Rewarding Outcome Research Articles

Insights into the interaction between time and reward prediction on the activity of striatal tonically active neurons: A pilot study in rhesus monkeys.

Prior studies have documented the role of the striatum and its dopaminergic input in time processing, but the contribution of local striatal cholinergic innervation has not been specifically investigated. To address this issue, we recorded the activity of tonically active neurons (TANs), thought to be cholinergic interneurons in the striatum, in two male macaques performing self-initiated movements after specified intervals in the seconds range have elapsed. The behavioral data showed that movement timing was adjusted according to the temporal requirements. About one-third of all recorded TANs displayed brief depressions in firing in response to the cue that indicates the interval duration, and the strength of these modulations was, in some instances, related to the timing of movement. The rewarding outcome of actions also impacted TAN activity, as reflected by stronger responses to the cue paralleled by weaker responses to reward when monkeys performed correctly timed movements over consecutive trials. It therefore appears that TAN responses may act as a start signal for keeping track of time and reward prediction could be incorporated in this signaling function. We conclude that the role of the striatal cholinergic TAN system in time processing is embedded in predicting rewarding outcomes during timing behavior.

Medial prefrontal cortex suppresses reward-seeking behavior with risk of punishment by reducing sensitivity to reward.

Reward-seeking behavior is frequently associated with risk of punishment. There are two types of punishment: positive punishment, which is defined as addition of an aversive stimulus, and negative punishment, involves the omission of a rewarding outcome. Although the medial prefrontal cortex (mPFC) is important in avoiding punishment, whether it is important for avoiding both positive and negative punishment and how it contributes to such avoidance are not clear. In this study, we trained male mice to perform decision-making tasks under the risks of positive (air-puff stimulus) and negative (reward omission) punishment, and modeled their behavior with reinforcement learning. Following the training, we pharmacologically inhibited the mPFC. We found that pharmacological inactivation of mPFC enhanced the reward-seeking choice under the risk of positive, but not negative, punishment. In reinforcement learning models, this behavioral change was well-explained as an increase in sensitivity to reward, rather than a decrease in the strength of aversion to punishment. Our results suggest that mPFC suppresses reward-seeking behavior by reducing sensitivity to reward under the risk of positive punishment.

The Nutritional Implications of High Wheat Prices on Agriculture Households in Pakistan

This study analyzes the potential repercussions of high wheat prices on agriculture household economic and nutritional well-being in Pakistan. This task was accomplished by formulating a theoretical model to capture the economic behavior of agricultural households that produce marketable surpluses of wheat. For empirical verification, eight modules of nationally representative Household Integrated Economic Survey (HIES) were combined with approximate price levels to create a pooled cross-sectional sample of annual price-indices for household expenditure from 2000-01 to 2018-19. The study uses the Linear Approximate of Almost Ideal Demand System (LA-AIDS) model to derive demand elasticities and conduct a comparative static analysis. Finally, the model is extended to assess household nutritional well-being by linking price effects to calorie intake. The empirical findings demonstrated that high wheat prices resulted in high farm revenues for agricultural households. Although wheat consumption has declined, these households have used excess profits to diversify the food basket, which in turn led to an improvement in calorie intake. An indirect spillover effect from changes in wheat prices has also been observed, leading to an increase in demand for domestically produced commodities. Since the overall impact of wheat price increase on agricultural and non-agricultural households is mixed, it is proposed to pursue a careful food security policy to ensure the economic and nutritional well-being of the entire society. This study adopts a two-pronged approach of social to integrating social safety nets that does not hinder agricultural growth to achieve a mutually rewarding outcome.

The Role of Genetically Distinct Central Amygdala Neurons in Appetitive and Aversive Responding Assayed with a Novel Dual Valence Operant Conditioning Paradigm.

