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ENT surgeons may be the first specialists to encounter and diagnose patients with salivary gland disease. A new entity involving the salivary glands has recently been described of which ENT surgeons need to be aware: immunoglobulin G4 related chronic sclerosing sialadenitis.
Method:
A literature search of Medline, Embase and Cochrane Library databases was performed, using the search terms ‘IgG4’, ‘hyperIgG4 syndrome’ and ‘IgG4 related chronic sclerosing sialadenitis’.
Results:
Knowledge concerning immunoglobulin G4 related chronic sclerosing sialadenitis is rapidly increasing. This new entity is part of a fibro-inflammatory corticosteroid-responsive systemic disease (immunoglobulin G4 related disease) and has been described in almost every organ. Biopsy of the submandibular gland can be diagnostic. However, the diagnosis can easily be overlooked if: clinical suspicion is not high, one is unaware of the classical morphology and/or immunoglobulin G4 staining is not performed. This paper presents a summary of the current understanding of the disease and its management.
Conclusion:
ENT surgeons should be aware of this new disease entity. Patients with systemic disease should be managed under a multidisciplinary team, with input from clinicians who have an interest in such diseases (such as gastroenterologists and rheumatologists), and input from histopathologists and radiologists.
G4 alloys (Ti51Al47Re1W1Si0.2) are developed by Spark Plasma Sintering (SPS) with the aim to improve the creep resistance of SPS materials. The microstructure is analyzed by Scanning and Transmission Electron Microscopies (SEM and TEM). The mechanical properties at low and high temperatures are measured. The addition of heavy elements does not lead to an improvement of the mechanical strength.
Immunoglobulin G4 related disease is a recently described systemic syndrome. The head and neck region is the second most common site for presentation after the pancreas.
Methods
PubMed and the Cochrane Library were searched from 1995 to July 2017 for all the studies on immunoglobulin G4 related disease diagnosed in the head and neck compartment. Patient-specific data were extracted and basic statistical analysis was performed.
Results
Ninety-one patients were identified. Treatment was specified in 76 patients. Twenty patients received surgical treatment, eight of them in association with medical therapy. Fifty-six patients received medical treatment. The disease recurred in 25 per cent of patients treated with surgical treatment alone, in 3.6 per cent of patients treated with medical treatment alone and in 12.5 per cent of patients treated with both. All medical treatment protocols contained high-dose corticosteroids.
Conclusion
Early and correct diagnosis can avoid unnecessary surgical treatment, and glucocorticoid therapy can improve the long-term prognosis.
To report a rare condition affecting the temporal bone. Immunoglobulin G4 related systemic sclerosing disease is a recently described autoimmune condition with manifestations typically involving the pancreas, biliary system, salivary glands, lungs, kidneys and prostate. Histologically, it is characterised by T-cell infiltration, fibrosis and numerous immunoglobulin G4-positive plasma cells. This condition previously fell under the umbrella diagnosis of inflammatory pseudotumour and inflammatory myofibroblastic tumour.
Case report:
We present the case of a 58-year-old woman with multiple inflammatory masses involving the pharynx, gall bladder, lungs, pelvis, omentum, eyes and left temporal bone, over a seven-year period. We describe this patient's unusual clinical course and pathological features, which resulted in a change of diagnosis from metastatic inflammatory myofibroblastic tumour to immunoglobulin G4 related systemic sclerosing disease. We also review the literature regarding the management of inflammatory pseudotumours of the temporal bone, and how this differs from the management of immunoglobulin G4 related systemic sclerosing disease.
Conclusion:
We would recommend a full review of all histological specimens in patients with a diagnosis of temporal bone inflammatory pseudotumour or inflammatory myofibroblastic tumour. Consideration should be given to immunohistochemical analysis for anaplastic lymphoma kinase and immunoglobulin G4, with measurement of serum levels of the latter. Management of the condition is medical, with corticosteroids and immunosuppression, rather than surgical excision.
