IgG4-Related Disease in a 90-Year-Old Man with an 18-Year Disease Course: A Case Report.

IgG4-related disease (IgG4-RD) is a multi-organ inflammatory immune-mediated illness caused by IgG4-secreting plasma cells infiltrating the tissue. This condition usually affects elderly men. A 90-year-old Chinese male was diagnosed with IgG4-RD based on the new 2019 ACR/EULAR classification criteria, as he had multiple organ involvement. After receiving treatment with glucocorticoids, leflunomide, and gamma-globulin, the patient's clinical symptoms significantly improved, confirming the accuracy of the diagnosis. The patient had an 18-year medical history during which the disease progressively worsened due to delayed diagnosis and treatment. Although the relevant symptoms were alleviated with appropriate medication, the overall treatment process encountered challenges. Due to the patient's relative lack of adrenocortical function, he experienced symptoms such as nausea, exhaustion, and loss of appetite during the hormone reduction process. Therefore, timely intervention is especially crucial to address the side effects of hormone therapy.

Secondary adrenocortical insufficiency after treatment with retifanlimab: a case report.

With advancements in medical oncology, immune checkpoint inhibitors (ICIs) have become the first-line treatment for many malignancies. ICIs play a significant role in improving cancer prognosis, but a series of immune-related adverse events (irAEs), including immune-related endocrine events (irEEs), caused by ICIs have also aroused concerns. Rapid clinical identification of irAEs caused by ICIs is particularly important. We describe a case of secondary adrenocortical insufficiency (AI) after PD-1 treatment in a postoperative patient with endometrial cancer. A 73-year-old female patient developed anorexia, nausea, vomiting, malaise, electrolyte disturbances, ineffective symptomatic treatment, and decreased serum adrenocorticotropin and cortisol levels six months after retifanlimab treatment. The vomiting resolved, and the electrolyte levels were corrected after 3 days of treatment with glucocorticoids (hydrocortisone, intravenous, 200 mg/day). When patients present with gastrointestinal symptoms, such as poor appetite and nausea, not only symptomatic treatment but also a search for the etiology behind the symptoms is needed, especially in immunotherapy patients who should undergo a thorough evaluation of the endocrine system and be alert for adrenocortical insufficiency.

Hypophysitis after COVID-19 vaccination in a patient with Rathke's cleft cyst: A case report.

With the widespread vaccination of COVID-19 vaccine, a few cases have been reported that COVID-19 vaccine may cause endocrine disorders. A 59-y-old man presented with a loss of appetite after the first COVID-19 vaccination, which resolved spontaneously after 3 d. After the second COVID-19 vaccination, the symptoms including the loss of appetite, nausea, and vomiting reappeared and worsened along with loss of vision. He was found to have severe hyponatremia, and further investigations revealed secondary adrenal insufficiency, secondary hypothyroidism and Rathke's cleft cyst. The patient responded well to glucocorticoid and levothyroxine supplementation, and at 1-y follow-up the patient developed hypogonadism. We hypothesize that hypophysitis is probably induced by COVID-19 vaccine and report the rare but serious adverse reactions for early recognition and intervention.

Case report: POEMS syndrome masquerades as diabetic foot.

We present the case of a 54-year-old woman with reasonable blood sugar control who presented with a diabetic foot combined with severe peripheral neuropathy and vascular disease. Lower limb muscle weakness, muscle atrophy, skin pigmentation, and emaciation were also observed. Although her muscle strength improved after glucocorticoid treatment, it remained challenging to account for the other symptoms in this particular patient with chronic inflammatory demyelinating polyneuropathy. Plump liver and spleen, hidden bone lesions combined with seemingly unexplained cerebral infarction, and serous effusion led us to suspect polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. The abnormal proliferation of monoclonal plasma cells and a significant increase in vascular endothelial growth factor (VEGF) levels confirmed the diagnosis of POEMS syndrome. After 1 month of treatment with lenalidomide and dexamethasone, the diabetic foot ulcers healed, and the symptoms of myasthenia and fatigue improved. Diabetic feet may represent only the tip of the iceberg of an underlying POEMS syndrome. Our report aimed to increase awareness of this rare yet significant situation, advocating for the prompt identification and treatment of POEMS syndrome.

Primary Ewing's sarcoma/primitive neuroectodermal tumor of the ileum: case report of a 16-year-old Chinese female and literature review.

