Bicolor Tuning and Hyper-Reflective Color Switching Based on Two Stacked Cholesteric Liquid Crystal Cells with Asymmetric Electrothermal Optical Responses.

We propose a double-cell cholesteric liquid crystal (CLC) device composed of a left-handed (LH) CLC cell with a pair of sheet electrodes and a right-handed (RH) CLC cell with a tri-electrode configuration characterized by a sheet electrode on the top and an interdigitated electrode on the bottom substrates. Bi-reflected color tuning and hyper-reflective color switching are revealed from this cell stack via the electrothermal control of the central wavelengths of the LH- and RH-bandgaps by voltage-induced pseudo-dielectric heating. The two CLCs are thermally sensitive and exhibit overlapped bandgaps in the field-off state with nearly identical temperature dependence, resulting in a hyper-reflective color at 720 nm at 23.4 °C and 380 nm at 29.8 °C. Upon the application of 4 Vrms at 2 MHz across the stacked device to induce pseudo-dielectric heating, two reflective colors can be resolved due to asymmetrical temperature elevations. Accordingly, the difference in wavelength between the two colors increases with increasing voltage through a series cell connection, while maintaining approximately constant via a parallel connection. This study provides a feasible pathway to developing a multifunctional device with electrothermally tunable bi-reflected and hyper-reflective states based on two conventional cell geometries, which is promising for lasers and color-related display applications.

Electrochemically-assisted intensification of As(III) removal through integrated alkalization and oxidation process.

In response to the need for trace arsenic removal and detoxification, an electro-assisted self-alkalization and oxidant-free processes (ESOP) cell was developed and investigated. It was found that the ESOP removed 90.3 % of arsenic and reduced the As(III) concentration from 150 µg L-1 to less than 5 µg L-1 in its cathode chamber. The As removal involved migration of As(III) and As(V) from the cathode to the anode driven by electrical current. In the ESOP cathode, As(III) was dissociated to As(III) oxyanions via alkalization and then oxidized into As(V) by H2O2. Nearly 80 % of As(III) migration could be attributed to the oxidation by H2O2 and approximately 20 % dissociation by pH alkalization. The voltage-controlled conditions (1.2 -1.5 V) achieved a peak cumulative H2O2 concentration of 10.9 mg L-1. The ESOP demonstrated a high As(III) oxidation to As(V) conversion efficiency of 97.0 % as well as a low energy cost of 0.013 kWh m-3 at 1.2 V. The migrated arsenic was stabilized onto the anode electrode through in-situ electro-oxidation of As(III) and electrosorption of As(III, V); this would help with the post-treatment waste disposal. Those results have provided important insights into an electrochemical approach for highly efficient arsenic detoxification.

Prevalence and risk factors of non-tuberculous mycobacterial pulmonary isolates and infection in interstitial lung disease associated with systemic autoimmune disease.

OBJECTIVES: Non-tuberculous mycobacterial (NTM) lung disease (NTM-LD) prevalence is increasing worldwide. In this study, we aimed to evaluate the clinical significance of NTM pulmonary isolates (NTM-PI) and NTM-LD in patients with systemic autoimmune disease (SAD) who had a concurrent interstitial lung disease (ILD) diagnosis. METHODS: We retrospectively identified patients with SAD who had a concurrent ILD diagnosis (SAD-ILD) and from whom clinically indicated sputum specimens were collected for NTM culture between 2003 and 2018 at a tertiary referral hospital. We analysed the prevalence and risk factors of NTM pulmonary isolates (NTM-PI; ≥1 positive culture) and NTM-LD (≥2 positive cultures). RESULTS: This study included 258 patients. Rheumatoid arthritis and Sjögren's syndrome were the most common SADs (32.2% and 26.7%, respectively). The NTM-negative subgroup had 204 patients (79.1%) and the NTM-PI subgroup had 54 patients (20.9%). In the NTM-PI subgroup, 33 patients had one NTM positive set of specimens (NTM 1+, 12.8% of the entire sample) and 21 had NTM-LD (8.1% of the entire sample). In a multivariable analysis, chronic kidney disease (CKD; adjusted odds ratio [aOR]: 3.10 [1.53, 6.29]) and chronic obstructive pulmonary disease (COPD; aOR: 2.59 [1.16, 5.78]) were significantly associated with NTM-PI. For NTM-LD, CKD (aOR: 2.79 [1.00, 7.76]) and COPD (aOR: 3.70 [1.23, 10.72]) remained significant risk factors. CONCLUSIONS: In patients with SAD-ILD, the NTM-PI and NTM-LD prevalence rates were 20.9% and 8.1%, respectively. COPD and CKD were independent risk factors of both NTM-PI and NTM-LD. Previous use of biological agents was associated with NTM-PI.

