Background. Deficiency of interleukin-1 receptor antagonist (DIRA) is a rare life-threatening autosomal recessive autoinflammatory disease with symptoms including but not limited to osteomyelitis, periostitis, and systemic inflammation. DIRA is developed from the loss-of-function biallelic mutations of the IL1RN gene that encodes IL-1 receptor antagonist (IL-1RA), leading to the unchecked pro-inflammatory signaling and subsequent systemic inflammation. Thus, anakinra as the recombinant IL-1RA has become the primary drug to treat DIRA. Although anakinra has been effective for the complete remission of DIRA, it has also shown various side effects. To confirm the efficacy and safety issues associated with DIRA treatment, we conducted a literature review and secondary data analysis to enhance our understanding on this important topic. Methods. Through comprehensive literature search, we have identified 15 papers with 25 patients studied. The demographic, clinical, and genetic data were extracted, followed by statistical analysis to support the physiological mechanisms of anakinra treatment. Results. Through the literature review and data analysis, it was found that 88% of patients had complete clinical remission of DIRA upon continual treatment with anakinra; patients had a mean improvement of Hemoglobin (+3.18 g/dL), Erythrocyte Sedimentation Rate (−53.4 mm/h), and C-reactive Protein (−135.45 mg/L) levels, suggesting that the improvement of hematopoietic function and inflammation is a mechanism for anakinra treatment. Various genetic variants were also identified from the patient data that cause the loss of function of IL-1RA, providing real patient genomic data to support the anakinra treatment. Conclusions. Considering the inconsistency and certain variations from clinical research influenced by specific conditions, this review along with the data analysis confirms the efficacy and safety of anakinra treatment for DIRA.

Background and Objectives: Cancer, as the second leading cause of death in the United States, poses a huge healthcare burden. Barriers to access to advanced therapies influence the outcome of cancer treatment. In this study, we examined whether insurance types affect the quality of cancer clinical care. Materials and Methods: Data for 13,340 cancer patients with Purchased or Medicaid insurance from the All of Us database were collected for this study. The chi-squared test of proportions was employed to determine the significance of patient cohort characteristics and the accessibility of healthcare services between the Purchased and Medicaid insurance groups. Results: Cancer patients who are African American, with lower socioeconomic status, or with lower educational attainment are more likely to be insured by Medicaid. An analysis of the survey questions demonstrated the relationship between income and education level and insurance type, as Medicaid cancer patients were less likely to receive primary care and specialist physician access and more likely to request lower-cost medications. Conclusions: The inequities of the US healthcare system are observed for cancer patient care; access to physicians and medications is highly varied and dependent on insurance types. Socioeconomic factors further influence insurance types, generating a significant impact on the overall clinical care quality for cancer patients that eventually determines treatment outcomes and the quality of life.

Deficiency of interleukin-1 receptor antagonist (DIRA) is a rare life-threatening autosomal recessive autoinflammatory disease with symptoms including but not limited to osteomyelitis, periostitis, and systemic inflammation. DIRA is developed from the loss-of-function mutations of IL1RN gene that encodes IL-1 receptor antagonist (IL-1RA), leading to the unchecked pro-inflammatory signaling and subsequent systemic inflammation. Thus, Anakinra as the recombinant IL-1RA has become the primary drug to treat DIRA. Although Anakinra has been effective for complete remission of DIRA, it also showed various side effects. To further address its efficacy and safety in treating DIRA, a review of literature was conducted in this study. We have identified 15 papers with 25 patients studied, making it possible to conduct reliable statistical analyses. The literature review found that continual treatment with Anakinra is effective to cause clinical remission of DIRA. Statistical analyses found that after the treatment with Anakinra, patients had improved Hemoglobin, Erythrocyte Sedimentation Rate, and C-reactive Protein levels. All known cytogenetic abnormalities were also analyzed to inform clinicians for genetic screening and rapid diagnosis of DIRA. The results from this study provide a comprehensive view for further improving the treatment of DIRA by Anakinra.