BACKGROUND: Ewing's sarcoma (ES) and primitive neuroectodermal tumors (PNET) are closely related tumors. Although soft tissue ES/PNET are common in clinical practice, they are rare in the small intestine. Because of the absence of characteristic clinical symptoms, they are easily misdiagnosed as other benign or malignant diseases. CASE PRESENTATION: Here, we present the case of a 16-year-old female who complained of anemia and interval hematochezia. Her serum test results showed only a slight elevation of CA-125 and a low level of hemoglobin. Computer tomography and magnetic resonance imaging revealed a cystic and solid mass in the lower abdominal quadrant and pelvic region, which prompted suspicion of a malignant gastrointestinal stromal tumor of the small intestine. After resection, the tumor's histology and immunohistochemistry (positive for CD99, vimentin and synaptophysin) results suggested ES/PNET. Fluorescent in situ hybridization tests proved the breakpoint rearrangement of the EWSR1 gene in chr 22.Ultrastructural analysis revealed neurosecretory and glycogen granules in the tumor cell cytoplasm. CONCLUSIONS: Together, these data supported the diagnosis of a rare case of localized ES/PNET in the small intestine without adjuvant chemo- or radiotherapy. To our knowledge, this is the first report from China of a primary small bowel ES/PNET in the English-language literature. In addition, on the basis of findings from previous publications and the current case, the optimal treatment for localized gastrointestinal ES/PNET is discussed.

Superior anti-CO poisoning capability: Au-decorated PtFe nanocatalysts for high-performance methanol oxidation.

Herein we demonstrate a surface engineering strategy, namely, decorating Au on the surface of bimetallic PtFe nanocatalysts, to effectively decrease the adsorption energy of CO on the Pt center, which promotes the electrocatalytic activity towards methanol oxidation, far better than those of PtFe and commercial Pt/C catalysts.

Single-Crystalline Ultrathin Nickel Nanosheets Array from In†Situ Topotactic Reduction for Active and Stable Electrocatalysis.

Simultaneously synthesizing and structuring atomically thick or ultrathin 2D non-precious metal nanocrystal may offer a new class of materials to replace the state-of-art noble-metal electrocatalysts; however, the synthetic strategy is the bottleneck which should be urgently solved. Here we report the synthesis of an ultrathin nickel nanosheet array (Ni-NSA) through in situ topotactic reduction from Ni(OH)2 array precursors. The Ni nanosheets showed a single-crystalline lamellar structure with only ten atomic layers in thickness and an exposed (111) facet. Combined with a superaerophobic (low bubble adhesive) arrayed structure the Ni-NSAs exhibited a dramatic enhancement on both activity and stability towards the hydrazine-oxidation reaction (HzOR) relative to platinum. Furthermore, the partial oxidization of Ni-NSAs in ambient atmosphere resulted in effective water-splitting electrocatalysts for the hydrogen-evolution reaction (HER).

Risk factors for brain metastases in completely resected small cell lung cancer: a retrospective study to identify patients most likely to benefit from prophylactic cranial irradiation.

BACKGROUND: The role of prophylactic cranial irradiation (PCI) on small cell lung cancer (SCLC) has been established based on the two-stage system of limited versus extensive disease and the treatment modality of chemoradiotherapy. However, the use of PCI after combined-modality treatment with surgery for resectable limited-stage SCLC has not been investigated sufficiently. We conducted a retrospective study to evaluate risk factors for brain metastasis (BM) in patients with surgically resected SCLC to identify those most likely to benefit from PCI. PATIENTS AND METHODS: The records of 126 patients with completely resected SCLC and definitive TNM stage based on histological examination between 2003 and 2009 were reviewed. The cumulative incidence of BM was estimated using the Kaplan-Meier method and differences between the groups were analyzed using the log-rank test. Multivariate Cox regression analysis was applied to assess the risk factors of BM. RESULTS: Twenty-eight patients (22.2%) developed BM at some point during their clinical course. The actuarial risk of developing BM at 3 years was 9.7% in patients with p-stage I disease, 18.5% in patients with p-stage II disease, and 35.4% in patients with p-stage III disease (p = 0.013). The actuarial risk of developing BM at 3 years in patients with LVI was 39.9% compared to 17.5% in patients without LVI (p = 0.003). Multivariate analysis identified pathologic stage (hazard ratio [HR] = 2.013, p = 0.017) and LVI (HR = 1.924, p = 0.039) as independent factors related to increased risk of developing BM. CONCLUSION: Patients with completely resected p-stage II-III SCLC and LVI are at the highest risk for BM.

Ultrathin dendritic Pt3Cu triangular pyramid caps with enhanced electrocatalytic activity.

Here we report on the synthesis of novel dendritic Pt3Cu triangular pyramid caps via a solvothermal coreduction method. These caps had three-dimensional caved structures with ultrathin branches, as evidenced by high-resolution transmission electron microscopy (HRTEM) and HAADF-STEM characterization. Tuning the reduction kinetics of two metal precursors by an iodide ion was believed to be the key for the formation of an alloyed nanostructure. Electro-oxidation of methanol and formic acid showed dramatically improved electrocatalytic activities and poison-tolerance for these nanoalloys as compared to commercial Pt/C catalysts, which was attributed to their unique open porous structure with interconnected network, ultrahigh surface areas, as well as synergetic effect of the two metallic components.

[Spinal fixed-point rotating reduction in treating lumbar disc herniation by three-dimensional MRI].