Ossification of posterior atlantoaxial membrane causing spinal stenosis - A case report.

Background: Ossification of the posterior atlantoaxial membrane (PAAM) is a rare cause of spinal cord compression. Case presentation: A 46-year-old woman with rheumatoid arthritis (RA) and a 2-year history of slowly progressive gait disturbance underwent surgery for right knee stiffness and right lower limb mild weakness. A neurologic examination revealed brisk deep tendon reflexes (DTR) and spasticity in her four limbs. A computed tomography (CT) scan revealed spinal stenosis caused by ossification of the PAAM, a rare cause of spinal cord compression. The patient's lower limbs weakness and walking capability were ameliorated post-surgery. Conclusions: Although the exact mechanism of ossification of PAAM remains unclear, chronic mechanical stress as well as persistent atlantoaxial instability may promote the development of the ossification.

Relapsing autoimmune inner ear disease with significant response to methotrexate and azathioprine combination therapy: A case report and mini literature review.

RATIONALE: Autoimmune inner ear disease typically presents with bilateral hearing loss that progresses over weeks or months though its mechanisms are unknown. Corticosteroids are the first-line treatment, but their responses are variable and relapses are frequent. Thus, many experts have sought to replace corticosteroids with immunosuppressive agents. PATIENT CONCERNS: A 35-year-old woman experienced a progressive hearing impairment, initially on the left side and later becoming bilateral. Her response to corticosteroid monotherapy was temporary, and there have been two relapse episodes over several months. DIAGNOSES: Autoimmune inner ear disease was considered due to evidence of autoimmunity combined with a clinical course of bilateral and recurrent sensorineural hearing loss and a partial response to corticosteroid therapy. INTERVENTIONS: The patient received a 3-day mini-pulse of methylprednisolone at 250 mg/d, followed by 12 mg/d maintenance, and concurrently began an azathioprine regimen gradually increasing to 100 mg/day as a corticosteroid-sparing agent. OUTCOMES: Three weeks after immunosuppressive therapy, hearing and pure-tone audiometry improved, and after 7 weeks, methylprednisolone was tapered to 8 mg/d. The dosage was further reduced by adding methotrexate at 7.5 mg/week, resulting in a reduction to 4 mg/d as maintenance therapy after 4 weeks. LESSONS: For patients who are unresponsive to corticosteroids or experience difficulty tolerating them, a combination therapy of methotrexate and azathioprine is recommended as a viable alternative as this regimen is well-tolerated and yields positive outcomes.

Mirabegron is better tolerated than solifenacin in Sjogren's syndrome patients with overactive bladder symptoms-A randomized controlled trial.

OBJECTIVES: This study investigates the efficacy and adverse events of beta-3 agonists and antimuscarinic agents for managing overactive bladder syndrome in Sjogren syndrome. METHODS: Sjogren's syndrome patients with an Overactive Bladder Symptom Score (OABSS) >5 were enrolled and were randomly assigned to mirabegron 50 mg/day or solifenacin 5 mg/day. Patients were evaluated on the recruitment day and reassessed at Week 1, 2, 4, and 12. The study's primary endpoint was to have a significant change in OABSS at Week 12. The secondary endpoint was the adverse event and crossover rate. RESULTS: A total of 41 patients were included in the final analysis, with 24 in the mirabegron group and 17 in the solifenacin group. The study's primary outcome was a change of the OABSS at Week 12. We found that both mirabegron and solifenacin significantly reduce patients' OABSS after 12 weeks of treatment. The evolution of the OABSS was -3.08 for mirabegron and -3.71 for solifenacin (p = .56). Six out of 17 patients from the solifenacin group crossed over to the mirabegron arm due to severe dry mouth or constipation, while none from the mirabegron arm crossed over to the solifenacin group. Sjogren's syndrome-related pain was also improved in the mirabegron group (4.96-1.67, p = .008) compared to the solifenacin group (4.39-3.4, p = .49). CONCLUSIONS: Our study showed that mirabegron is equally effective as solifenacin in treating Sjogren's syndrome patients with overactive bladder. Mirabegron is superior to solifenacin in terms of treatment-related adverse events.

