNA gene sequencing, QIIME-based data processing, and statistical analyses were carried out using several different analytical approaches to detect differences in the oral microbiome between the two groups. Males had higher Chao1 index, observed species, and phylogenetic diversity whole tree values than females. Analysis of β-diversity indicated that the samples were reasonably divided by the gender. The linear discriminant analysis effect size showed that the most representative biomarkers were the genus Haemophilus in males, whereas the dominant bacteria in females were Campylobacter. Kyoto Encyclopedia of Genes and Genomes analysis showed that predicting changes in the female oral microbiota may be related to the immune system and immune system diseases are the main factor in males. These data suggest that gender may be a differentiating factor in the microbial composition of subgingival plaques in elderly patients with initial periodontitis. These results could deepen our understanding of the role of gender in the oral microbiota present during initial periodontitis.