Exploring Global Demands for Integrating Social Aspects into Community Healthcare: A Literature Review

Aging and crises like pandemics and climate change are global concerns that affect community environments. These social and natural changes influence people’s health worldwide. Aging impacts human health, including physical and mental aspects, and increases the need for care. Recent crises have affected not only the elderly but also younger populations, necessitating further efforts to develop a systematic community strategy. The goal of such a strategy is to maintain or enhance people’s well-being. As we face aging and crises like pandemics and climate change, it becomes essential to consider health holistically and globally, taking into account the community environment and social determinants without boundaries. The present study aimed to explore the necessary aspects of incorporating social determinants into clinical practice, enabling healthcare providers to view health from a holistic and planetary perspective. This approach facilitates the development of integrated community strategies. The study reviewed literature from PubMed, MEDLINE, and CINAHL databases, focusing on medicine, health, and welfare. An electronic search for English-language articles in peer-reviewed journals was conducted up to July 2024, using search terms such as “holistic health,” “planetary health,” and “social determinants.” Eight articles were identified through the search. After excluding three based on their titles, abstracts, and full texts, five articles were selected. The research focused on three areas: perceiving health in ecosystems, considering health-related policy in clinical situations, and addressing health in primary care settings. This study emphasizes the need for further research on innovative, integrated community strategies in the context of a globally aging society, focusing on non-medical aspects like pandemics, climate change, and social determinants to achieve a holistic and planetary understanding of people’s health. It suggests that understanding the social aspects of ecosystems in clinical settings, through interdisciplinary collaboration, is crucial for developing systematic community strategies for people’s well-being life in medical, health, and welfare contexts.

Liver biopsy in the post-hepatitis C virus era in Japan

In Japan,liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus(HCV)and diagnosing HCV-related hepatocellular carcinoma(HCC).However,due to the development of effective antiviral treatments and advanced imaging,the necessity for biopsies has significantly decreased.This change has resulted in fewer chances for diagnosing liver disease,causing many general pathologists to feel less confident in making liver biopsy diagnoses.This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan.First,it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence.Second,it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions,because clinically diagnosable HCCs are not targets for biopsy.Third,the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs.In conclusion,pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001;women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

Operationally Simple Enantioselective Silane Reduction of Ketones by the [Ir(OMe)(cod)]2/Azolium Catalytic System

An operationally simple protocol was designed for the enantioselective silane reduction (ESR) of ketones using air- and moisture-stable [Ir(OMe)(cod)]2 (cod = 1,5-cyclooctadiene) (3) as a metal catalyst precursor. This reaction was driven by chiral hydroxyamide-functionalized azolium salt 2. The catalytic ESR reaction could be performed under benchtop conditions at room temperature. Treatment of 2 with 3 in THF yielded the monodentate IrCl(NHC)(cod) (NHC = N-heterocyclic carbene) complex 4 in 93% yield, herein the anionic methoxy ligand of 3 serves as an internal base that deprotonates the azolium ring of 2. The well-defined Ir complex 4 catalyzed the ESR reaction of propiophenone (6) with (EtO)2MeSiH using the pre-mixing reaction procedure. Based on this success, the catalytic ESR reaction was designed and implemented using an in situ-generated NHC/Ir catalyst derived from 2 and 3. Thus, a wide variety of aryl ketones could be reduced to the corresponding optically active alcohols in moderate to excellent stereoselectivities at room temperature without temperature control. Since the high catalytic activity of 3 was observed, we next evaluated several other transition metal catalyst precursors for the catalytic ESR reaction under the influence of 2. This evaluation revealed that Ir(acac)(cod) (acac = acetylacetonate) (28) and [IrCl(cod)]2 (5) can be successfully used as metal catalyst precursors in the ESR reaction.

Combinations of Transportation Policies to Promote BRT Usage Using Artificial Society Model

Various transportation systems have been developed in recent years.In this study,an artificial society model is developed to examine the combination of transportation policies in urban areas.In this model,each trip maker selects the primary and terminal transportation modes.An artificial society model is applied to the southeastern region of Osaka City,Japan.The effects of introducing BRT(bus rapid transit,primary transportation)and on-demand buses(terminal transportation)are investigated.The results confirm that BRT is used by a certain number of users.An increase in the use of BRT will increase the amount of walking,thus resulting in a healthy city.However,on-demand buses are rarely used as terminal transportation.Additionally,the development of bicycle parking stations near BRT stops is shown to be effective in the northern section of the BRT route.