Optical and flexoelectric biosensing based on a hybrid-aligned liquid crystal of anomalously small bend elastic constant.

Liquid crystal (LC)-based biosensors rely on the response of the LC molecules to perturbation generated by analytes at the interface, leading to the susceptible change in molecular alignment or orientation. The sensitivity of these biosensors is primarily dependent on the LC's material properties and surface anchoring strength. By incorporation of an unconventional mesogenic compound (CB7CB) coupled with the hybrid-alignment cell configuration, this work presents a binary nematic LC for label-free biosensing, manifesting a novel sensing technology that takes advantage of CB7CB-induced flexoelectricity in the transducer. Herein, we prepared LC mixtures by blending a typical rod-like nematic LC (E7) with the bent-core mesogen CB7CB in various weight ratios and studied the effect of the CB7CB content on E7/CB7CB-based biosensing performance in vertically aligned and hybrid-aligned nematic (HAN) cells. Owing to the anomalously small bend elastic constant K33 in CB7CB, the mixture designated CB45 with the highest CB7CB weight percentage (45 wt% in this study) was best applicable to biosensing in HAN cells. When observed under a polarizing optical microscope, CB45 in the HAN geometry showed the capability of detection of as low as 10-10 g/mL for the protein standard bovine serum albumin (BSA). Moreover, the quantitation of the assay was fulfilled by both dielectric and light transmission measurements of the hybrid-aligned cholesteric CB45/R5011. The limit of detection of 7 × 10-10 g/mL was achieved by spectrometric analysis. To the best of our knowledge, this work is the first to demonstrate flexoelectric biosensing on the basis of flexoelectric polarization associated with giant flexoelectricity in CB7CB partially constituting the LC transducer.

Association between Exposure to Ambient Air Pollution and the Risk of Rheumatoid Arthritis in Taiwan: A Population-Based Retrospective Cohort Study.

Background: The association between ambient air pollution (AAP) and the risk of Rheumatoid arthritis (RA) remains debatable. We conducted a population-based cohort study to investigate the association between exposure to AAP and the risk of RA in Taiwan. Methods: We analyzed and combined the longitudinal Health Insurance Database (LHID) and the Taiwan Air Quality-Monitoring Database (TAQMD), which were in line with the residential areas. We calculated the RA incidence rates per 10,000 person-years exposed to each quartile of PM2.5 or PM10 concentrations or RH. Hazards regression was conducted to analyze the associations between exposure to each quartile of PM2.5 and PM10 concentrations and the risk of developing RA. The hazard ratios of RA were analyzed between participants exposed to annual average concentrations of PM2.5 and PM10. All the hazard ratios of RA were stratified by gender and adjusted for age and relative humidity (RH). A p-value < 0.05 was considered statistically significant. Results: Among 722,885 subjects, 9338 RA cases were observed. The analyses adjusted for age, gender, and humidity suggested an increased risk of developing RA in the exposure to PM2.5 in the last quartile (Q4) with the adjusted hazard ratio (aHR) was 1.053 (95%CI: 1.043 to 1.063). Conclusion: Our study suggests that exposure to PM2.5 is associated with an increased risk of RA. The finding has implications for policymaking to develop coping strategies to confront AAP as a risk factor for RA.

Polymer Stabilization of Uniform Lying Helix Texture in a Bimesogen-Doped Cholesteric Liquid Crystal for Frequency-Modulated Electro-Optic Responses.

