Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated, chronic fibroinflammatory disease characterized by multisystem involvement. As it is relatively rare and has been recognized for a short time, standardized treatment and disease assessment remain clinical challenges. In recent years, substantial progress has been made both internationally and domestically in the diagnosis, treatment, and management of IgG4-RD, with more evidence-based studies now available in this field. However, there is no Chinese guideline focusing on the treatment and evaluation of systemic involvement in IgG4-RD. To address this gap, the Chinese Rheumatology Association and the IgG4-Related Disease Group, Committee of Rheumatology and Immunology, Cross-Strait Medicine Exchange Association jointly organized experts from multiple disciplines, including rheumatology, gastroenterology, ophthalmology, stomatology, pulmonology, nephrology and urology, to systematically review and evaluate the latest domestic and international literature. In combination with clinical practice in China, and following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence grading system, the experts addressed 9 clinical questions of concern prioritized by frontline clinicians in China and formulated 18 evidence-based recommendations. The guideline aims to improve the standardized treatment and evaluation of IgG4-RD, promote daily clinical care, and ultimately improve patient outcomes.

Recent studies have highlighted a poor correlation between the outcomes of in vitro and in vivo characterization of biomaterials. This highlights the poor reliability of the current in vitro models, caused by the lack of knowledge concerning the early-stage interactions between the implanted material and its surrounding tissue, which is largely regulated by protein adsorption on implant. This study investigates the adsorption kinetics of human serum albumin (HSA), immunoglobulin G (IgG), and fibronectin (FN), which are the main protein constituents of human blood plasma, on the clinically available silicate bioactive glass S53P4 before and after surface modification by conditioning and silanization, respectively. Vroman effect was evaluated in real time by an electrokinetic analyzer, and protein adsorption studied and quantified by fluorescence confocal microscopy. IgG and FN, promoters of cell adhesion, displaced the antifouling HSA on the untreated and conditioned glasses, while a long-lasting affinity persisted between the silanized surfaces and HSA. This study provides a foundation for understanding how surface properties influence the Vroman effect on bioactive glasses, enabling the development of more predictive in vitro models and improved control of cell behavior.

Intravenous immunoglobulin (IVIG) 10% and hyaluronidase-facilitated subcutaneous immunoglobulin (fSCIG) 10% are both used as maintenance treatments for patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Owing to the rarity of the condition, data regarding the relationship between dose, exposure, and clinical outcomes are sparse for these therapies. This analysis aimed to characterize the relationships between dose, exposure, and clinical efficacy of IVIG 10% and fSCIG 10% in CIDP.

Neuromyelitis optica spectrum disorder (NMOSD) predominantly affects women and has a median age at onset of 40 years, meaning that many patients are of childbearing age. However, management of pregnant women with NMOSD remains extremely challenging. We report two patients with NMOSD who had unplanned pregnancies during inebilizumab (INE) treatment and successful deliveries. These cases provide preliminary clinical information regarding maternal disease control and pregnancy outcomes following INE exposure.

Background and objectives Varicella-zoster (VZV) virus infection can be severe in children with nephrotic syndrome. Lack of varicella vaccination through the national immunisation programme in India leaves many vulnerable to infection. We conducted this study to document the seroprevalence of Varicella antibodies in patients with nephrotic syndrome. Methods This cross-sectional study (Oct 2024-May 2025) was conducted at a tertiary-care teaching hospital in India, in children (1-18 y) with nephrotic syndrome (both steroid-sensitive and steroid-resistant) in disease remission. Serum VZV IgG antibodies were measured using the EUROIMMUN ELISA kit; titres ≥100 IU/L were considered seroprotective. Results 100 patients were enrolled (median age 8 y). None had received varicella vaccination, and only two reported prior infection. Overall seroprotection was 22% with a geometric mean titre of 9.472 IU/L [median (IQR) 7.59 (3.35; 73.38) IU/L]. No significant difference was observed in titres between steroid-sensitive and steroid-resistant nephrotic syndrome (P=0.532), but seroprotection increased with age (11.1% in <5 y to 33.3% in >10 y). Interpretation and conclusions Low seroprevalence likely reflects the inadequacy of natural immunity and absence of routine varicella vaccination, warranting larger seroprevalence studies and future research on the need for priority immunisation for this high-risk population.