Immunological role of sulfatide in the pathogenesis of multiple sclerosis

Multiple sclerosis(MS) is a chronic inflammatory demyelinating disease of the central nervous system.A certain population of patients with MS present with a relapse-remitting disease course(RRMS) during the early phase and eventually advance to a progressive course(PMS).While immune modulation therapies have recently seen tremendous success in RRMS,our limited knowledge of pathogenesis hampers the development of effective treatments for PMS.

Polyvinyl alcohol–potassium iodide gel probe to monitor the distribution of reactive species generation around atmospheric-pressure plasma jet

This study proposes polyvinyl alcohol–potassium iodide(PVA–KI)as a novel gel chemical probe.The probe uses the reactions among PVA,KI,water,borax,and oxidative species to visualize the distribution of reactive species.This method provides information regarding the distribution of reactive species by coloration on the gel surface.The effects of the surrounding gas phase on the distribution and diffusion of the reactive species are also investigated using the PVA–KI gel probe.Further,the relationship between the irradiation distance and reactive species diffusion is determined on the surface of the PVA–KI probe with and without plastic shielding.Adjusting the irradiation distance appropriately leads to an increase in the modified area as detected by the PVA–KI gel probe analysis.The relative concentration distributions of the reactive species are also obtained from visualized color distributions measured using a colorimeter.Furthermore,reactive species generation by long-scale line plasma is confirmed by the color reaction on the PVA–KI gel surface,with a greater area being covered by an atmospheric-pressure pulsed microwave line plasma source.

Comparison of Community Health between Rural and Urban Areas in View of the Impact of the COVID-19 Pandemic: Global Perspective through a Literature Review

The progressive aging of society is expected to lead to the development of effective integrated community-based care system considering the characteristics based on community environments. However, the COVID-19 pandemic has influenced population health worldwide. This study aimed to examine disparities in population health and health-related factors between rural and urban communities during the COVID-19 pandemic. A literature search was conducted using PubMed, Medline, and CINAHL for articles published up to September 2022 with the following search terms: community health, rural, urban, and COVID-19. A total of 105 articles were identified, of which three articles with a cross-sectional quantitative research design met the inclusion criteria. Two articles focused on mental health, and among them, one recognized a significant disparity between rural and urban areas. Four health-related factors in view of the COVID-19 pandemic in rural and urban areas were perceived, including knowledge, behavior, lifestyle, and social support. And, two factors: health-related knowledge and health-related behavior, were perceived as the significant disparities between rural and urban during the COVID-19 pandemic. The further efforts will be needed to pursue effective integrated community-based care system during and post-COVID-19, taking into account community environment at both community and individual levels.

Two-Stage Procrustes Rotation with Sparse Target Matrix and Least Squares Criterion with Regularization and Generalized Weighting

In factor analysis, a factor loading matrix is often rotated to a simple target matrix for its simplicity. For the purpose, Procrustes rotation minimizes the discrepancy between the target and rotated loadings using two types of approximation: 1) approximate the zeros in the target by the non-zeros in the loadings, and 2) approximate the non-zeros in the target by the non-zeros in the loadings. The central issue of Procrustes rotation considered in the article is that it equally treats the two types of approximation, while the former is more important for simplifying the loading matrix. Furthermore, a well-known issue of Simplimax is the computational inefficiency in estimating the sparse target matrix, which yields a considerable number of local minima. The research proposes a new rotation procedure that consists of the following two stages. The first stage estimates sparse target matrix with lesser computational cost by regularization technique. In the second stage, a loading matrix is rotated to the target, emphasizing on the approximation of non-zeros to zeros in the target by least squares criterion with generalized weighing that is newly proposed by the study. The simulation study and real data examples revealed that the proposed method surely simplifies loading matrices.

