Gastric emptying effect of the aqueous extract of xiao-ban-xia-tang (XBXT) was investigated in mice. Mice with food deprived for 18 hours were orally administered a certain amount of test meal (ca. 0.8 g) equaling 0.8 ml in volume. The percentage of 0.8 g test meal remaining in the stomach after 20 minutes was estimated. It was shown that XBXT significantly antagonized dopamine- (0.56 mg/kg, i.p.), not atropine- (0.3 mg/kg, i.p.), induced gastric emptying inhibition. It also significantly restored metoclopramide-induced (8 mg/kg, p.o.) propulsion and potentiated methylneostigmine-induced (2 mg/kg, p.o.) gastric emptying enhancement. The aqueous extract of Pinellia ternata, but not that of Zingiber officinale showed an inhibitory activity on gastric emptying. The present results suggest that XBXT possesses a regulative effect on gastric motility.

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Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune inflammatory disease characterized by infiltration of IgG4+ plasma cells that can simulate a tumor manifesting as a tumor-like mass. This disease involves the pancreas, biliary tract, kidneys, salivary glands, lymph nodes, aorta, and retroperitoneum amongst other organs. However, testicular involvement is a rare entity in this disease. The treatment of testicular involvement in IgG4-RD is currently controversial. We present the case of a 65-year-old man with swelling and pain in his right scrotum three months ago. On examination, a mobile mass of approximately 2 cm in diameter was found in the right scrotum. Serological tests showed elevated levels of IgG4 and negative for tumor markers. Enhanced computed tomography of the scrotum showed a nodular hyperdense shadow with a diameter of approximately 23 mm on the right epididymis. Pathological biopsy of the right epididymis showed infiltration of plasma cells, lymphocytes, and a few neutrophils. IgG4+ plasma cells stained positive, with an IgG4/IgG ratio of more than 40% and more than 30 IgG4+ plasma cells per high-power field. A diagnosis of IgG4-RD involving the testicles was made. Prednisone 30 mg/d was given for three weeks. No scrotum swelling or pain was observed at the follow-up after six months. IgG4-related disease should be considered whenever a mass-like lesion with typical histomorphologic features involving multiple organs/anatomical sites is encountered. The testicles are an important male reproductive organ, especially for young male patients with fertility requirements. For patients with IgG4-RD testicular involvement, surgical or medical treatment requires further study.

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We read with great interest the recent retrospective analysis by Fan and colleagues on the outcomes of tofacitinib (TOF) or tacrolimus (TAC) in combination with glucocorticoids for melanoma differentiation-associated gene 5 (MDA5)-related interstitial lung disease (MDA5-ILD), published inThe Journal of Rheumatology.1The authors mainly investigated whether TOF exposure was associated with reduced mortality at 6 months and 1 year, and also compared the incidence of adverse events and discontinuation rates in the TOF and TAC groups for the treatment of MDA5-ILD.

We read with great interest the recent population-based cohort study by Kodishala and colleagues inThe Journal of Rheumatologyon risk factors for the development of dementia in patients with incident rheumatoid arthritis (RA).1The authors reached the conclusion that clinically active RA and the presence of cardiovascular (CV) disease are associated with an elevated risk of developing dementia incidence in patients with RA, in addition to age, hypertension, depression, and anxiety, which are universally recognized risk factors for dementia.

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Rationale: Hydroxychloroquine has excellent anti-inflammatory and immunomodulatory effects as one of the antimalarial drugs. In particular, hydroxychloroquine was once widely used as a treatment for the new coronavirus pneumonia epidemic in 2020. Retinopathy caused by hydroxychloroquine is normally irreversible, but little attention has been paid to it. Patient concerns: A 38-year-old young Chinese woman was taking oral hydroxychloroquine 400 mg daily to control lupus disease activity for six years after the diagnosis of systemic lupus erythematosus (SLE). She did not have any history of eye disease and was admitted to the hospital with a sudden blurring of both eyes. Diagnoses: The diagnosis of retinal macular degeneration caused by hydroxychloroquine was made after excluding other interfering diseases based on the patient's long-term use of hydroxychloroquine and the results of the eye examination. Interventions: The patient was discontinued from hydroxychloroquine. To control the recurrence of SLE, she was given intravenous methylprednisolone, oral tacrolimus and mycophenolate. Meanwhile, she was asked to take extra care of her eyes and to come to the hospital every three months to have her vision checked. Outcomes: The patient's blurred vision improved one week later. Three months later, her vision examination showed no further decline (0.4 in the right eye and 0.6 in the left eye). Meanwhile, the SLE disease activity index (SLEDAI) decreased from six points to five points currently. Lessons: Retinopathy caused by hydroxychloroquine is irreversible and there is no particularly effective treatment. Discontinuation of hydroxychloroquine, better daily eye protection, and regular vision checks are the keys to preventing retinopathy. Although hydroxychloroquine causing retinal toxicity was mentioned several years ago, the rate and severity of retinal toxicity require further research. How to get more patients to take care of their eyes requires continuous and increased education by doctors.