Current Opinion in Rheumatology

This manuscript features the promising findings of a study conducted by Ju et al , who used graphene nanocomposites for air disinfection in dental clinics. Their study demonstrated that, compared with conventional filters, graphene nanocomposites substantially improved air quality and reduced microbial contamination. This manuscript highlights the innovative application of graphene materials, emphasizing their potential to enhance dental clinic environments by minimizing secondary pollution. On the basis of the unique antimicrobial properties of graphene and the original study’s rigorous methodology, we recommend using graphene nanocomposites in clinical settings to control airborne infections.

BACKGROUND Since the advent of the 20th century, alongside the progression of medical science and technological advancements, immunotherapy has emerged as a pivotal therapeutic approach for tumor patients subsequent to undergoing radiotherapy and chemotherapy. Arimab (camrelizumab), a flagship drug in the realm of immunotherapy, functions as a monoclonal antibody specifically targeting the programmed death protein 1 (PD-1). This drug engages with the human PD-1 receptor, effectively inhibiting the PD-1/programmed death ligand 1 signaling pathway. This inhibition results in the restoration of T cell activity and the induction of an anti-tumour response. However, it is noteworthy that such interference could lead to immune-related adverse events resembling autoimmune reactions. The growing availability and clinical use of immune checkpoint inhibitors have raised significant clinical concerns regarding their safety. Numerous instances of immune-related adverse reactions and the associated management strategies have been extensively reported. Timely identification and diagnosis, coupled with multidisciplinary consultation and the prompt administration of immunosuppressants, can effectively address severe immune-related adverse reactions. CASE SUMMARY Arimab (camrelizumab), a monoclonal antibody targeting programmed death protein 1 (PD-1), disrupts the PD-1/ programmed death ligand 1 (PD-L1) interaction, reactivating T cell function and triggering anti-tumor immunity. However, this disruption may trigger immune-mediated adverse events akin to autoimmune disorders. Approximately 2.8% of such events manifest as immune-related dermatologic reactions, with 0.7% classified as grade 3, which are infrequently documented. Here, this study describes a case of grade 3 bullous dermatitis occurring 15 days after initiating camrelizumab therapy. The patient, a 67-year-old male with oesophageal squamous cell carcinoma, received camrelizumab plus paclitaxel alongside chemotherapy and radiotherapy in early 2022. Due to disease progression, maintenance monotherapy with camrelizumab (200 mg) commenced in June 2022. On the fourth cycle, 15 days into treatment, the patient presented with an immune-checkpoint inhibitor-related rash, despite unremarkable test results. Dermatology and pharmacy consultations were conducted, leading to glucocorticoid therapy, topical interventions, and supportive care. Gastric mucosal protection, nutritional supplementation, and other adjunctive treatments were also provided. The patient's symptoms resolved within 15 days post-discharge, resulting in discontinuation of camrelizumab. Like other PD-1 inhibitors, camrelizumab is associated with immune-mediated dermatitis. Thus, optimal management of these events requires a multidisciplinary approach, vigilant monitoring, regular evaluations, prompt glucocorticoid administration, and specialized dermatologic care. CONCLUSION The increasing adoption of immune checkpoint inhibitors in clinical practice has prompted substantial concerns about their safety profile. A wide range of immune-related adverse events and corresponding management strategies have been well-documented. Early recognition and accurate diagnosis, combined with interdisciplinary collaboration and swift initiation of immunosuppressive therapy, are essential in managing severe immune-related adverse reactions effectively. This report details the treatment trajectory and outcome of a case involving immune-related cutaneous adverse reactions, providing pertinent clinical insights for future cases.

Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs. Interleukin-6 (IL-6) is a significant component of the inflammatory response as part of the pathogenesis of sepsis. It aids in the development of Acute lung injury and, subsequently, multiple organ dysfunction syndrome. This letter probes into the correlation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis. While it shows promising results, limitations like its observational study design, a limited sample size, a single center involvement, single-time-point measurement, and a lack of a control group restrain its cogency. The study is a big step in identifying IL-6 as a biomarker to improve patient care.

BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients, typically managed with insulin infusion. However, the occurrence of transient extreme insulin resistance (EIR) requiring exceptional high-dose insulin is rare. CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest, subsequently developing transient EIR following a new episode of sepsis. Remarkably, insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour (a total of 18224 units on that day), and it was promptly titrated down to zero upon achieving the target glucose level. CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR, which is typically transient. Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.

BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation. This case report highlights a unique manifestation of OHSS involving pleural effusion (PE) in a patient without identifiable risk factors. CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization (IVF) cycle experienced dyspnea on the eleventh day of post oocyte retrieval. The diagnosis was severe OHSS with a unique manifestation of PE without ascites. Clinical management involved fluid balance and treatment with albumin, furosemide, thromboembolic prophylaxis, and thoracentesis. A continued drainage of the pleural cavity was performed. The patient had a favorable outcome, and a dichorionic diamniotic gestation passed without incident. CONCLUSION OHSS and its potential complications can include respiratory distress and PE, as well as thromboembolic disorders.

BACKGROUND Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease characterized by nonspecific symptoms such as fever, rash, sore throat and arthralgia. This paper reports a clinical case of AOSD successfully treated with Bo’s abdominal acupuncture (BAA). CASE SUMMARY We report a 20-year-old man who suffered from cold exposure, presenting with high fever, rash, sore throat, arthralgia, and elevated erythrocyte sedimentation rate, leukocytosis with neutrophilic predominance, elevated ferritin, elevated C-reactive protein, and negative rheumatoid factors. He was diagnosed with AOSD based on the Yamaguchi criteria. After treatment with traditional Chinese medicine (TCM) decoction and prednisone acetate tablets, there was some alleviation of sore throat, joint and muscle pain, and fever, but he still had persistent low-grade fever, rash, sore throat and arthralgia. He went to the TCM acupuncture outpatient department to receive BAA. Abdominal acupoints Zhongwan (CV12), Xiawan (CV10), 0.5 cm below Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), bilateral Qixue (KI13), bilateral Huaroumen (ST24), bilateral Shangfengshidian (AB1) and bilateral Daheng (SP15) were selected. After 3 months treatment, all symptoms disappeared, and the laboratory examination returned to normal levels. He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards, and no relapse was observed during the 3-year follow-up period. CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.

BACKGROUND The root of mesentery dissection is one of the critical maneuvers, especially in borderline resectable pancreatic head cancer. Intra-abdominal chyle leak (CL) including chylous ascites may ensue in up to 10% of patients after pancreatic resections. Globally recognized superior mesenteric artery (SMA) first approaches are invariably performed. The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study. AIM To assess incidence, risk factors, clinical impact of CL following root of mesentery dissection, and the different treatment modalities. METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreatoduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1, 2021 to February 28, 2024. Intraoperative findings and postoperative outcomes were analyzed. RESULTS In three years, ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy. The mean age was 67.6 years with a male-to-female ratio of 4:5. CL was seen in four patients. With virtue of CL, Clavien-Dindo grade II or higher morbidity was observed in four patients. Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement. The mean operative time was 330 minutes. Curative resection was achieved in 100% of the patients. The mean duration of the intensive care unit and hospital stay were 2.55 ± 1.45 days and 15.7 ± 5.32 days, respectively. CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL. After complete curative resection, these were managed with total parenteral nutrition without adversely impacting outcome.

BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etiologies with negative cerebrospinal fluid (CSF) bacterial culture. The most common etiologies are viruses [enteroviruses, arboviruses, and herpes simplex virus type 2 (HSV-2)]. Aseptic meningitis can have various presentations, including sensorineural deafness. While sensorineural deafness from mumps meningoencephalitis has been reported, cases of HSV-2-induced hearing loss are rare. Herein, we report a case of HSV-2-induced meningitis that presented with sudden deafness. CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day. Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss (thresholds 80-90 dB). After treatment with high-dose steroids for 1 week, he experienced an acute consciousness change with left hemiparesis. The laboratory data showed no significant abnormalities. Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemorrhage or obvious brain lesion. The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity. Hence, under the diagnosis of herpes meningoencephalitis, acyclovir was prescribed and his symptoms gradually resolved. CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm (UAP), as well as an analysis of UAP etiology. This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures. The patient underwent timely relevant examinations to confirm the diagnosis, allowing for crucial time required for her treatment. In this study, the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility, suggesting that the selection and implementation of dilatation catheters are some of the predisposing factors for UAP. In conclusion, this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment, offering valuable insights for the clinical diagnosis and management of UAP.