A Study of Hie and LBP: The First Step to Improve Subjective Well-Being

Backgrounds: Health does not only physical health, therefore, we need to study it from various viewpoints. Many Japanese female complain of a Hie or a low back pain (LBP), which they reduce their subjective well-being. We analyze. Those patients often have acupuncture therapy. In this study, we analyze the characteristics of Hie and LBP, the satisfaction level of alternative therapy and we pursue a tip to improve subjective well-being. Methods: Of 1000 women, Hie (+)/Hie (−) or LBP (+)/LBP (−), we compared their body temperature (BT) (axilla) and body mass index (BMI). Furthermore, the Chi test identified ten factors of “body” and seven “mind” information. Results: In the result of BT (axilla) while LBP indicated a significant difference. Both Hie and LBP showed difference in the opposite direction. Hie did now show such clear differences in “body” information. However, interestingly, all seven questions in the “mind” information showed statistical difference. Discussion and conclusion: One reason why those patients have acupuncture therapy may acupuncture therapy traditionally has not separate “mind” and “body” and it has the concept of “mind-body unity”. To improve subjective well-being, first we need to focus on “Mind” as well as “mind-body unity”. Mental-health support is important for patients with Hie or LBP to reduce physiological stress.

A Literature Review of Fertility Education for High School Students

Purpose: Fertility education for high school students leads them to be able to decide when to get pregnant and give birth, and to think about their desired life plan. However, knowledge of fertility in Japan is low compared to other countries. This study aims to understand the state of fertility knowledge among high school students in Japan and to clarify issues in fertility education. Method: Ten articles published from 2013 to July 2023 were selected for review from ICHUSHI Web Ver. 5 and CiNii with the keywords “high school students,” “fertility,” and “education.” The review was limited to Japanese-language literature due to differences in fertility education and knowledge between Japan and other countries. Results/Conclusion: 60% - 90% of the high school students indicated that their source of information on fertility was school lessons. Half of the students understood egg aging and the effects of smoking and drinking on fertility, but their knowledge of menstruation, male reproductive physiology/function, and infertility was insufficient. 50% - 80% of students wanted to marry by the age of 30, and 70% - 80% wanted to have children. 80% of students who attended a lecture on preconception care considered the lesson an opportunity to think about their future life plans. 90% of school nurse teachers reported that fertility should be taught in schools, and half said that egg aging, causes of infertility, and other topics should be covered in high school. Educational caution points included the consideration of developmental stages and the relatedness of the content to what had already been taught, among other things. High school is the best time for fertility education because it gives students the opportunity to accept their own sexuality and think about their future. In addition, since many students plan to marry and have children by the age of 30, the acquisition of fertility knowledge can be an effective means of future life design.

帕博利珠单抗联合以铂类为基础的化疗治疗非小细胞肺癌合并稳定性脑转移患者的结局:KEYNOTE-021、-189和-407研究的汇总分析

背景与目的此项探索性分析回顾评价了晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的结局,旨在确定基线时合并脑转移是否会影响一线应用帕博利珠单抗联合化疗(pembrolizumab plus chemotherapy,PC)比对单用化疗的疗效。患者和方法对KEYNOTE-021队列G(非鳞癌)、KEYNOTE-189(非鳞癌)和KEYNOTE-407(鳞癌)三项研究晚期NSCLC患者的数据进行汇总分析。患者接受含铂两药化疗和/或35个周期帕博利珠单抗治疗(每3周200 mg)。所有研究均纳入了经治或初治的稳定性脑转移患者(KEYNOTE-189与KEYNOTE-407研究纳入初治脑转移患者)。经治的脑转移患者已处于病情稳定的状态≥2周(KEYNOTE-021队列G患者≥4周),无新发或脑转移病灶扩大的证据且入组前至少3天以上未使用激素。初治的无症状脑转移患者需定期接受脑部影像学检查。结果共纳入1298例患者,其中171例有基线脑转移,1127例无脑转移。两组的中位随访时间(范围)在数据截止时分别为10.9(0.1-35.1)个月和11.0(0.1-34.9)个月。合并脑转移和无脑转移患者的总生存期[0.48(95%CI:0.32-0.70)和0.63(95%CI:0.53-0.75)]和无进展生存期[0.44(95%CI:0.31-0.62)和0.55(95%CI:0.48-0.63)]的风险比(PC/化疗)相似。合并脑转移的患者中,PC组和单用化疗组患者的中位总生存期分别为18.8个月和7.6个月,中位无进展生存期分别为6.9个月和4.1个月。无论是否合并脑转移,PC组患者的客观缓解率都高于单用化疗组,且缓解持续时间有显著延长。合并脑转移的患者中,PC组与单用化疗组的治疗相关不良事件发生率分别为88.2%和82.8%;而无脑转移的患者中,两组治疗相关不良事件的发生率分别为94.5%和90.6%。结论无论是否合并脑转移,与单用化疗相比,帕博利珠单抗联合以铂类为基础的组织学特异性化疗可改善所有PD-L1亚组的临床结局,其中包括PD-L1肿瘤比例评分<1%的患者,并且在晚期NSCLC患者中安全性良好。该方案是晚期NSCLC初治患者的标准方案,并可用于合并稳定性脑转移的患者。