A polymer network (PN) can sustain the uniform lying helix (ULH) texture in a binary cholesteric liquid crystal (LC) comprising a calamitic LC and a bimesogenic LC dimer. Upon copolymerization of a bifunctional monomer with a trifunctional monomer at a concentration of 5 wt% to create the desired polymer network structure, the PN-ULH was obtained with high stability and recoverability even when cycles of helical unwinding-to-rewinding processes were induced after the electrical or thermal treatment. Utilizing dielectric spectroscopy, the flexoelectric-polarization-dominated dielectric relaxation in the PN-ULH state was characterized to determine two frequency regions, f < fflexo and f > fdi, with pronounced and suppressed flexoelectric effect, respectively. It is demonstrated that the cell in the PN-ULH state can operate in the light-intensity modulation mode by the flexoelectric and dielectric effects at f < fflexo and phase-shift mode by the dielectric effect at f > fdi. Moreover, varying the voltage frequency from f < fflexo to f > fdi results in a frequency dispersion of transmittance analogous to that of flexoelectric-polarization-dominated dielectric relaxation. The unique combination of the bimesogen-doped cholesteric LC with a stable and recoverable PN-ULH texture is thus promising for developing a frequency-modulated electro-optic device.

An integrated active biochar filter and capacitive deionization system for high-performance removal of arsenic from groundwater.

An integrated process of filtration and electrosorption was first applied to enable high-performance arsenic removal for groundwater remediation. An active manganese dioxide-rice husk biochar composite (active BC) filter was utilized for oxidization of As(III) to As(V) and initial removal of As(III, V). Subsequently, electrosorption by capacitive deionization (CDI) was applied as a posttreatment to improve arsenic removal. The active BC approach exhibited fast removal rates of 0.75 and 0.63 g mg-1 h-1 and high maximum removal capacities of 40.76 and 48.15 mg g-1 for As(III) and As(V), respectively. Importantly, column experiments demonstrated that the arsenic removal capacity in the active BC filter was 2.88 mg g-1, which was 72 times higher than that of BC. The results were due to the high efficiency (94%) of redox transformation of As(III) to As(V). The electrosorptive removal of arsenic was further controlled by changing the voltage in CDI. With a charging step of 1.2 V, the total arsenic concentration can be reduced to 0.001 mg L-1 with a low energy consumption of 0.0066 kW h m-3. Furthermore, the integrated system can remove As from real groundwater to achieve the World Health Organization guideline value for drinking water quality.

Herbal Formula SS-1 Increases Tear Secretion for Sjögren's Syndrome.

Background: Sjögren's syndrome (SS) is an autoimmune inflammatory disease that primarily affects the exocrine glands, leading to glandular dysfunction. The hallmark symptoms of SS are dry eyes and mouth, compromising the quality of life of patients and decreasing their capacity to perform their daily activities. Objective: This study aims to evaluate the efficacy of the herbal formula SS-1 for its potential therapeutic benefits for patients with Sjögren's syndrome. Materials and Methods: The bioactivity profile of SS-1 was determined using four different SS-1 concentrations across 12 human primary cell systems of the BioMAP profile. After that, a randomized, double-blind, crossover, placebo-controlled trial was performed including 57 patients treated with SS-1 for 28 weeks. Results: Biologically multiplexed activity profiling in cell-based models indicated that SS-1 exerted anti-proliferative activity in B cells and promoted anti-inflammatory and immunomodulatory activity. In the clinical trial, Schirmer's test results revealed significant improvements in both eyes, with increases of 3.42 mm (95% CI, 2.44-4.41 mm) and 3.45 mm (95% CI, 2.32-4.59 mm), respectively, and a significant reduction in artificial tear use, which was -1.38 times/day, 95% CI, -1.95 to -0.81 times/day. Moreover, the increases in B-cell activating factor (BAFF) and B-cell maturation antigen (BCMA) levels were dampened by 53.20% (295.29 versus 555.02 pg/ml) and 58.33% (99.16 versus 169.99 pg/ml), respectively. Conclusion: SS-1 treatment significantly inhibited B-cell maturation antigen. No serious drug-related adverse effects were observed. Oral SS-1 administration may be a complementary treatment for Sjögren's syndrome.

