Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology. It is characterized by the presence of rheumatoid factor and anticitrullinated peptide antibodies. The orchestra of the inflammatory process among various immune cells, cytokines, chemokines, proteases, matrix metalloproteinases (MMPs), and reactive oxidative stress play critical immunopathologic roles in the inflammatory cascade of the joint environment, leading to clinical impairment and RA. With the growing understanding of the immunopathogenic mechanisms, increasingly novel marked and potential biologic agents have merged for the treatment of RA in recent years. In this review, we focus on the current understanding of pathogenic mechanisms, highlight novel biologic disease-modifying antirheumatic drugs (DMRADs), targeted synthetic DMRADs, and immune-modulating agents, and identify the applicable immune-mediated therapeutic strategies of the near future. In conclusion, new therapeutic approaches are emerging through a better understanding of the immunopathophysiology of RA, which is improving disease outcomes better than ever.

Since April 2022, another wave of the Omicron epidemic has struck Taiwanese society, and children with severe neurological complications have been reported frequently. A few cases even developed acute fulminant encephalitis. To investigate the possible causes of the increased incidence of such complications in Taiwan, we reviewed several cases of pediatric patients with severe neurological symptoms. We collected the medical records of pediatric patients with COVID-19 infection who presented with severe neurological symptoms. The COVID-19 infection was diagnosed by nasal swab reverse transcriptase-polymerase chain reaction. The remaining samples were sent for whole genome sequencing and spike (S) protein amino acid variation mapping. The increase of several inflammatory markers was observed in all patients included in this study. However, none of the cerebrospinal fluid samples tested positive for SARS-CoV-2. The result of whole genome sequencing showed that all the sequences belonged to the lineage BA.2.3.7. However, the sequences had a K97E mutation in the S protein that differed from other BA.2.3.7 lineage strains, which was located at the S protein N-terminal domain. The new mutation in the S protein, which had not previously been observed but was discovered in this study, potentially explains the sudden increase in incidence of extremely adverse neurological symptoms in pediatric patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of pediatric infections and has shown evolving molecular characteristics over time. This study aimed to investigate the phenotypic and genotypic features of MRSA isolates collected from pediatric patients at a tertiary medical center in northern Taiwan between 2011 and 2020. A total of 182 MRSA strains were analyzed for SCCmec types, PVL gene presence, antimicrobial susceptibility, multilocus sequence typing (MLST), and clonal relatedness using pulsed-field gel electrophoresis (PFGE). ST59/SCCmec Vt was the most prevalent genotype, followed by ST59/SCCmec IV and ST8/SCCmec IV. Most ST59/SCCmec Vt and ST8/SCCmec IV isolates clustered genetically. Clindamycin and erythromycin resistance remained high, whereas co-trimoxazole susceptibility ranged from 76% to 100%. These findings confirm ST59 as the dominant clone and highlight the emergence of ST8 and ST45 in community-associated MRSA (CA-MRSA) infections. Oral co-trimoxazole remains the most effective empirical option, while clindamycin and erythromycin should be avoided. Continuous molecular surveillance is warranted to monitor trends and guide treatment strategies in pediatric MRSA infections.

Acinetobacter baumannii is a major pathogen in neonatal intensive care units, particularly affecting extremely premature infants and posing challenges due to its extensively drug-resistant (XDR) or pan-drug-resistant (PDR) profiles. This report describes the successful treatment of two extremely premature neonates with severe, XDR/PDR A. baumannii infections using combination therapy of colistin, tigecycline, and cefoperazone/sulbactam. The first case involved a 26-week gestation neonate with ventilator-associated pneumonia unresponsive to initial therapy. The infant was successfully extubated after a tailored regimen. The second case, a 26-week neonate with XDR A. baumannii bacteremia and septic shock, presented with complications including necrotizing enterocolitis. Despite these challenges, the infant recovered fully after the combination therapy, with no long-term sequelae observed. These findings emphasize the potential of combination therapy as a life-saving intervention for critically ill neonates with multidrug-resistant A. baumannii infections, highlighting the need for further research to refine therapeutic strategies in this vulnerable population.

Epidural analgesia (EA) is widely used during labor and frequently associated with maternal intrapartum fever, often prompting neonatal sepsis evaluations. Data from East Asia is scarce; we evaluated whether EA is associated with increased neonatal infection risk and related complications in a Taiwanese cohort. This retrospective cohort study included 2375 full-term, singleton vaginal deliveries at a tertiary medical center in Northern Taiwan from 2018 to 2021. Neonatal outcomes were compared between mothers who received EA and those who did not. Neonatal infection was operationalized as admission to the NICU for suspected infection, and prolonged antibiotic therapy (>48 h) was evaluated as a secondary outcome. Neonates in the EA group had a slightly higher rate of NICU admission for suspected infection than non-EA infants (4.04% vs 2.81%; p = 0.157), but this difference was not statistically significant. Maternal intrapartum fever occurred significantly more often with EA (28.3% vs 11.4%; p < 0.001), whereas neonatal fever was rare and similar between groups (1.79% vs 1.58%), and only one infant had culture-confirmed infection. In the NICU subgroup (EA N = 63; non-EA N = 23), low Apgar scores and meconium aspiration occurred only in EA-exposed infants, but these rare events and neonatal fever were not independently associated with EA in exploratory Firth logistic regression. Stratified analyses instead suggested that maternal intrapartum fever, rather than EA exposure, was more closely linked to neonatal fever. In this cohort, EA was associated with frequent precautionary neonatal sepsis evaluation without an increase in culture-confirmed infection. Potential residual confounding suggests that these findings should be interpreted as exploratory rather than causal. These findings highlight the need for cautious evaluation to prevent unnecessary antibiotic use in neonates.