OBJECTIVE: To observe three-dimensional space position change of nucleus pulposus and nerve root before and after treatment of lumbar disc herniation by spinal fixed-point rotating reduction, and explore the mechanisms. METHODS: Totally 52 patients with L5S1 lumbar disc hernation treated by spinal fixed-point rotating reduction were collected from April 2009 to June 2011. There were 33 males and 19 females with an average age of 34.6 years old (ranged, 19 to 55). Three-dimensional MRI were performed to observe relationship between nucleus pulposus and related nerve root,configuration change of spine and pelvic on coronary MRI. RESULTS: MRI showed relationship between nucleus pulposus and related nerve root mainly located on axillary, shoulder, front and surround. Vertebral displacement disappeared, lumbocrural pain alleviated after manipulative therapy. All patients were followed up from 2 to 28 months with an average of 12 months, and no recurred. All patients recovered work. Nucleus pulposus had no change,while lumbral spinal and pelvic curve changed before and after admission. CONCLUSION: Lumbar disc herniation combined with single (multiple) vertebral displacement,can cause biomechanical properties of nucleus puplosus and related nerve root, while spinal fixed-point rotating reduction can correct vertebral displacement, recover balance between inside and outside of spinal.

[Study on the mechanism of Feng's spinal manipulation for treatment of lumbar disk hernation with a calcified herniated mass using 3D CT].

OBJECTIVE: To measure position changes of lumber disk herniation before and after treatment of Feng's spinal manipulation to study the mechanism of the manipulation for lumber disk herniation. METHODS: In 2010, 8 patients with lumber disk herniation were treated by Feng's spinal manipulation, including 3 males and 5 females who ranged in age from 14 to 53 years with a mean of 35.4 years. The patients received CT scan before and after treatment. All images were reconstructed to measure the distance between the apex of the calcified lumber disk herniation and the top of the next adjacent spinal process. RESULTS: The position of calcified lumber disk herniation underwent change after Feng's spinal manipulation, with a slight subluxation between the two adjacent vertebrae. CONCLUSION: If subluxation is restored,the relation between the nerve root and the hernation will undergo change, followed by subsequent change of the hernation mass, thus restoring the inner-outer balance of the spinal column system.

[Treatment of the lumbar disc herniation of sequestered type with Feng's spinal manipulation].

OBJECTIVE: To evaluate the clinical effect of the treatment for sequestered type lumbar disk herniation (SLDH) with FENG's spinal manipulation. METHODS: Forty-one patients (27 male, 14 female) were treated by FENG's spinal manipulation. The clinical results were measured by the Japanese and FENG's lumbar treatment standard and evaluated by scoring system for assessment of treatment for low back pain between pre- and post-treatment. To measure MRI sagittal index (SI) of lumbar disc herniation between pre- and post-treatment. RESULTS: The score of subjective symptoms and clinical signs increased obviously after treatment. There was no statistical difference of SI between pre- and post-treatment (P<0.05). The outcome of treatment was satisfying. CONCLUSION: The major pathologic change of SLDH is the single/multiple vertebral subluxation. FENG's spinal manipulation can correct the vertebral subluxation which leading to the series of clinical manifestations. The good clinical outcome may due to the alleviation of distortion and tension of dura and nerve root with the recovery of the spinal column's stability.

[Pilot study on clinical application of hepatic perfusion with multi-slice spiral CT].

OBJECTIVE: To research the value of hepatic perfusion with multi-slice spiral CT in the diagnosis of liver diseases. METHODS: Among the 48 patients undergone dynamic CT of the liver, 20 were volunteers without hepatic disorder, 17 with cirrhosis, 11 suffered from hepatic cancer. The perfusion indexes were calculated and compared. RESULTS: (1) Compared with the control group, HPP (ml/min/ml), PPI and HPP/HAP of patients with cirrhosis were significant lower (HPP: 0.49+/-0.19 vs 0.60+/-0.16, P=0.038; PPI: 0.58+/-0.14 vs 0.67+/-0.06, P=0.015; HPP/HAP: 1.63+/-0.87 vs 2.12+/-0.65, P=0.04), whereas HPI was higher (0.42+/-0.14 vs 0.33+/-0.06, P= 0.015), which indicated the decrease of portal inflow and the increase of arterial inflow in cirrhosis patients. (2) Patients with hepatic cancer got a significant higher average HAP than that in volunteers and cirrhosis patients (F=11.71, P<0.001), while their HPP and HPP/HAP showed significant declining (F=22.84, P=0.0001; F=20.67, P<0.0001, respectively), which implied that hepatic cancer was mainly supplied by artery. CONCLUSIONS: Hepatic perfusion with multi-slice spiral CT is an non-invasive technique to evaluate the arterial and portal inflow separately, which can inflect the hemodynamic change of the lesion by the perfusion indexes, and identify the condition of the tissue round the lesion prior to morphologic change. This method shows important value of diagnosis and differential diagnosis in hepatic diseases.