To survive, animals must meet their biological needs while simultaneously avoiding danger. However, the neurobiological basis of appetitive and aversive survival behaviors has historically been studied using separate behavioral tasks. While recent studies in mice have quantified appetitive and aversive conditioned responses simultaneously (Jikomes et al., 2016; Heinz et al., 2017), these tasks required different behavioral responses to each stimulus. As many brain regions involved in survival behavior process stimuli of opposite valence, we developed a paradigm in which mice perform the same response (nose poke) to distinct auditory cues to obtain a rewarding outcome (palatable food) or avoid an aversive outcome (mild footshoock). This design allows for both within-subject and between-subject comparisons as animals respond to appetitive and aversive cues. The central nucleus of the amygdala (CeA) is implicated in the regulation of responses to stimuli of either valence. Considering its role in threat processing (Wilensky et al., 2006; Haubensak et al., 2010) and regulation of incentive salience (Warlow and Berridge, 2021), it is important to examine the contribution of the CeA to mechanisms potentially underlying comorbid dysregulation of avoidance and reward (Sinha, 2008; Bolton et al., 2009). Using this paradigm, we tested the role of two molecularly defined CeA subtypes previously linked to consummatory and defensive behaviors. Significant strain differences in the acquisition and performance of the task were observed. Bidirectional chemogenetic manipulation of CeA somatostatin (SOM) neurons altered motivation for reward and perseveration of reward-seeking responses on avoidance trials. Manipulation of corticotropin-releasing factor neurons (CRF) had no significant effect on food reward consumption, motivation, or task performance. This paradigm will facilitate investigations into the neuronal mechanisms controlling motivated behavior across valences.

Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature.

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Incentive disengagement and the adaptive significance of frustrative nonreward.

Mammals respond to an unexpected reward omission or reduction with a variety of behavioral and physiological responses consistent with an aversive emotion traditionally called frustrative nonreward. This review focuses on two aspects of frustrative nonreward, namely (1) the evidence for an aversive emotional state activated by the surprising omission or reduction of a rewarding outcome, and (2) the adaptive value of frustration. Frustrative nonreward has been mainly studied in terms of its mechanisms, across development in rats and across vertebrate species in comparative research. However, its adaptive function remains obscure. Following Domjan's approach to animal learning, this article explores a specific adaptive function hypothesis of frustrative nonreward called the incentive disengagement hypothesis. According to this hypothesis, the adaptive function of frustrative nonreward is to break an attachment to a site, situation, or stimulus that no longer yields appetitive resources (especially food and fluids) to promote the search for rewards in alternative locations. This function is of particular relevance given that mammals are especially vulnerable to reward loss due to their high metabolic rate and the energy demands of their relatively large brain.

Posterior malleolus fractures and their role in prognosis of malleolar fractures

Introduction: The treatment of ankle fractures with involvement of the posterior tibial margin remains a subject of debate. We have evaluated the clinical, radiological, and functional outcome of such fractures in 25 patients, all of which were managed surgically over an average follow- up period of 6 months. The treatment options available for malleolar fractures, to attain a proper anatomical alignment and stability of ankle joint, can lead to rewarding outcome for the patient.Materials and Methods: 25 patients with posterior malleolus fractures were managed surgically between June 2019 to November2021 were included in this series. The mean age, gender ratio, mode of trauma, fracture union time, and complications were noted. The AOFAS Hindfoot scores were used for assessing the Ankle function.Results: Of the 25 patients in the study, 21 were males and 4 were females. The mean age was 38.12 years. The mean fracture union (radiological) time was 14.04 weeks (range: 10–18 weeks). However Ankle function was excellent in 17 cases (68%) on the AOFAS hindfoot score with a average AOFAS score of 94.8. Also platting gives a better result than using cannulated cancellous screws. Better syndesmotic stability is observed after surgically treating posterior malleolus fractures.Conclusion: Fixation of the posterior malleolus to reduce persistent fragment displacement, regardless of size, as well as to restore syndesmotic stability, may lead to improved outcomes. We conclude that posterior malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness and have achieved excellent clinical and functional outcomes of surgically fixing the posterior malleolus fractures.

Preparation and In Vitro-In Vivo Evaluation of Luteolin Loaded Gastroretentive Microsponge for the Eradication of Helicobacter pylori Infections.

The current study aimed to develop a luteolin gastric floating microsponge for targeting Helicobacter pylori. The microsponge formulations were prepared by a quasi-emulsion method, and then evaluated for various physicochemical variables. The best microsponge was further assessed for drug-polymer interactions, surface morphology, in vivo floating, and in vitro anti H. pylori activity. The formulation which exhibited comparatively good production yield (64.45% ± 0.83), high entrapment efficiency (67.33% ± 3.79), prolonged in vitro floating time (>8 h), and sustained in-vitro drug release was selected as the best microsponge. The SEM study revealed that the best microsponge was spherical in shape and has a porous surface with interconnecting channels. DSC and XRD studies demonstrated the dispersion of luteolin in the polymeric matrix of the microsponge. Ultrasonography confirmed that the best microsponge could in the rat stomach for 4 h. The in vitro MIC results indicate that the anti H. pylori activity of the best microsponge was almost doubled and more sustained compared to pure luteolin. To conclude, it can be said that the developed luteolin gastric floating microsponge could be a better option to effectively eradicate H. pylori infections and the histopathological and pharmacodynamic assessments of our best microsponge can be expected to provide a rewarding outcome.