Ratio of mean platelet volume to platelet count is a potential surrogate marker predicting liver cirrhosis

AIM To provide a simple surrogate marker predictive of liver cirrhosis(LC).METHODS Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospectively analyzed. Based on pathologic findings, patients were divided into groups based on whether or not they had LC. Parameters associated with hepatic functional reserve were compared in these two groups using MannWhitney U-test for univariate analysis. Factors differing significantly in univariate analyses were entered into multivariate logistic regression analysis.RESULTS There were significant differences between the LC group(n = 100) and non-LC group(n = 202) in prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, cholinesterase, type Ⅳ collagen, hyaluronic acid, indocyanine green retention rate at 15 min, maximal removal rate of technitium-99 m diethylene triamine pentaacetic acid-galactosyl human serum albumin and ratio of mean platelet volume to platelet count(MPV/PLT). Multivariate analysis showed that prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin and hyaluronic acid, and MPV/PLT ratio were factors independently predictive of LC. The area under the curve value for MPV/PLT was 0.78,with a 0.8 cutoff value having a sensitivity of 65% and a specificity of 78%.CONCLUSION The MPV/PLT ratio, which can be determined simply from the complete blood count, may be a simple surrogate marker predicting LC.

Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy(SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy(DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of singleballoon endoscopy(SBE) and spiral endoscopy(SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

Effect of biliary obstruction and internal biliary drainage on hepatic cytochrome P450 isozymes in rats

AIM: To investigate the total cytochrome P450 (CYP) content, microsomal mixed-function oxidase (MFO) activity, and expression of mRNAs for various CYP isozymes in a simple rat model of reversible obstructive jaundice. METHODS: Obstructive jaundice was created in male rats by causing bile duct obstruction with polyester tape. In another group of rats, bile duct obstruction was followed by internal biliary drainage after releasing the tape. The expression of various CYP isozyme mRNAs was semi-quantitatively assessed by competitive RT- PCR. RESULTS: The total CYP content and microsomal MFO activity showed a significant decrease after biliary obstruction, but returned to respective control levels after biliary drainage. A marked reduction in the expression of CYP1A2, 2B1/2, 2C11, 2E1, 3A1, and 3A2 mRNA was detected during biliary obstruction, while expression increased significantly toward the control level after biliary drainage. Although expression of CYP4A1 mRNA showed no reduction during biliary obstruction, it still increased significantly after biliary drainage. CONCLUSION: These results suggest that not only obstructive jaundice, but also the subsequent internal biliary drainage may affect regulatory medications of the synthesis of individual CYP isozymes differently.

Linker phosphorylation of Smad3 promotes fibro-carcinogenesis in chronic viral hepatitis of hepatocellular carcinoma

Epidemiological and clinical data point to a close association between chronic hepatitis B virus infection or chronic hepatitis C virus infection and development of hepatocellular carcinoma (HCC). HCC develops over several decades and is associated with fibrosis. This sequence suggests that persistent viral infection and chronic inflammation can synergistically induce liver fibrosis and hepatocarcinogenesis. The transforming growth factor-&#x003b2; (TGF-&#x003b2;) signaling pathway plays a pivotal role in diverse cellular processes and contributes to hepatic fibro-carcinogenesis under inflammatory microenvironments during chronic liver diseases. The biological activities of TGF-&#x003b2; are initiated by the binding of the ligand to TGF-&#x003b2; receptors, which phosphorylate Smad proteins. TGF-&#x003b2; type&#x02005;I&#x02005;receptor activates Smad3 to create COOH-terminally phosphorylated Smad3 (pSmad3C), while pro-inflammatory cytokine-activated kinases phosphorylates Smad3 to create the linker phosphorylated Smad3 (pSmad3L). During chronic liver disease progression, virus components, together with pro-inflammatory cytokines and somatic mutations, convert the Smad3 signal from tumor-suppressive pSmad3C to fibro-carcinogenic pSmad3L pathways, accelerating liver fibrosis and increasing the risk of HCC. The understanding of Smad3 phosphorylation profiles may provide new opportunities for effective chemoprevention and personalized therapy for patients with hepatitis virus-related HCC in the future.