A Single-Substrate Biosensor with Spin-Coated Liquid Crystal Film for Simple, Sensitive and Label-Free Protein Detection.

A liquid crystal (LC)-based single-substrate biosensor was developed by spin-coating an LC thin film on a dimethyloctadecyl[3-(trimethoxysilyl)propyl]ammonium chloride (DMOAP)-decorated glass slide. Compared with the conventional sandwiched cell configuration, the simplified procedure for the preparation of an LC film allows the film thickness to be precisely controlled by adjusting the spin rate, thus eliminating personal errors involved in LC cell assembly. The limit of detection (LOD) for bovine serum albumin (BSA) was lowered from 10-5 g/mL with a 4.2-µm-thick sandwiched cell of the commercial LC E7 to 10-7 g/mL with a 4.2-µm-thick spin-coated E7 film and further to 10-8 g/mL by reducing the E7 film thickness to 3.4 µm. Moreover, by exploiting the LC film of the highly birefringent nematic LC HDN in the immunodetection of the cancer biomarker CA125, an LOD comparable to that determined with a sandwiched HDN cell was achieved at 10-8 g/mL CA125 using a capture antibody concentration an order of magnitude lower than that in the LC cell. Our results suggest that employing spin-coated LC film instead of conventional sandwiched LC cell provides a more reliable, reproducible, and cost-effective single-substrate platform, allowing simple fabrication of an LC-based biosensor for sensitive and label-free protein detection and immunoassay.

Effect of the Chinese Herbal Medicine SS-1 on a Sjögren's Syndrome-Like Disease in Mice.

Sjögren's syndrome (SS) is an inflammatory autoimmune disease primarily affecting the exocrine glands; it has a major impact on patients' lives. The Chinese herbal formula SS-1 is composed of Gan Lu Yin, Sang Ju Yin, and Xuefu Zhuyu decoction, which exerts anti-inflammatory, immunomodulatory, and antifibrotic effects. Our previous study demonstrated that SS-1 alleviates clinical SS. This study aimed to evaluate the efficacy and mechanism of the Chinese herbal formula SS-1 for salivary gland protein-induced experimental Sjögren's syndrome (ESS). These results showed that ESS treatment with the Chinese herbal formula SS-1 (1500 mg/kg) significantly alleviated the severity of ESS. We found that SS-1 substantially improved saliva flow rates in SS mice and ameliorated lymphocytic infiltrations in submandibular glands. In addition, salivary gland protein-induced SS in mice treated with SS-1 significantly lowered proinflammatory cytokines (including IFN-γ, IL-6, and IL-17A) in mouse salivary glands and decreased serum anti-M3R autoantibody levels. In addition, we found that CD4+ T cells isolated from SS-1-treated SS mice significantly reduced the percentages of IFN-γ-producing CD4+ T cells (Th1) and IL-17A-producing CD4+ T cells (Th17). Our data show that SS-1 alleviates ESS through anti-inflammatory and immunomodulatory effects, which provides new insight into the clinical treatment of SS.

Active MnO2/biochar composite for efficient As(III) removal: Insight into the mechanisms of redox transformation and adsorption.

In the present work, an active MnO2/rice husk biochar (BC) composite (MBC) was prepared to enhance As(III) removal for groundwater remediation. The MBC material obtained an improved porous structure (i.e., specific surface area, pore volume and mesoporosity) with MnO2, providing abundant reaction or interaction sites for surface or interface-related processes such as redox transformation and adsorption of arsenic. As a result, a significant enhancement in arsenic removal can be achieved by using MBC. More specifically, MBC showed a high removal capacity for As(III), which was tenfold higher than that of BC. This improvement can be ascribed to the redox transformation of As(III) via MnO2, resulting in the more effective removal of As(V) species. In addition, pH was an important factor that could influence the As(III) removal capacity. Under alkaline conditions, the As(III, V) removal capacity of MBC was clearly lower than those under acidic and neutral conditions due to the negative effects of electrostatic repulsion. Importantly, a powerful transformation capability of As(III) via MBC was presented; namely, only 5.9% As(III) remained in solution under neutral conditions. Both MnO2 and the BC substrate contributed to the removal of arsenic by MBC. MnO2 delivered Mn-OH functional groups to generate surface complexes with As(V) produced by As(III) oxidation, while the reduced Mn(II) and As(V) could precipitate on the MBC surface. The BC substrate also provided COOH and OH functional groups for As(III, V) removal by a surface complexation mechanism. Note that the application of MBC in the treatment of simulated groundwater demonstrated an efficient arsenic removal of 94.6% and a concentration of arsenic as low as the 10 µg L-1 WHO guideline.

