Background: Rheumatoid arthritis is a systemic inflammatory arthritis characterized by joint pain and morning stiffness. The affected joints are typically symmetrically affected, and given the inflammatory nature of t...Background: Rheumatoid arthritis is a systemic inflammatory arthritis characterized by joint pain and morning stiffness. The affected joints are typically symmetrically affected, and given the inflammatory nature of this condition, patients often present with warmth and erythema around affected joints as well as fatigue. Extra-articular manifestations, especially pleuro-pericardial inflammation, are rare initial presentations, although may be seen in advanced or undertreated disease. Case Presentation: We describe a case of a rheumatoid arthritis presenting atypically in a middle-aged male who came to the emergency department complaining of diffuse muscle pain and swelling in the distal extremities. Cardiac ultrasound revealed pleuro-pericardial inflammation and effusions. Myositis and infectious causes were ruled out and bilateral hand x-rays did not show erosions or any evidence of arthritic changes. All rheumatological auto-antibodies were negative except for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) and a diagnosis of rheumatoid arthritis was made. The patient was started on prednisone with excellent response. Conclusions: This case highlights that rheumatoid arthritis can uncommonly present initially with extra-articular manifestations that are often manifested in advanced disease. Typically, extra-articular manifestations, especially those as severe as this patient’s, occur with untreated, advanced disease and could accompany extensive arthritic joint changes. Thus, it is important to have an understanding of rare, atypical presentations of rheumatoid arthritis so that a high index of suspicion can be maintained to make the diagnosis and initiate treatment in a timely manner.展开更多
Almost 2 billion passengers embark on international and domestic air tr avel ea ch year. An increasing number of travelers will have cardiovascular disease as t he population continues to age and our ability to treat ...Almost 2 billion passengers embark on international and domestic air tr avel ea ch year. An increasing number of travelers will have cardiovascular disease as t he population continues to age and our ability to treat cardiac disease improves . Guidelines for safe air travel in this population vary and are supported by fe w concrete data from randomized trials. Although the overall risk for clinically sig nificant myocardial ischemia and arrhythmia during flight seems to be low in t he population with stable cardiovascular disease, certain groups may be at incre ased risk. In-flight venous thrombosis is an increasingly recognized potential complication of prolonged air travel. Travelers with cardiovascular disease may be at increased risk for venous thrombosis as a result of depressed ejection fra ction or immobility. This case-based review describes the risks of air travel i n a 65-year-old man with known cardiovascular disease. After reviewing the lim ited data on safe air travel after myocardial infarction and the common complica tions after both percutaneous intervention and coronary artery bypass grafting, we provide recommendations on safe air travel after myocardial infarction. We di scuss the safety of both preflight screening and the in-flight environment with regard to pacemakers and implantable automatic defibrillators. We also review t he literature on in-flight venous thrombosis and provide recommendations to pre vent in-flight deep venous thrombosis.展开更多
In the past decade,chimeric antigen receptor(CAR)-T cell therapy has emerged as a promising immunotherapeutic approach for combating cancers,demonstrating remarkable efficacy in relapsed/refractory hematological malig...In the past decade,chimeric antigen receptor(CAR)-T cell therapy has emerged as a promising immunotherapeutic approach for combating cancers,demonstrating remarkable efficacy in relapsed/refractory hematological malignancies in both pediatric and adult patients.CAR-natural killer(CAR-NK)cell complements CAR-T cell therapy by offering several distinct advantages.CAR-NK cells do not require HLA compatibility and exhibit low safety concerns.Moreover,CAR-NK cells are conducive to“off-the-shelf”therapeutics,providing significant logistic advantages over CAR-T cells.Both CAR-T and CAR-NK cells have shown consistent and promising results in hematological malignancies.However,their efficacy against solid tumors remains limited due to various obstacles including limited tumor trafficking and infiltration,as well as an immuno-suppressive tumor microenvironment.In this review,we discuss the recent advances and current challenges of CAR-T and CAR-NK cell immunotherapies,with a specific focus on the obstacles to their application in solid tumors.We also analyze in depth the advantages and drawbacks of CAR-NK cells compared to CAR-T cells and highlight CAR-NK CAR optimization.Finally,we explore future perspectives of these adoptive immunotherapies,highlighting the increasing contribution of cutting-edge biotechnological tools in shaping the next generation of cellular immunotherapy.展开更多