Background and objectives Mpox, declared a public health emergency of international concern by WHO, has demonstrated sporadic transmission globally. While India reported 66 confirmed cases predominantly linked to international travel, the possibility of silent community circulation remains unconfirmed, particularly within high-risk populations. Serological surveys are crucial for detecting past exposure, including asymptomatic infections that may be missed by clinical surveillance. This study aimed to assess the prevalence of anti-MPXV IgG and IgM antibodies and identify socio-demographic and behavioural determinants of seropositivity among key populations in India. Methods A multicentric, cross-sectional sentinel serosurvey was conducted between September 2023 to March 2024 across seven community-based organisation sites in India. A total of 1,790 participants aged 18-40 y (born after cessation of smallpox vaccination in India) were enrolled. Serological testing was performed using enzyme-linked immunosorbent assay (ELISA) for anti-MPXV IgG and IgM antibodies. Plaque reduction neutralisation test (PRNT50) was used to assess functional neutralising antibodies against both MPXV and Vaccinia virus. Results Among 1,790 participants, 14 (0.78%) tested positive for anti-MPXV IgG, with no IgM positivity detected. IgG-positive individuals were predominantly male (57.1%), aged 31-40 y (85.7%), and sexually active (75.9%). Geographic distribution ranged from 0.34% (Delhi NCR) to 2.07% (Kerala). PRNT50 assay revealed functional neutralising antibodies against MPXV in 64.3% (9/14) of IgG-positive samples, with evidence of cross-reactive immunity to Vaccinia virus in 93.9% (13/14). Interpretation and conclusions This multicentric sentinel serosurvey identified very low Mpox virus seroprevalence (0.78%) among key populations in India, suggesting limited prior exposure. The absence of IgM antibodies indicates that infections were not recent and provides no evidence of ongoing community transmission during the study period. Detection of neutralising antibodies in a subset of IgG-positive individuals supports prior Orthopoxvirus exposure. These findings establish baseline sero-epidemiological evidence for Mpox in India and underscore the importance of periodic sentinel sero surveillance for early detection and outbreak preparedness.

This article reports the management of a patient with Hodgkin lymphoma (HL) complicated by refractory critical autoimmune hemolytic anemia (AIHA) and explores the value of whole blood exchange (WBE) after failure of conventional therapy and plasma exchange. The patient was a 52-year-old woman with a history of classical HL treated with anti-PD-1 therapy. She was admitted due to progressive fatigue and altered mental status, with a nadir hemoglobin level of 24 g/L and a positive direct antiglobulin test for both anti-immunoglobulin G and anti-C3d (1:256). She also presented with impaired consciousness and shock, leading to a diagnosis of critical AIHA. The patient failed to respond to multiple lines of treatment, including high-dose corticosteroids, intravenous immunoglobulin, rituximab, eculizumab, and plasma exchange, and experienced recurrent hypotension. After multidisciplinary consultation, WBE was performed. Within 24 hours after the procedure, her urine color turned from dark tea-colored to light yellow, with no recurrence of dark urine. The hemoglobin level increased to 52 g/L on day 5 and to 63 g/L on day 10 post-procedure. The lactate dehydrogenase level decreased from a peak level of 2 304 U/L to 481 U/L, and the total bilirubin level dropped to 20.4 μmol/L. The patient's hemodynamic status stabilized, and she was transferred out of the hematological intensive care unit on day 16. The present case demonstrates that for severe AIHA refractory to conventional immunosuppression and plasma exchange, WBE can rapidly remove sensitized erythrocytes and complement components, serving as an effective rescue therapy.