Immunoglobulin G4 related disease is an inflammatory condition characterised by the presence of fibrotic lesions infiltrated by immunoglobulin G4 positive plasma cells. It can arise from almost any region of the body and it is being increasingly recognised in the head and neck. Regardless of the site of involvement, the histopathological resemblance is remarkable. Dense lymphoplasmacytic infiltration, overabundance of immunoglobulin G4 bearing plasma cells and presence of storiform fibrosis are typical findings.
Case reports:
This paper presents two cases of immunoglobulin G4 related disease in which there was involvement of the orbit, the infraorbital nerve and the infratemporal fossa. Diagnosis was established in both cases by biopsying radiologically abnormal tissue in the infratemporal fossa.
Conclusion:
An awareness of this condition is required to establish the diagnosis and initiate appropriate therapy. Glucocorticoids are the mainstay of initial treatment. The effectiveness of B-lymphocyte depletion with rituximab has also been reported. Correct diagnosis may spare patients from unnecessarily radical surgery.
This article is a case study on the Yunnanese scholar Li Yuanyang under the background of the Ming's incorporating and sinicizing Yunnan, exploring how he views the Ming's actions and writes Yunnan's becoming a part of China. First, it retells Li's life experiences and examines the Yunnan native things and Chinese traditions in his writings. Then, after noting his emphasis of Yunnan's belonging to China, it concentrates on his comments on the Ming's military campaigns. As it analyzes, on the one hand, he justifies these campaigns against indigenous rebellions, on the other hand, he also criticizes unnecessary wars and some imperial officials' selfish deeds. Besides, he considers the constructing and reconstructing projects as a symbol of the central state's righteous governance, which should also bring benefit and benevolence to the indigenes. In a word, Li's case reflects the deep impact of the Ming's invasion on the local elites, as well as how they react to this.
The estimation of diffusive transport of gases through tuffs is important in order to assess whether Yucca Mountain is an environmentally safe and acceptable repository for high-level radioactive waste. The purpose of this study is to provide effective diffusivity data which may be used to calculate the amount of diffusion of carbon dioxide through Yucca Mountain tuff layers to the environment. The effective diffusivity of carbon dioxide was measured for tuff samples from five different layers of the USW-G4 drillhole, which is located in the central part of the proposed repository horizon. The tuff samples studied are from the following layers and depths: Vapor Phase (83.6 m), Upper Lithophysal (130.1 m), Middle Nonlithophysal (224.5 m), Lower Lithophysal (243.9 m, 266.9 m, 297.3 m and 335.2 m), and Lower Nonlithophysal (356.3 m and 371.0 m). A steady-state, counter-diffusion method, using gas chromatographic analysis, was used to determine the effective diffusivity of carbon dioxide through tuff samples. Effective diffusivity increased with temperature between 25°C and 125°C for all layers. The effect of temperature on diffusivity correlated well using second-order polynomials. The porosity, specific surface area and mean pore radius were also determined. In general, diffusivity increased with porosity, specific surface area and mean pore radius, but did not correlate well. From the measured data , it appears that the diffusion takes place primarily in the combined Knudsen and bulk diffusion regimes.
Immunoglobulin G4 related disease is a rare condition. Cases involving the sinonasal region are exceptionally uncommon. This paper describes a case of immunoglobulin G4 related disease isolated solely to the nasal cavity.
Methods:
Case report and literature review.
Results:
A 34-year-old man presented with painless, progressive bilateral nasal obstruction. Clinical examination and imaging findings demonstrated bilateral submucosal swelling of the anterior septum and right external nasal wall. Biopsy revealed immunoglobulin G4 related disease. The patient responded to oral corticosteroids initially, followed by long-term methotrexate.
Conclusion:
To the best of our knowledge, this case represents the first report in the literature of immunoglobulin G4 related disease isolated solely to the nasal cavity.
This study traces the origins and development of the concept of Li 理 (Pattern) in early Chinese Cosmology, locating its foundation in the root metaphor derived from the natural lines or veins along which a block of jade can be split by a skilled artisan. From this relatively concrete image, li comes to eventually represent in Daoist cosmology the more abstract quality of the natural patterns or structures within the universe along which all phenomena move and interact with one another without the interference of human beings. After examining how early Confucian works emphasize the more abstract and derivative qualities of order and structure, we see that the likely Yangist authors in the Lüshi chunqiu return to the original metaphor of veins in jade but, instead, apply this to the veins through which the qi circulates through the human body.
