IgG4-related autoimmune pancreatitis and sclerosing cholangitis: A case report and literature review.

RATIONALE: Immunoglobulin G4-related disease (IgG4-RD) can involve various organs throughout the body, primarily manifesting as endocrine dysfunction, visual impairment, jaundice, and limited sexual function. IgG4-related autoimmune pancreatitis is triggered by autoimmune reactions and characterized by structural changes in the pancreas and pancreatic ducts. The disease mainly affects middle-aged and elderly males, typically presenting as progressive painless jaundice and misdiagnosed as cholangiocarcinoma or pancreatic cancer. PATIENT CONCERNS: This study reports a 54-year-old male who consulted with different institutions multiple times due to diabetes, pancreatitis, elevated liver enzymes, and jaundice. DIAGNOSES: Magnetic resonance imaging revealed swollen head of the pancreas and atrophic tail. Liver and pancreatic tissue pathology showed IgG4 plasma cell infiltration, while liver biopsy indicated interface hepatitis, liver fibrosis, and pseudolobule formation, with no evidence of bile duct damage. INTERVENTIONS: Following hormone therapy, the patient's serum IgG4 levels and liver enzyme levels returned to normal. OUTCOMES: The disease relapsed 2 years after maintaining hormone therapy, and the patient underwent additional hormone-induced remission therapy combined with azathioprine. LESSONS: The purpose of this research report is to enhance the awareness and understanding of IgG4-RD, emphasizing the necessity for personalized treatment strategies that take into account its recurrence, associations, and imaging features. This report provides valuable insights and guidance for clinicians in managing and diagnosing patients with IgG4-RD.

Anesthetic management for emergency cesarean section in a patient with status epilepticus: A case report.

RATIONALE: The presence of clinically significant repeated maternal epilepsies during pregnancy increases the risk of adverse maternal, fetal and neonatal outcomes. However, there are few guidelines for anesthesiologists to deal with this situation. PATIENT CONCERNS AND DIAGNOSES: A 28-year-old primigravida was transferred to the operating room for emergency cesarean section. Based on the patient's complaints and clinical appearance, provisional diagnosis of preeclampsia at 33 weeks' gestation as well as frequent and repeated grand mal convulsions at 14 years of age were considered. The anesthetic modalities of the disease are also discussed. INTERVENTIONS AND OUTCOMES: Because the usual antiepileptic therapy had failed, the patient with status epilepticus underwent surgery under general anesthesia. The newborn was handed to the pediatrician and the patient was transferred to the intensive care unit for further observation and discharged 4 days later. No peri-operative or anesthetic complications were observed. LESSONS: Providing anesthesia to patients undergoing cesarean section poses major challenges for anesthesiologists. Close monitoring and proper treatment can help reduce risks for both the mother and baby.

The influence of lightning activity on NOx and O3 in the Pearl River Delta region.

Extremely high-temperature lightning generates NOx by electrolyzing nitrogen and oxygen molecules, regulating ozone concentration. The Pearl River Delta (PRD) is located in the world's high-value area of lightning density, and lightning-generated NOx (LNOx) cannot be ignored. Using the flash data from Guangdong-Hong Kong-Macao Lightning Location System and multi-site atmospheric composition data, we estimate the NOx variations in lightning activity and its impact on O3 across the PRD region. The cloud-to-groud (CG) frequency from 2013 to 2021 shows a decreasing trend driven by urban regions. We observe that the lightning density is steadily decreasing from the south-central part of Guangzhou City to the surrounding area. A comparison of the different sites with lightning days and non-lightning days shows that a significant amount (13. 84-20. 47 %) of ground-level NOx concentration at urban stations can be attributed to lightning NOx emissions. A lower lightning frequency and low background concentration observed at suburban sites indicated a limited contribution of LNOx. The average decrease in O3 concentration at urban stations (15.92-25.06 %) was significantly higher than that at suburban stations (5.34-8.95 %) due to the influence of titration and lower actinic radiation. There was a greater fluctuation in NOx and O3 concentrations during the cases, and the surface NOx concentration displayed the most significant responsiveness to LNOx under direct lightning striking in the tall tower. This phenomenon has not been reported, however, it is consistent with the laboratory-based observations suggesting the amount of LNO increases with peak current. LNOx significantly impacts air quality in the PRD during the high convective season. Further in situ and vertical distribution observations are necessary to explore the ground-level impact of LNOx.

Comprehensive analysis of single-cell RNA-seq and bulk RNA-seq revealed the heterogeneity and convergence of the immune microenvironment in renal cell carcinoma.