Sepsis and septic shock result from a dysregulated host response to infection, encompassing both hyperinflammatory and immunosuppressed phenotypes. Although immunomodulatory adjunctive therapies have been extensively investigated over the past decades, none have demonstrated consistent clinical efficacy. In contrast, low circulating immunoglobulin levels are common in septic patients and are associated with greater disease severity and poorer outcomes, providing a biological rationale for the use of polyclonal intravenous immunoglobulins (IVIg) as phenotype-targeted adjunctive therapies. This expert consensus sought to systematically evaluate the appropriateness of IVIg therapy across predefined and clinically relevant scenarios in critically ill patients and deliver pragmatic, phenotype-oriented guidance. A multidisciplinary Italian panel comprising experts in intensive care, infectious diseases, transplant medicine, and oncology applied a modified RAND/UCLA Appropriateness Method. The process integrated a structured literature review (PubMed, EMBASE, and the Cochrane Library) with anonymous 9-point Likert scale ratings. Indications were classified according to the median score as appropriate (7-9), uncertain (4-6), or inappropriate (1-3), and interpanel disagreement was assessed using the Interpercentile Range Adjusted for Symmetry. The expert panel evaluated seven phenotypes that were identified as the most clinically relevant and extensively addressed in the available literature. IVIg use was judged appropriate without formal disagreement in severe community-acquired pneumonia with hyperinflammation plus shock (median 8), low IgM < 60 mg/dL (median 8), or prior immunosuppression (median 8), whereas hyperinflammation without shock was uncertain (median 6). Appropriateness was also supported for abdominal infection with endotoxaemic shock, immune suppression/paralysis, or low IgM (all median 8); sepsis in solid-organ transplant recipients (median 7), particularly with low IgM (median 8), while prophylaxis in high-risk transplant recipients was uncertain (median 5). IVIg was rated appropriate for overwhelming septic shock with severe hyperinflammation (median 8), especially with low IgM (median 8) and toxin-mediated syndromes (median 9); for post-cardiac surgery sepsis with immune suppression (median 7) but not clearly for hyperinflammation (uncertain, median 6); for multidrug-resistant pathogen sepsis with immune suppression (median 7-8); and in haematologic malignancies, as prophylaxis or treatment primarily when immunoglobulins are low (medians 7-8), with prophylaxis otherwise uncertain. Across all phenotypes, IgM-enriched preparations were consistently preferred (median 8-9). Available evidence suggests no major safety signals, although adverse events are likely to be underreported. Overall, the consensus supports personalised, phenotype-oriented consideration of IgM-enriched IVIg as an adjunctive strategy to optimise standard care, while underscoring persistent evidence gaps and the need for adequately powered trials to define timing, dosing, and responsive subgroups.

Accurate, label-free analysis of complex biological mixtures is limited by poor multiplexing scalability and inconsistent responses across sensor samples. We introduce a transformative sensing platform that integrates large-scale photonic multiplexing with data-driven analytics to overcome these constraints. Our modular, affordable glass-chip whispering-gallery-mode (WGM) photonic architecture is designed to support simultaneous readout of up to 100 sensing channels comprising over 10 000 high-Q microresonators, exceeding existing multiplexing capabilities by more than two orders of magnitude. The photonic system is reinforced by the novel, cross-platform, deep learning framework BioCCF. It applies cross-channel fusion in biosensing for the first time and enables harmonized operation across heterogeneous chips by leveraging domain adaptation. Using over 200 h of measurements from nine independent chips, we demonstrate chip-independent multiplexed biosensing with 99.3% identification accuracy and relative quantification errors of 10 - 4 for immunoglobulin G mixtures. Beyond this validation, the platform supports multi-analyte immunoassays, environmental monitoring, and distributed diagnostics, enabling aligned sensor networks with shared data infrastructures and continuously improving generalization of the common analyzing framework.

Forested Guinea has been the site of multiple high-consequence viral spillover events, including the index case of the 2013-16 West African Ebola epidemic. Deforestation and wildlife hunting rapidly expand the human-animal interface, increasing opportunities for transmission. Here we integrate serologic, spatial and questionnaire data to characterize zoonotic filovirus spillover events and risk factors amongst wildlife hunter communities in Forested Guinea. Hunters and close contacts from 43 villages in 2017 (n = 511) and 2023 (n = 648) were screened using a multiplex microsphere-based immunoassay panel of 9 filoviruses, identifying IgG binding against Ebola virus (EBOV) in 57/1159 individuals (4.9%), as well as species-specific binding against Bundibugyo (BDBV) (49/1159, 4.2%), Taï Forest (TAFV) (13/1159, 1.1%), Reston (4/1159, 0.3%), Měnglà (MLAV) (8/1159, 0.7%), Lloviu (LLOV) (8/1159, 0.7%) and Bombali (BOMV) (1/1159, 0.1%) viruses. Parallel pseudotyped virus neutralization assays identified species-specific neutralization of EBOV, BDBV and TAFV, as well as likely cross-neutralization of BOMV, LLOV and MLAV, suggesting multiple zoonotic virus spillover events. Mixed-effects regression analyses of satellite-derived land-cover data identified environmental risk factors (including forest fragmentation) reflecting potential pathways of exposure. Together, our data suggest multiple ongoing zoonotic filovirus spillover events in wildlife hunting communities and highlight the importance of landscape configuration in driving pathogen spillover.

