OBJECTIVE: In this case series, we present 5 cases of autoimmune rheumatic disease onset shortly after receiving mRNA vaccination against coronavirus disease 2019 (COVID-19).
METHODS: We identified 5 patients from Brooke Army Medical Center who developed new manifestations of rheumatic disease following the second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccinations. All patients were initially seen in primary care and then referred to rheumatology for further evaluation and management. Clinical data were obtained through review of the electronic medical record.
RESULTS: Three cases involve elderly women with insidious onset of symmetric wrist and hand polyarthritis with seropositivity for rheumatoid factor. One case involves an elderly woman with a subacute onset of lower extremity-predominant, symmetric polyarthritis. One case involves an elderly man with insidious onset of bilateral shoulder and hip stiffness and arthralgias in the setting of elevated erythrocyte sedimentation rate and a rapid response to glucocorticoid therapy.
CONCLUSIONS: Whether there exists a causal or contributory relationship between COVID-19 mRNA vaccination and the development of autoimmune rheumatic disease remains to be determined. Ultimately, further research is needed to establish if there is a true connection between the two.

BACKGROUND: Safety concerns, caused by complex and unpredictable adulterants, run through the entire industrial chain of traditional Chinese medicines (TCMs). However, the conventional circulation traceability system only focuses on a certain end or link at the back end of the TCM industrial chain, ignoring the integrity of the links cross the entire industrial chain and lacking traceability. In consequence, a strict and rational supervision system is urgently required for the entire industrial chain.
OBJECTIVE: We hypothesize that DNA barcoding would be a suitable measure for the traceability of adulterants in the entire TCM industrial chain.
METHODS: In this study, Rhei Radix et Rhizoma was selected as a model to establish a traceability system for the entire TCM industrial chain. A total of 110 samples, including leaves, seeds, roots, decoction pieces, and traditional Chinese patent medicines (TCPMs), were collected upstream, midstream, and downstream of the entire industrial chain of Rhei Radix et Rhizoma. The ndhF-rpl32 fragment rather than the universal DNA barcodes, which could not distinguish the three original species of Rhei Radix et Rhizoma, was selected as a specific DNA barcode to evaluate the practical application of DNA barcoding in the chain.
RESULTS: The results showed that the ndhF-rpl32 fragment in all samples could be amplified and bi-directionally sequenced. Based on the standard operating procedures of DNA barcoding, the ndhF-rpl32 fragment clearly distinguished the seven Rheum species collected upstream of the entire industrial chain. For the samples collected midstream and downstream of the entire industrial chain, 25% of the 36 commercial decoction pieces samples were identified as adulterants, whereas the eight TCPM samples were all derived from genuine Rhei Radix et Rhizoma.
CONCLUSIONS: This study shows that DNA barcoding is a powerful and suitable technology that can be applied to trace TCMs in the entire industrial chain, thereby assuring clinical medication safety.

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An integrated strategy based on characteristic fragment filter (CFF) supplemented by multivariate statistical analysis (MSA) for MSn chromatograms [(CFF)s MSA] was proposed for the large-scale detection of natural plant-derived ingredients in vivo. To prove the practicability of this [(CFF)s MSA] strategy, rhubarb was taken as an example. First, representative authentic standards of homologous components contained in rhubarb were chosen, from which the fragmentation rules and chemical characteristic fragments (CCFs) were proposed. Second, the metabolic pathways of the representative compounds were deciphered, and the metabolic characteristic fragments (MCFs) of each family of compounds were acquired. Third, combined with CCFs and MCFs, a CFF method was established. Finally, MSA was used to supplement the xenobiotics missed by the CFF method. In our research, 274 compounds were detected in rhubarb, and 298 ingredients were identified in vivo after oral administration. The results demonstrated that this integrated strategy could comprehensively screen for plant-derived compounds in vivo.

Amyloid beta (1-42) peptide is considered responsible for the formation of senile plaques that accumulate in the brains of patients with Alzheimer\'s disease (AD). In the last years considerable attention has been focused on identifying natural food products, such as phytochemicals that prevent or almost retard the appearance of amyloid beta (1-42)-related neurotoxic effects. In this study, human neuroblastoma cells (IMR-32) was used as system model to evaluate the protective role of rhaponticin (3,3\',5-trihydroxy-4\'-methoxystilbene 3-O-d-glucoside) a stilbene glucoside extracted from rhubarb roots (Rhei rhizoma) and rhapontigenin, its aglycone metabolite, against amyloid beta (1-42)-dependent toxicity. The obtained results show that rhapontigenin maintains significant cell viability in a dose-dependent manner and it exerts a protective effect on mitochondrial functionality, as evidenced by mitochondrial oxygen consumption experiments. A similar behaviour, but to a lesser extent, has been shown by rhaponticin. The protective mechanism mediated by the two stilbenes could be related to their effect on bcl-2 gene family expression. Bax, a pro-apoptotic gene, resulted down-regulated by the treatment with rhaponticin and rhapontigenin compared with the results obtained in the presence of amyloid beta (1-42) peptide. Conversely, bcl-2, an anti-apoptotic gene, highly down-regulated by amyloid beta (1-42) treatment, resulted expressed in the presence of stilbenes similarly to that shown by control cells. The obtained results support the hypothesis that amyloid beta (1-42)-induced neurotoxicity occurs via bax over-expression, bcl-2 down-regulation, firstly indicating that rhaponticin and its aglycone moiety may alter this cell death pathway. Based on these studies, we suggest that rhaponticin and its main metabolite could be developed as agents for the management of AD.

In the course of industrial-scale manufacture of unfermented rhubarb fruit juice, the deacidifying agent CaCl2 was confused with the disinfectant NH4HF2. Hence, fluoride in a quantity of up to 0.6 g/l was present in the unfermented fruit juice. Signs of acute fluoride poisoning were therefore seen after ingestion of the rhubarb juice. The incident as well as the steps taken by the relevant control authorities are described in detail.