Liquid crystal-photopolymer composite films for label-free single-substrate protein quantitation and immunoassay.

Conventional liquid crystal (LC)-based biosensing at the LC-glass interface requires the assembly of an LC cell formed by two glass substrates with an LC film sandwiched in between. As most biochemical and clinical assays are performed on a single solid substrate, the feasibility of a single-substrate biodetection platform based on a thin film of LC-photopolymer composite was explored in this study. The LC mixture, consisting of nematic LC, E7 or AY40-006, doped with a small amount (≤ 5 wt%) of a photocurable prepolymer was spin-coated on a glass substrate modified with dimethyloctadecyl[3-trimethoxysilyl)propyl] ammonium chloride (DMOAP), a vertical alignment reagent, followed by irradiation with ultraviolet (UV) light. During the photopolymerization process, the accumulated and polymerized NOA65 at the LC-glass interface weakened the anchoring strength of DMOAP, resulting in a decrease in the pretilt angle of LC and allowing the LC molecules to be more easily disturbed in the presence of biomolecules, compared with vertically aligned LC in the absence of polymerized NOA65. Incorporating NOA65 in the LC film therefore provides a means for signal amplification. When an LC-photopolymer composite film consisting of AY40-006 and 4-wt% NOA65 was exposed to UV at 15 mW/cm2 for 30 s and utilized as the biosensing mesogen, the limits of detection were 1.6 × 10-12 g/ml for the direct detection of bovine serum albumin (BSA) and 2.1 × 10-8 g/ml for the immunoassay of the cancer biomarker CA125, significantly lower than those detected with AY40-006 alone or AY40-006/NOA65 mixture without UV irradiation. The results from this study offer a compelling implication on the biomedical application of LC-photopolymer composites in label-free and single-substrate biodetection.

Nonionic and anionic surfactant-washing of polycyclic aromatic hydrocarbons in estuarine sediments around an industrial harbor in southern Taiwan.

Various surfactants, such as nonionic Triton X-100 and Simple Green™ (SG), and anionic sodium dodecylsulfate (SDS) and sodium dodecylbenzene sulfonate (SDBS) were utilized to remove polycyclic aromatic hydrocarbons (PAHs) from heavily contaminated harbor sediments dredged from Kaohsiung Harbor in Taiwan. Desorption/re-sorption equilibrium, kinetics, and washability of PAHs using the selected surfactant were evaluated under different critical micelle concentrations (CMC). Experimental results revealed that the desorption rate of high molecular weight PAHs was greater than those of low molecular weight PAHs, and the anionic SDS was relatively effective in the removal of total PAHs (>50%) compared to the other surfactants. The correlation between the effectiveness of the surfactant washing processes and the physicochemical properties of individual PAH was statistically analyzed. The resulting data suggested that hydrophobic factors (Kow, Koc and Sw) affected PAH treatability more than the reactivity of PAH (electron affinity and ionization potential). Since the adsorption of anionic surfactant altered the hydrophobicity of organic matter in the sediment, PAHs preferred transferring from the sediment to the hydrophobic core of micelles in aqueous solution. Nevertheless, the nonionic surfactant enhanced the PAH partition in the aqueous phase, thus increasing the micellar solubilization of PAH.

Glutathione peroxidase 8 negatively regulates caspase-4/11 to protect against colitis.