Background and Objectives: Cancer as the second leading cause of death in the United States poses a huge healthcare burden. Barriers to access to advanced therapies influence the outcome of cancer treatment. In this study, we examined whether insurance types affect the quality of cancer clinical care regarding access to an important monoclonal antibody, ramucirumab. Materials and Methods: Data for 13,340 cancer patients with Purchased or Medicaid insurance from the All of Us Database were collected for this study. The Chi-square test of proportions was employed to determine the significance of patient cohort characteristics and ramucirumab usage between Purchased and Medicaid insurance groups. The independent t-test was utilized to assess the influences of other determinants on insurance types. Results: Cancer patients who are African American, with lower socioeconomic status, or with lower educational attainment are more likely to be insured by Medicaid. Analysis of survey questions demonstrated the relationship between income and education level with insurance type as Medicaid cancer patients were less likely to receive primary care and specialist physician access and more likely to request lower cost medications. In addition, those with Medicaid insurance were identified to have poorer access to expensive therapeutics like ramucirumab compared to those with Purchased insurance. Conclusions: The inequities of the US healthcare system are observed for cancer patient care; access to physicians and therapeutics are highly varied and dependent on insurance types. Socioeconomic status determines insurance type, which unfortunately generates a significant impact on cancer treatment and disease outcome.

Obstructive sleep apnea (OSA) is a highly prevalent yet frequently underdiagnosed condition that is associated with significant cardiopulmonary, metabolic, and neurocognitive outcomes. Risk factors for OSA overlap with illnesses commonly observed in intensive care unit (ICU) patients, resulting in a disproportionately elevated burden on healthcare. This structured narrative review synthesizes current evidence regarding the prevalence, diagnostic challenges, and clinical implications of obstructive sleep apnea (OSA) in critically ill adults admitted to intensive care units (ICUs) using PubMed, EMBASE, and Scopus. Key search terms included “obstructive sleep apnea,” “ICU,” and “critical illness.” Results showed that OSA is present in up to 60–70% of ICU patients, yet only ~5% are formally diagnosed during hospitalization. Underdiagnosis is linked to prolonged mechanical ventilation, extubation failure rates as high as 30%, 2-fold higher perioperative complication rates, cardiovascular instability, 1.8-fold greater 30-day ICU readmission rates, and 2.2-fold mortality. Standard screening tools have limited applicability in ICU patients. Emerging alternatives, such as overnight oximetry, polygraphy, and machine learning models lack validation. Our analyses reveal that current diagnostic and treatment strategies are poorly adapted to critically ill patients. Integration of OSA as a part of ICU management, diagnosis, and intervention may reduce readmissions and mortality.

Breast implant illness (BII) is an emerging clinical disorder characterized by systemic symptoms, such as fatigue, cognitive dysfunction, musculoskeletal pain, and autoimmune-like complications. Despite increasing patient awareness and improved clinical care, BII remains controversial due to the absence of standardized diagnostic criteria and accurate biomarkers. In this review, we address the current clinical and research gaps in symptoms, diagnosis, and treatment outcomes of BII by focusing on the underlying immunological mechanisms, aiming to identify potential biomarkers for improving these areas in the clinical care of BII. Through comprehensive literature analysis, it has been found that patient-reported data consistently indicate a high prevalence of systemic symptoms, with up to one-third of women reporting BII-related complaints. Outcomes following explantation are remarkably positive, with 57–96% of patients experiencing partial or complete symptom relief. Among many etiological factors, immunological mechanisms are identified to be more relevant to BII, including silicone-related autoimmune/inflammatory syndrome induced by adjuvants (ASIA), chronic inflammation induced by bacterial biofilms, immune responses to connective tissue remodeling, and genetic predisposition associated with different HLA alleles. Potential endocrine or neuroimmune responses to degraded silicone products also contribute to the development of BII symptoms. Immunological mechanisms related to BII clinical symptoms and their utility in the development of diagnostic and therapeutic strategies are also discussed.