Adolescent Dopamine Neurons Represent Reward Differently during Action and State Guided Learning.

Neuronal underpinning of learning cause-and-effect associations in the adolescent brain remains poorly understood. Two fundamental forms of associative learning are Pavlovian (classical) conditioning, where a stimulus is followed by an outcome, and operant (instrumental) conditioning, where outcome is contingent on action execution. Both forms of learning, when associated with a rewarding outcome, rely on midbrain dopamine neurons in the ventral tegmental area (VTA) and substantia nigra (SN). We find that, in adolescent male rats, reward-guided associative learning is encoded differently by midbrain dopamine neurons in each conditioning paradigm. Whereas simultaneously recorded VTA and SN adult neurons have a similar phasic response to reward delivery during both forms of conditioning, adolescent neurons display a muted reward response during operant but a profoundly larger reward response during Pavlovian conditioning. These results suggest that adolescent neurons assign a different value to reward when it is not gated by action. The learning rate of adolescents and adults during both forms of conditioning was similar, supporting the notion that differences in reward response in each paradigm may be because of differences in motivation and independent of state versus action value learning. Static characteristics of dopamine neurons, such as dopamine cell number and size, were similar in the VTA and SN of both ages, but there were age-related differences in stimulated dopamine release and correlated spike activity, suggesting that differences in reward responsiveness by adolescent dopamine neurons are not because of differences in intrinsic properties of these neurons but engagement of different dopaminergic networks.SIGNIFICANCE STATEMENT Reckless behavior and impulsive decision-making by adolescents suggest that motivated behavioral states are encoded differently by the adolescent brain. Motivated behavior, which is dependent on the function of the dopamine system, follows learning of cause-and-effect associations in the environment. We find that dopamine neurons in adolescents encode reward differently depending on the cause-and-effect relationship of the means to receive that reward. Compared with adults, reward contingent on action led to a muted response, whereas reward that followed a cue but was not gated by action produced an augmented phasic response. These data demonstrate an age-related difference in dopamine neuron response to reward that is not uniform and is guided by processes that differentiate between state and action values.

Choledochal cyst perforation: experience from a centre with limited emergency resources

Spontaneous perforation in Choledochal cyst (CDC) is a very rare initial manifestation and more commonly seen beyond infantile age. The management is challenging due to acute presentation, poor general condition of the patient and inflamed tissue that may jeopardize the appropriateness of any surgical intervention. The aim of the study was to analyse this rarity depending on clinical findings, diagnostic difficulty and optimum management plan in a limited resource set-up. It was a retrospective observational study where five patients presenting to the casualty department with biliary peritonitis between January 2015 and December 2020 were included. They were analysed with respect to symptomatology, laboratory parameters, radiology, emergency intervention with findings and definitive management plan. A female preponderance (60%) was found. Mean age was 5.4 years. One was a known case of CDC. Abdominal pain was the most common symptom. Inflammatory markers like Total leucocyte count (TLC) and Erythrocyte sedimentation rate (ESR) were raised in all (100%). Lipase was raised in 40% (2/5). Anaemia and low serum albumin were non-specific findings. A dilated Common bile duct (CBD) on Ultrasound (US) was seen in 80% (4/5). Magnetic resonance cholangio pancreaticography (MRCP) demonstrated type I CDC in all. All underwent laparotomy with lavage and external drainage followed by interval definitive surgery. Pre-operative diagnosis of a perforated CDC may not be possible. Strong clinical suspicion and bilious peritoneal fluid may point to this rare complication. Minimum exploratory manoeuvre with good lavage and external drainage should be the optimum emergency intervention. Definitive bilio-pancreatic reconstruction should be performed when tissue oedema subsides and general condition is improved. This approach usually achieves a rewarding outcome.

