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Background: Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disease that results in the tissue destruction of multiple organs. IgG4-RD is often underdiagnosed or misdiagnosed as malignant, infectious, or other inflammatory disorder. Case presentation: We describe a 56-year-old woman presented with jaundice and weight loss. Radiological imaging showed common hepatic duct wall thickening and nodular lesions in the pancreas, which was highly suspicious of malignancy. However, she was contraindicated for biopsy; hence, the diagnosis of IgG4-RD was made based on her high serum IgG4 level, multiorgan involvement, and steroid response. The effect of steroid therapy was significant, although the disease relapsed during the maintenance treatment. The dosage of steroid was re-increased, and the patient was under close follow-up. Conclusions: The diagnosis of IgG4-RD is challenging due to its diverse manifestations. Therefore, a careful systematic assessment is necessary to improve the accuracy of IgG4-RD diagnosis, and a close follow-up is important to monitor the disease development as well as adjust the treatment strategy accordingly.

Additional file 1. Fig. S1: Diurnal expression of Ehd1, OsphyB, and OsGI in GLA 4 and the osftl4 mutants under CLD and CSD conditions. Fig. S2 Protein sequence alignment of 14-3-3 proteins. Fig. S3 Analysis of OsFTL4 expression in ABA-treated rice seedlings. Fig. S4 Day length in Yangzhou and Lingshui during the period from sowing to flowering.

Autoimmune metaplastic atrophic gastritis (AMAG) is associated with an increased risk of gastric neoplasms. This study aimed to systematically analyze the incidence rate of gastric cancer (GC), low-grade dysplasia (LGD) and type-1 gastric neuroendocrine tumor (gNETs) development in AMAG adults. Studies on AMAG patients reporting the incidence of gastric neoplasms was identified through a systematic search in PUBMED and EMBASE. Study quality was assessed using the Joanna Briggs Institute quality assessment tool. Incidence rates of GC, LGD and type-1 gNETs were examined by meta-analysis. Thirteen studies met eligibility criteria. Incidence rate of gastric cancer calculated from the pooled data was 0.14% per person-year in both single-center studies and national registration studies. Meta-analysis showed a relative risk of 11.05 (95% CI: 6.39–19.11) for gastric cancer development in AMAG patients. The calculated pooled gastric LGD and type-1 gNETs incidence rates were 0.52% and 0.83% per person-year, respectively. As for experience from our center, we presented three distinctive cases of gastric neoplasm arising from the background of AMAG. This study underscores the potential for malignant transformation of precancerous lesions and reiterates the importance of careful esophagogastroduodenoscopy screening.

Published studies have evaluated the association between PPAR-γ rs1801282 polymorphism and Alzheimer's disease (AD) susceptibility. However, a definitive conclusion remains elusive. The aim of this study was to derive a more precise estimation of this association. We searched PubMed, Embase, Alzgene database, Chinese National Knowledge Infrastructure (CNKI), China Biological Medicine Database and Wanfang Databases for related studies. Twelve case-control studies with a total of 4874 cases and 5439 controls were finally identified to be eligible studies in this meta-analysis. The association was assessed by summarizing the odds ratios (ORs) with the corresponding 95% confidence intervals (CIs). Overall, there was no significant association between PPAR-γ rs1801282 polymorphism and Alzheimer's disease risk in all genetic models (the allele model G vs. C: OR=1.09, 95% CI 0.99-1.19, p=0.07; the homozygous model GG vs. CC: OR=1.04, 95% CI 0.75-1.44, p=0.80; heterozygote model GC vs. CC: OR=1.11, 95% CI 1,00-1.22, p=0.05; the dominant model GG+GC vs. CC: OR=1.10, 95% CI 1.00-1.22, p=0.05; the recessive model GG vs. GC+CC: OR=1.02, 95% CI 0.74-1.41, p=0.90). In subgroup analysis by ethnicity, no significant difference was found in both Asians and Caucasians. In summary, the present meta-analysis suggests that the PPAR-γ rs1801282 polymorphism may not be associated with genetic susceptibility of AD in general population.