With rising demands for plasma-derived medicinal products (PDMPs), the pressure on plasma donors is increasing. Donation practices vary worldwide and depend on differing guidelines. However, an inventory of current international practices is still lacking. Here, we assess plasma donor health protection practices across blood establishments in Europe and North America. We distributed an online survey about plasmapheresis procedures and donor health protection measures to representatives of plasma collecting organizations. Between March and June 2023, we received 20 responses from 19 countries to an online survey distributed via the European Blood Alliance and social media. Plasma is collected via plasmapheresis by 17 organizations, which were included for analysis. The typical donor is required to be aged 18 to 65 at registration, have a minimum weight of 50 kg, have suitable veins for plasmapheresis, and be in good general health. The maximum plasmapheresis frequency ranges from 12 to 104 donations annually (mode = 26). Predonation hemoglobin or hematocrit levels are assessed by 15 of 17 organizations. All organizations measure total protein, and 7 organizations include immunoglobulin G levels (both primarily in new donors and annually). Many plasma donor health protection practices are similar across organizations. Most nonprofit organizations seem to employ conservative donation frequencies (maximum annual frequency <34). Organizations allowing more frequent donations generally combine this with more frequent biomarker measurements. To conclude, our study provides insights into international plasma donation practices. These findings support efforts to establish more uniform policies while meeting the growing plasma demand and maintaining donor health.

Guillain-Barre syndrome (GBS) is an immune-mediated acute inflammatory polyradiculoneuropathy, with intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) established as standard first-line treatments. A subset of severe overlapping GBS patients carrying multiple pathogenic anti-ganglioside immunoglobulin G (IgG) antibodies typically exhibits poor therapeutic responses to IVIG. Efgartigimod, a neonatal Fc receptor (FcRn) antagonist, accelerates the clearance of circulating pathogenic IgG, conferring theoretical therapeutic value for IgG-driven autoimmune neurological disorders. Herein, we present a 51-year-old female patient with severe multi-antibody-positive overlapping GBS who failed full-course standard IVIG treatment; sequential salvage Efgartigimod administration induced progressive recovery of limb muscle strength. We further performed a systematic literature review pooling 15 previously published cases of efgartigimod-treated GBS to synthesize global clinical evidence. Our pooled analysis suggests that Efgartigimod could act as a salvage therapeutic candidate for IVIG-refractory severe GBS complicated by multiple anti-ganglioside antibody positivity. Nevertheless, the definitive efficacy and optimal timing of intervention remain to be validated by large‑sample randomized controlled trials.

IgG4-related ophthalmic disease (IgG4-ROD) is a common manifestation of IgG4-related disease, but its clinicopathologic features and the mechanisms underlying fibrosis remain incompletely understood. We retrospectively analyzed 100 cases of IgG4-ROD and investigated fibrosis using immunohistochemistry for IgG4, FOXP3, CD68, and CD163, together with RNA in situ hybridization for TGFB1. IgG4-ROD was histologically categorized into four patterns (Patterns 1-4) reflecting progressive fibrosis, demonstrating a spectrum from lymphoplasmacytic inflammation to marked fibrosis. Fibrosis was absent or minimal in 51% of cases, indicating that fibrosis is not essential for diagnosis, whereas obliterative phlebitis was rare. Compared with non-fibrotic cases, fibrotic cases showed significantly increased numbers of CD68-positive and CD163-positive macrophages (p < 0.001), predominantly localized at the interface between lymphoid and fibrotic areas. In contrast, fibrosis was not associated with IgG4-positive plasma cells, FOXP3-positive regulatory T cells, or EBV status. TGFB1 expression was significantly higher in lymphocyte-rich than fibrotic areas (p < 0.001), suggesting a closer association with lymphocyte-rich inflammation than established fibrosis. These findings demonstrate progressive histologic changes from Pattern 1 to Pattern 4 and suggest that accumulation of CD163-positive macrophages is associated with fibrosis in IgG4-ROD.