Concerns about air quality in dental clinics where aerosol generation during procedures poses significant health risks, have prompted investigations on advanced disinfection technologies. This editorial describes the strengths and limitations of ventilation and aerosol control measures in dental offices, especially with respect to the use of graphene nanocomposites. The potential of graphene nanocomposites as an innovative solution to aerosol-associated health risks is examined in this review due to the unique properties of graphene (e.g. , high conductivity, mechanical strength, and antimicrobial activity). These properties have produced promising results in various fields, but the application of graphene in dentistry remains unexplored. The recent study by Ju et al which was published in World Journal of Clinical Cases evaluated the effectiveness of graphene-based air disinfection systems in dental clinics. The study demonstrated that graphene-based disinfection techniques produced significant reductions in suspended particulate matter and bacterial colony counts, when compared with traditional methods. Despite these positive results, challenges such as material saturation, frequency of filter replacement, and associated costs must be addressed before widespread adoption of graphene-based disinfection techniques in clinical practice. Therefore, there is need for further research on material structure optimization, long-term safety evaluations, and broader clinical applications, in order to maximize their positive impact on public health.

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies, with more than 80% of children with cancer who have access to contemporary treatment being cured. However, the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes, referred to as late effects, which appear months to years after the completion of cancer treatment. Research has shown that 60% to 90% of childhood cancer survivors (CCSs) develop one or more chronic health conditions, and 20% to 80% of survivors experience severe or life-threatening complications during adulthood. Therefore, understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

In this editorial, we comment on a recent article by Chen et al , that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section. Poor management of post-cesarean pain is associated with decreased maternal care for the baby, longer hospitalization, and higher risk of developing postpartum depression. Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies. However, due to its potential adverse effects on the neurological and hemodynamic status of patients, it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain. Before any recommendation for routine perioperative use of esketamine, more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.

Foot reflexology (FR) is a Chinese-originated and non-invasive complementary therapy increasingly used by functional, alternative and para-medical professionals. Enhance attempts are made to study FR in non-functional organic conditions. The present invited Editorial discusses the application of FR in autoimmune diseases (AD), highlighting a few successful studies demonstrating symptomatic relief and objective improvements. Despite promising results, the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases, including AD, is highly recommended.

BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes, particularly in cases of intensive care unit (ICU)-acquired hypernatremia (IAH). Nevertheless, its relevance in patients with septic shock remains uncertain. AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock. METHODS In the present retrospective single-center study, a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University, between August 1, 2018, and May 31, 2023, were analyzed. Patients were categorized based on the timing of hypernatremia occurrence into the IAH group (n = 62), the non-IAH group (n = 41), and the normonatremia group (n = 54). RESULTS In the present study, there was a significant association between the high serum sodium concentrations, excessive persistent inflammation, immunosuppression and catabolism syndrome and chronic critical illness, while rapid recovery had an apparent association with normonatremia. Moreover, multivariable analyses revealed the following independent risk factors for IAH: Total urinary output over the preceding three days [odds ratio (OR) = 1.09; 95%CI: 1.02–1.17; P = 0.014], enteral nutrition (EN) sodium content of 500 mg (OR = 2.93; 95%CI: 1.13–7.60; P = 0.027), and EN sodium content of 670 mg (OR = 6.19; 95%CI: 1.75–21.98; P = 0.005) were positively correlated with the development of IAH. Notably, the area under the curve for total urinary output over the preceding three days was 0.800 (95%CI: 0.678–0.922, P = 0.001). Furthermore, maximum serum sodium levels, the duration of hypernatremia, and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients (P < 0.05). CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU. It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

This editorial discusses a case report recently published in the World Journal of Clinical Cases . The report describes the clinical presentation, imaging, diagnosis, and treatment of a patient with tuberous sclerosis complex (TSC) combined with primary lymphedema (PLE). Additionally, it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology, genetic diagnosis, and current main treatments of these patients. The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE. TSC combined with PLE is rare; therefore, the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE. Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations, often requiring a multidisciplinary approach for newly diagnosed cases.