Substantial progress has been made in cancer biology and treatment in recent years, but the clinical outcome of patients with renal cell carcinoma (RCC) remains unsatisfactory. The tumor microenvironment (TME) is a potential target. By analyzing single-cell RNA sequencing (sc-RNAseq) data from six RCC tumor samples, this study identified 11 different cell types in the RCC cellular microenvironment, indicating a high degree of intratumoral heterogeneity. Through re-dimensionality reduction clustering of epithelial cells, neutrophils, macrophages, and T cells, we deeply reveal differences in the RCC tumor microenvironment. By analyzing differentially expressed genes in normal epithelial cells and malignant epithelial cells, we identify RNASET2 and GATM as potential prognostic biomarkers in RCC. In addition, by transcriptional factor analysis, we found significant differences in the expression of GZMK-CD8 T cell and B cell transcription factors between cancer tissues and normal tissues. By cell correlation analysis, we found significant correlations between neutrophils and macrophages and between IL7R-CD4 T cells and T regulatory (Treg) cells in RCC, which may be involved in the formation of immune TMEs. By cell developmental trajectory analysis, we showed that macrophages may be derived from neutrophils, whereas Treg cells may be derived from IL7R-CD4 T cells. By cell communication analysis, we found a clear interaction between macrophages and endothelial cells, neutrophils, and GZMK-CD8 T cells. In addition, we found that ADGRE5 signaling was mainly derived from mast cells and GZMK-CD8 T cells, and had a significant communication effect with neutrophils. The COLLAGEN signaling pathway is mainly derived from fibroblasts and has a significant communication effect with mast cells. Finally, we verified that RNASET2, which is highly expressed in epithelial cells, promotes proliferation and migration of RCC in vitro. RNASET2 is likely to be a potential target for renal cell carcinoma therapy. The results based on sc-RNAseq data analysis help to further elucidate the cellular microenvironment of RCC and provide help for cancer heterogeneity studies. This will help to provide more accurate personalized treatment for patients in clinical diagnosis.

Cathelicidin LL-37 promotes EMT, migration and metastasis of hepatocellular carcinoma cells in vitro and mouse model.

The effect of cathelicidin hCAP18/LL-37 in hepatocellular carcinoma (HCC) metastasis remains unclear. Here, we confirmed that LL-37 expression enhanced endothelial-mesenchymal transition (EMT), migration and invasion in HCC cells. And the HER2/EGFR-MAPK/ERK signal participated in the process above. More frequent lung metastases were observed in an LL-37-overexpressing hematogenous metastasis model. Interestingly, 1,25(OH)2D3 together with si-LL-37 significantly enhanced 1,25(OH)2D3-induced inhibition of migration and invasion in PLC/PRF-5 cells, and also enhanced reversion of the EMT process. Therefore, LL-37 is involved in HCC metastases, and may act as an important factor to attenuate the inhibitory activity of 1,25(OH)2D3 on HCC metastasis. Targeting hCAP18/LL-37 may offer a potential strategy to improve the anticancer activity of 1,25(OH)2D3 in HCC therapy.

Intestinal Ecology Changes in Diarrheic Père David's Deer Revealed by Gut Microbiota and Fecal Metabolites Analysis.

Diarrhea is one of the most common diseases affecting the health of Père David's deer (Elaphurus davidianus). It is believed that an imbalanced intestinal ecology contributes to the etiology of the condition. However, little is known about how the intestinal ecology changes in these diarrheic animals. In this study, 16S rRNA gene sequencing and ultra-high performance liquid chromatography combined with tandem mass spectrometry (UPLC-MS/MS) were used to investigate the gut microbiota and fecal metabolites in five Père David's deer with diarrhea. The results showed that when compared with healthy individuals, considerable changes in the gut microbiome were observed in diarrheic animals, including a significant reduction in microbial diversity and gut microbiota composition alterations. Furthermore, the profiles of numerous fecal metabolites were altered in diarrheic individuals, showing large-scale metabolite dysregulation. Among metabolites, acylcarnitines, lysophosphatidylcholine, bile acids, and oxidized lipids were elevated significantly. Constantly, several metabolic pathways were significantly altered. Interestingly, predicted metabolic pathways based on 16S rRNA gene sequence and differential metabolite analysis showed that lipid metabolism, cofactor, and vitamin metabolism were altered in sick animals, indicating microbiota-host crosstalk in these deer. When combined, the results provide the first comprehensive description of an intestinal microbiome and metabolic imbalance in diarrheic Père David's deer, which advances our understanding and potential future treatment of diarrheic animals.

Cathelicidin hCAP18/LL-37 promotes cell proliferation and suppresses antitumor activity of 1,25(OH)2D3 in hepatocellular carcinoma.

