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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Research Article: Autoimmune fibroinflammation in IgG4-related ophthalmic disease: TLR8-dependent signaling pathways and fibrotic remodeling revealed by proteomic profiling

Date Published: 2026-01-28

Abstract:
Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is an immune-mediated ocular condition characterized by tumefactive lesions with IgG4+ plasma cell infiltration, and commonly affecting the lacrimal gland, extraocular muscles, and trigeminal nerves.The precise pathogenesis of IgG4-ROD remains unclear. Elucidating its molecular mechanisms is crucial for the development of targeted molecular therapies. To investigate the molecular pathogenesis of IgG4-ROD, we conducted a case-controlled study involving 15 patients who presented at the Second Hospital of Jilin University between 2021 and 2022. In accordance with the comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD) established in 2011, participants were stratified into three distinct cohorts based on lacrimal gland histopathological findings: confirmed IgG4-ROD, suspected IgG4-ROD, and a control group. We then utilized 4D-Fast DIA technology to acquire proteomic profiles from the lacrimal gland biopsies, with rigorous bioinformatics methodologies employed to process and interpret these data, focusing on the differential protein expression patterns across the groups, aiming to identify signaling pathways that are significantly associated with IgG4-ROD. The comparative analysis of clinical characteristics, imaging features, and histopathological findings among the control group, patients with suspected IgG4-ROD, and diagnosed patients revealed a progressive trend towards more severe pathology. Principal component analysis (PCA) and Pearson correlation heatmaps indicated that the profiles of differentially expressed proteins in lacrimal gland samples from the suspected and diagnosed groups were highly similar, suggesting that the patients from these two groups may belong to the same population. Further analysis of protein expression changes across the three groups revealed significant enrichment in pathways related to asthma, Th1 and Th2 cell differentiation, and other relevant signaling pathways. Notably, Toll-like receptor (TLR), NF-?B, Wnt, and PI3K-AKT signaling pathways were prominently activated. In the diagnosed group, proteins such as MMP7, POSTN, and CD163 exhibited characteristic high-level expression. Furthermore, compared with the suspected group, the diagnosed group showed significant downregulation of proteins related to elastin fibers, indicating a more severe degree of fibrosis in the lacrimal gland tissues. Additionally, the diagnosed group exhibited a significant decrease in proteins associated with lacrimal secretion, suggesting impaired function of lacrimal gland. We also observed a notable upregulation of TLR-8-related proteins in both the suspected and diagnosed groups, implying that the TLR signaling pathway may be closely related to this disease. Proteomic analysis of lacrimal gland samples from the diagnosed, suspected, and control groups suggests that patients with suspected IgG4-ROD may be part of the same population as diagnosed patients. In the diagnosed group, the lacrimal gland tissue displayed more severe fibrosis and a significant loss of lacrimal secretion function. This study postulates that the TLR - 8/IRAK4/NF - ?B pathway may contribute to the molecular pathogenesis of IgG4 - ROD by promoting tissue fibrosis. Proteins such as MMP7, POSTN, and CD163 could potentially serve as molecular markers for the early diagnosis and potential therapeutic targets of IgG4 - ROD. Based on these findings, proteomics offers significant advantages in the molecular diagnosis of IgG4 - ROD and should be regarded as a crucial tool in the diagnosis of this disease.

Introduction:
Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is an immune-mediated ocular condition characterized by tumefactive lesions with IgG4+ plasma cell infiltration, and commonly affecting the lacrimal gland, extraocular muscles, and trigeminal nerves.The precise pathogenesis of IgG4-ROD remains unclear. Elucidating its molecular mechanisms is crucial for the development of targeted molecular therapies.

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