Human caspase-4 and its mouse homolog caspase-11 are receptors for cytoplasmic lipopolysaccharide. Activation of the caspase-4/11-dependent NLRP3 inflammasome is required for innate defense and endotoxic shock, but how caspase-4/11 is modulated remains unclear. Here, we show that mice lacking the oxidative stress sensor glutathione peroxidase 8 (GPx8) are more susceptible to colitis and endotoxic shock, and exhibit reduced richness and diversity of the gut microbiome. C57BL/6 mice that underwent adoptive cell transfer of GPx8-deficient macrophages displayed a similar phenotype of enhanced colitis, indicating a critical role of GPx8 in macrophages. GPx8 binds covalently to caspase-4/11 via disulfide bonding between cysteine 79 of GPx8 and cysteine 118 of caspase-4 and thus restrains caspase-4/11 activation, while GPx8 deficiency leads to caspase-4/11-induced inflammation during colitis and septic shock. Inhibition of caspase-4/11 activation with small molecules reduces the severity of colitis in GPx8-deficient mice. Notably, colonic tissues from patients with ulcerative colitis display low levels of Gpx8 and high caspase-4 expression. In conclusion, these results suggest that GPx8 protects against colitis by negatively regulating caspase-4/11 activity.

Immunoglobulin G4-Related Disease Presented as Recurrent Otitis Media and Mixed Hearing Loss Treated With Cyclophosphamide and Rituximab: A Case Report.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic autoimmune disease; however, it rarely presents as recurrent otitis media and mixed hearing loss. In this article, we present a 43-year-old male patient who presented with recurrent otitis media and mixed hearing loss that is the 12th case of IgG4-RD with middle and inner ear involvement. We also report the clinical response of cyclophosphamide and rituximab therapy in IgG4- RD. These two drugs have never been used to treat otologic symptoms, but were used to treat other organs affected by IgG4-RD. One year later, the patient underwent mastoidectomy of the right ear and the pathological reports revealed IgG4-related disease. A rheumatologist administered immunosuppressive therapy comprising cyclophosphamide and rituximab. After therapy, patient's right-sided mixed hearing loss partially improved. We recorded all pure tone audiometry data to evaluate the clinical course and treatment effect. Finally, we concluded that pathological confirmation and further immunosuppressive therapy should be considered in a timely manner to prevent hearing impairment. We recommend cyclophosphamide and rituximab for the treatment of diseases involving the middle and inner ear.

Sclareol attenuates the development of atopic dermatitis induced by 2,4-dinitrochlorobenzene in mice.

Context: Atopic dermatitis is a common chronic inflammatory skin disease affecting up to 20% of children and 1% of adults worldwide. Treatment of atopic dermatitis include corticosteroids and immunosuppressants, such as calcineurin inhibitors and methotrexate. However, these treatments often bring about adverse effects including skin atrophy, osteoporosis, skin cancer, and metabolic syndrome. Objective: In this study, we evaluated the therapeutic effects and mechanisms of sclareol, a natural diterpene, on atopic dermatitis (AD)-like skin lesions induced by 2,4-dinitrochlorobenzene (DNCB) in mice. Materials and methods: To evaluate the effect of sclareol in vivo model, BALB/c mice were repeatedly injected intraperitoneally with sclareol (50 and 100 mg/kg) in 2,4-dinitrochlorobenzene (DNCB)-induced AD-like murine model. Major assays were enzyme-linked immunosorbent assay, histological analysis, flow cytometry, western blot analysis. Results: Intraperitoneal administration of sclareol (50 and 100 mg/kg) significantly attenuated AD-like symptoms, such as serum IgE levels, epidermal/dermal hyperplasia, and the numbers of infiltrated mast cells. In addition, systemic sclareol treatments reduced local pro-inflammatory cytokine concentrations, including IL-6, IL-1b, TNF-a, IL-4, IFN-g, and IL-17A, on AD-like lesions. Furthermore, we demonstrated that sclareol also suppressed T cell activation and the capability of cytokine productions (IFN-g, IL-4 and IL-17A) in response to DNCB stimulation. By examining the skin homogenate, we found that sclareol inhibited the AD-like severity likely through suppressions of both NF-kB translocation and phosphorylation of the MAP kinase pathway. Discussion and conclusions: Cumulatively, our results indicate that sclareol induced anti-inflammatory effects against the atopic dermatitis elicited by DNCB. Thus, sclareol is worth of being further evaluated for its potential therapeutic benefits for the clinical treatment of AD.