We then see how this metaphor is expanded beyond the human body in the classical Daoist texts to come to represent the natural guidelines both within all phenomena and those that guide their movements within the cosmos. Within phenomena these include such varied things as the structures for the generation and expression of emotions within human beings as well as the natural lines along which the butcher's chopper passes in order to cleave oxen. In Daoist inner cultivation literature it is these patterns with which sages accord so that their spontaneous actions are completely in harmony with the greater forces of the cosmos. Only after long practice of the apophatic contemplative methods that include concentrating on one breathing and emptying out the normal contents of consciousness can the sage be able to accomplish this goal of “taking no action yet leaving nothing undone.” Thus the concept of li as these natural guidelines comes to serve as an explanation for why this classical Daoist dictum is effective in the world.
Finally, the Huainanzi contains the most sophisticated and sustained usages of the concept of li as the natural patterns and guidelines in the cosmos arguing that complying with them is the key to a genuinely contented life.
Human rights — Freedom of thought, conscience and religion — Neutrality — Employer policy of neutrality — Applicant dismissed for wearing religious clothing — European Union Directive 2000/78 — Discrimination — Direct discrimination — Indirect discrimination — Whether employer prohibition on religious clothing constituting discrimination under Directive 2000/78 — The law of the European Union
To improve the diagnosis of human fascioliasis caused by Fasciola gigantica, we developed a peptide-based enzyme-linked immunosorbent assay (peptide-based ELISA) based on the detection of specific IgG4 subclass antibody. Two identified B-cell epitopes of F. gigantica cathepsin L1 were synthesized as single synthetic peptides, acetyl-DKIDWRESGYVTELKDQGNC-carboxamide (peptide L) and acetyl-DKIDWRESGYVTEVKDQGNC-carboxamide (peptide V), and their diagnostic potential was evaluated. The sera of 25 patients infected with F. gigantica, 212 patients with other parasitic infections, 32 cholangiocarcinoma patients and 57 healthy controls were analysed. The sensitivity, specificity, accuracy, and positive and negative predictive values of this assay were the same with both peptides at 100%, 99·7%, 99·7%, 96·2% and 100%, respectively. These highly sensitive and specific peptide-based ELISAs for the detection of specific IgG4 antibody could be useful for laboratory diagnosis of human fascioliasis in future large-scale surveys throughout Southeast Asia where this disease is prevalent.
The Variscan crust of the Iberian massif is 32–35 km thick, although this thins towards the Atlantic margin. To the north and south in the Pyrenees and Betics, the crustal structure is much more complex, but a crustal thickness of up to 50 km is well established in the Pyrenees. In the related foreland basins (Ebro and Guadalquivir) lithospheric flexing appears to have taken place without significant modification of the crust. The Neogene Valencia trough and Alboran basins formed by thinning of the crust, and minimum thicknesses of 15 km or less have been measured in each case.
Introduction
The shallow structure and stratigraphy of the Tertiary basins of Spain are relatively well known from industrial exploration and field geology. However, because sedimentary basins reflect deformation processes on a lithospheric scale, knowledge of the structure and mechanical properties of the lithosphere in which basins develop is essential for a complete understanding of basin evolution. Therefore, a brief introduction to lithospheric structure, which will be limited to the crust and uppermost mantle, in relation to Tertiary basins in Spain is presented.
The Tertiary basins of Spain (Fig. la) have generally formed by deformation of the Variscan (Hercynian) crust of the Iberian Massif. The crustal structure of Iberia has been extensively explored by seismic methods including refraction/wide-angle reflection and near-vertical deep reflection (Fig. lb). Consequently, the basement of the Tertiary basins in Spain, i.e., the crystalline crust of pre-basin formation, can be considered to be reasonably well known.