Diagnostic criteria for autoimmune pancreatitis in Japan

Autoimmune pancreatitis （AIP） is a particular type of pancreatitis of presumed autoimmune etiology. Currently, AIP should be diagnosed based on combination of clinical, serological, morphological, and histopathological features. When diagnosing AIP, it is most important to differentiate it from pancreatic cancer. Diagnostic criteria for AIP, proposed by the Japan Pancreas Society in 2002 first in the world, were revised in 2006. The criteria are based on the minimum consensus of AIP and aim to avoid misdiagnosing pancreatic cancer as far as possible, but not for screening AIR The criteria consist of the following radiological, serological, and histopathological items： （1） radiological imaging showing narrowing of the main pancreatic duct and enlargement of the pancreas, which are characteristic of the disease; （2） laboratory data showing abnormally elevated levels of serum y-globulin, IgG or IgG4, or the presence of autoantibodies; （3） histopathological examination of the pancreas demonstrating marked fibrosis and prominent infiltration of lymphocytes and plasma cells, which is called lymphoplasmacytic sclerosing pancreatitis （LPSP）. For a diagnosis of AIP, criterion 1 must be present, together with criterion 2 and/ or criterion 3. However, it is necessary to exclude malignant diseases such as pancreatic or biliary cancer.

A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients

BACKGROUND:In Asian population, there is limited infor mation on the relevance between obesity and poor outcomes in acute pancreatitis(AP). The objective of this study was to examine the clinical impact of obesity based on body mass index(BMI) on prognosis of AP in Japanese patients.METHODS:A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients’ outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predic tive accuracy of a Japanese prognostic factor score(PF score)a receiver-operating characteristic(ROC) curve analysis of mortality was conducted.RESULTS:Multiple logistic regression analyses revealed that BMI ≥25 kg/m2was associated with a significant higher mor tality [odds ratio(OR)=15.8; 95% confidence interval(CI):1.1-227; P=0.043]. The area under the ROC curve(AUC) for the combination of PF score and BMI ≥25 kg/m2(AUC=0.881;95% CI:0.809-0.952) was higher than that for the PF score alone(AUC=0.820; 95% CI:0.713-0.927)(P=0.034).CONCLUSIONS:The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population Including BMI ≥25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

Endoscopic retrograde pancreatography: When should we do it?

Endoscopic retrograde pancreatography(ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques(computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis(1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.

Immunoglobulin G4-related gastrointestinal diseases, are they immunoglobulin G4-related diseases?

In immunoglobulin G4(IgG4)-related disease(RD),organ enlargement or nodular lesions consisting of abundant infiltration of lymphocytes and IgG4-positive plasma cells and fibrosis are seen in various organs.Although infiltration of many IgG4-positive plasma cells is detected in the gastric and colonic mucosa and major duodenal papilla of patients with autoimmune pancreatitis,it cannot be diagnosed as a gastrointestinal lesion involved in IgG4-RD,because none of the following is observed in these lesions:a mass-like formation;dense fibrosis;or obliterative phlebitis.Based on our review of the literature,there appear to be two types of IgG4-related gastrointestinal disease.One is a gastrointestinal lesion showing marked thickening of the wall of the esophagus and stomach,consisting of dense fibrosis with abundant infiltration of IgG4-positive plasma cells,which usually show submucosal spreading.The other is an IgG4-related pseudotumor occurring in gastrointestinal regions such as the stomach,colon,and major duodenal papilla,showing polypoid or mass-like lesions.Most solitary IgG4-related gastrointestinal lesions that are not associated with other IgG4-RD appear to be difficult to diagnose.It is of utmost importance to rule out malignancy.However,these lesions may respond to steroid therapy.To avoid unnecessary resection,IgG4-related gastrointestinal diseases should be considered in the differential diagnosis.