文摘Background: Rheumatoid arthritis is a systemic inflammatory arthritis characterized by joint pain and morning stiffness. The affected joints are typically symmetrically affected, and given the inflammatory nature of this condition, patients often present with warmth and erythema around affected joints as well as fatigue. Extra-articular manifestations, especially pleuro-pericardial inflammation, are rare initial presentations, although may be seen in advanced or undertreated disease. Case Presentation: We describe a case of a rheumatoid arthritis presenting atypically in a middle-aged male who came to the emergency department complaining of diffuse muscle pain and swelling in the distal extremities. Cardiac ultrasound revealed pleuro-pericardial inflammation and effusions. Myositis and infectious causes were ruled out and bilateral hand x-rays did not show erosions or any evidence of arthritic changes. All rheumatological auto-antibodies were negative except for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) and a diagnosis of rheumatoid arthritis was made. The patient was started on prednisone with excellent response. Conclusions: This case highlights that rheumatoid arthritis can uncommonly present initially with extra-articular manifestations that are often manifested in advanced disease. Typically, extra-articular manifestations, especially those as severe as this patient’s, occur with untreated, advanced disease and could accompany extensive arthritic joint changes. Thus, it is important to have an understanding of rare, atypical presentations of rheumatoid arthritis so that a high index of suspicion can be maintained to make the diagnosis and initiate treatment in a timely manner.
文摘Almost 2 billion passengers embark on international and domestic air tr avel ea ch year. An increasing number of travelers will have cardiovascular disease as t he population continues to age and our ability to treat cardiac disease improves . Guidelines for safe air travel in this population vary and are supported by fe w concrete data from randomized trials. Although the overall risk for clinically sig nificant myocardial ischemia and arrhythmia during flight seems to be low in t he population with stable cardiovascular disease, certain groups may be at incre ased risk. In-flight venous thrombosis is an increasingly recognized potential complication of prolonged air travel. Travelers with cardiovascular disease may be at increased risk for venous thrombosis as a result of depressed ejection fra ction or immobility. This case-based review describes the risks of air travel i n a 65-year-old man with known cardiovascular disease. After reviewing the lim ited data on safe air travel after myocardial infarction and the common complica tions after both percutaneous intervention and coronary artery bypass grafting, we provide recommendations on safe air travel after myocardial infarction. We di scuss the safety of both preflight screening and the in-flight environment with regard to pacemakers and implantable automatic defibrillators. We also review t he literature on in-flight venous thrombosis and provide recommendations to pre vent in-flight deep venous thrombosis.
基金SC is supported by the Cancer Research Institute Lloyd J.Old STAR Award(CRI4964),NIH(R33CA281702),DoD(W81XWH-21-1-0514,HT94252310472),and Pershing Square Sohn Cancer Research Alliance.
文摘In the past decade,chimeric antigen receptor(CAR)-T cell therapy has emerged as a promising immunotherapeutic approach for combating cancers,demonstrating remarkable efficacy in relapsed/refractory hematological malignancies in both pediatric and adult patients.CAR-natural killer(CAR-NK)cell complements CAR-T cell therapy by offering several distinct advantages.CAR-NK cells do not require HLA compatibility and exhibit low safety concerns.Moreover,CAR-NK cells are conducive to“off-the-shelf”therapeutics,providing significant logistic advantages over CAR-T cells.Both CAR-T and CAR-NK cells have shown consistent and promising results in hematological malignancies.However,their efficacy against solid tumors remains limited due to various obstacles including limited tumor trafficking and infiltration,as well as an immuno-suppressive tumor microenvironment.In this review,we discuss the recent advances and current challenges of CAR-T and CAR-NK cell immunotherapies,with a specific focus on the obstacles to their application in solid tumors.We also analyze in depth the advantages and drawbacks of CAR-NK cells compared to CAR-T cells and highlight CAR-NK CAR optimization.Finally,we explore future perspectives of these adoptive immunotherapies,highlighting the increasing contribution of cutting-edge biotechnological tools in shaping the next generation of cellular immunotherapy.