Cathelicidin hCAP18/LL-37 can resist infection from various pathogens and is an essential component of the human immune system. Accumulating evidence has indicated that hCAP18/LL-37 plays a tissue-specific role in human cancer. However, its function in hepatocellular carcinoma (HCC) is poorly understood. The present study investigated the effects of hCAP18/LL-37 on HCC in vitro and in vivo. Results showed that hCAP18/LL-37 overexpression significantly promoted the proliferation of cultured HCC cells and the growth of PLC/PRF-5 xenograft tumor. Transcriptome sequencing analyses revealed that the PI3K/Akt pathway was the most significant upregulated pathway induced by LL-37 overexpression. Further analysis demonstrated that hCAP18/LL-37 stimulated the phosphorylation of EGFR/HER2 and activated the PI3K/Akt pathway in HCC cells. Furthermore, stronger EGFR/HER2/Akt signals were observed in the PLC/PRF-5LL-37 xenograft tumor. Interestingly, even though the expression of hCAP18/LL-37 was significantly downregulated in HCC cells and tumors, 1,25(OH)2D3 treatment significantly upregulated the hCAP18/LL-37 level both in HCC cells and xenograft tumors. Moreover, 1,25(OH)2D3 together with si-LL-37 significantly enhanced the antitumor activity of 1,25(OH)2D3 in the PLC/PRF-5 xenograft tumor. Collectively, these data suggest that hCAP18/LL-37 promotes HCC cells proliferation through stimulation of the EGFR/HER2/Akt signals and appears to suppress the antitumor activity of 1,25(OH)2D3 in HCC xenograft tumor. This implies that hCAP18/LL-37 may be an important target when aiming to improve the antitumor activity of 1,25(OH)2D3 supplementation therapy in HCC.

Characteristics of boundary layer ozone and its effect on surface ozone concentration in Shenzhen, China: A case study.

In late September 2019, the longest and most extensive ozone (O3) pollution process occurred at Pearl River Delta. Base on the observational data, surface-level O3, vertical distribution characteristics boundary layer O3 as well as its effect on surface-level O3 are thoroughly analyzed. The O3 lidar results showed similar vertical O3 profiles both in pollution episodes and clean periods, from which a high O3 concentration layer between 300 and 500 m and a sub-high O3 concentration layer between 1300 and 1700 m (near the top of the mixing layer) can be found. Besides, the downward O3 transport paths from the high/sub-high O3 concentration layers could be observed along with the boundary layer evolution: At nighttime, large amounts of O3 were effectively stored into the residual layer (RL). Due to the upward development of Mixing layer (ML) in early morning, atmospheric vertical mixing carried the O3 inside the RL down to the surface, which led to a rapid increase in the surface-level O3. The sub-high O3 layer began the downward mixing at noon, and became well-mixed after the boundary layer was fully developed in the afternoon, by which the near surface O3 pollution deteriorated again. Further analysis of the heavy O3 pollution episodes show that, the high O3 concentration inside the RL contributed 54% ± 6% of the surface-level O3 at 9:00 LT and the average contribution of O3 in the sub-high concentration layer to the surface-level O3 at 14:00 LT was 26% ± 9%. Based on the quantitative analysis of the observational data, this paper focus to reveal the importance of the contribution of O3 inside the RL and near the top of the ML to the surface O3.

Patterns of immune infiltration in gastric cancer and their clinical significance.

OBJECTIVE: The malignant phenotypes of cancer are defined not only by its intrinsic tumor cells but also by the tumor-infiltrating immune cells activated and recruited to the cancer microenvironment. However, a comprehensive introduction of gastric cancer immune cell infiltration has not been identified so far. METHODS: In this study, we comprehensively analyzed the tumor-infiltrating immune cells abundance in gastric cancer for the first time by CIBERSORT. The meta-analysis, single-sample gene set enrichment analysis and hierarchical agglomerative clustering were used to measure and evaluate the respective proportions of 22 cell types of immune infiltration using normalized gene expression data. The fraction of tumor-infiltrating immune cells subpopulations was also evaluated to determine the associations with clinical features and molecular subtypes. RESULTS: Tumor-infiltrating immune cells are extensively involved in the pathogenesis and development of the gastric cancer. We discovered Tfh and activated CD4+ memory T cells were associated with poorer overall survival and Progression-free survival (PFS), but that naïve B cells were opposite for PFS. Unsupervised clustering analysis revealed there existed three tumor-infiltrating immune cells subgroups with distinct survival patterns. Specially, cluster 1 showed significantly better clinical outcome than other two clusters. CONCLUSIONS: Collectively, our data explored the differences of tumor-infiltrating immune cells in gastric cancer, and these variations were likely to be important clues for prognosis and management of its future clinical implementation.