Nursing the seizure patient

Seizures are a common emergency presentation to veterinary practice and can be challenging cases to treat and nurse. There are a large variety of underlying causes for seizures in companion animals, and nursing care can vary depending on the differential diagnoses. Nursing interventions such as seizure plans, intravenous catheter placement and constant rate infusions can all help to provide a rewarding outcome for both the nurse and the patient.

Ketogenic diet for anxiety disorders: Dietary regimen for relapse prevention?

IntroductionAnxiety disorders are a mental disorder that is widespread all over the world and are associated with a high burden of the disease. While poor dietary habits are common in depression, they can lead to worsening of the illness or prolong the treatment, which also leads to a higher risk of developing chronic diseases.ObjectivesWith the array of the treatment modalities including monoaminergic antidepressants, benzodiazepines, psychotherapy, there is the unmet need for the effective treatment of anxiety disorders resulting in full remission and relapse prevention. Benzodiazepines can quickly resolve anxiety due to their positive allosteric GABA modulation mechanism of action. Although, they are not recommended for chronic use.Methods Ketogenic diet(KD) may be hypothesized as the promising strategy impacting treatment strategies, in particularly facilitating full remission, recovery and preventing relapses. In this popular high-fat diet, where daily calories intake is consists in at least 70% from fat, up to 25 % from protein and as little sugar as possible is mainly known for its helpful role in drug resistant epilepsy treatment, glucose levels balance or fast way for weight-loss.ResultsCould be effective in anxiety disorders treatment due to its possible role in GABA:glutamate balance change in favor of GABA levels, which may enhance the anxiolytic effect in sustaining remission and preventing relapse.ConclusionsKD in some anxiety disorders may provide a rewarding outcome, but more research is needed. The evidence mentioned in this paper should encourage psychiatrists to recommend KD as advice somewhere between psychotherapy, pharmacology or as an add-on to those two.

The Applicability of Communication Accommodation Theory and Empathy Strategy in Speeches ——A Case Study from Remarks by Ambassador Cui Tiankai in 2018

This paper is mainly based on the topic of whether the theory of Communication Accommodation (CAT) is applicable in speeches and how the Empathy strategy is applied in speeches. A case study from a speech by Ambassador Cui Tiankai at the Welcome Dinner Hosted by Kentucky Governor Matt Bevin is analyzed as a sample of intercultural communication practice. The research analyzes and explores the origin of the CAT and its related theories as well as elaborates on similarity-attraction theory, social exchange theory, causal attribution, social identity theory and some major strategies such as convergence, divergence and over-convergence for the purpose of the applicability of CAT in speeches. What is more, empathy as an important strategy is illustrated in detail. After a careful analysis, it has been proved that it is effective and practical for the application of CAT in speeches. Furthermore, the application of Empathy strategy in speeches will create a rewarding outcome.

The influence of associative reward learning on motor inhibition

Stimuli that predict a rewarding outcome can cause difficulties to inhibit unfavourable behaviour. Research suggests that this is also the case for stimuli with a history of reward extending these effects on action control to situations, where reward is no longer accessible. We expand this line of research by investigating if previously reward-predictive stimuli promote behavioural activation and impair motor inhibition in a second unrelated task. In two experiments participants were trained to associate colours with a monetary reward or neutral feedback. Afterwards participants performed a cued go/no-go task, where cues appeared in the colours previously associated with feedback during training. In both experiments training resulted in faster responses in rewarded trials providing evidence of a value-driven response bias as long as reward was accessible. However, stimuli with a history of reward did not interfere with goal-directed action and inhibition in a subsequent task after removal of the reward incentives. While the first experiment was not conclusive regarding an impact of reward-associated cues on response inhibition, the second experiment, validated by Bayesian statistics, clearly questioned an effect of reward history on inhibitory control. This stands in contrast to earlier findings suggesting that the effect of reward history on subsequent action control is not as consistent as previously assumed. Our results show that participants are able to overcome influences from Pavlovian learning in a simple inhibition task. We discuss our findings with respect to features of the experimental design which may help or complicate overcoming behavioural biases induced by reward history.

Environment-based object values learned by local network in the striatum tail

Basal ganglia contribute to object-value learning, which is critical for survival. The underlying neuronal mechanism is the association of each object with its rewarding outcome. However, object values may change in different environments and we then need to choose different objects accordingly. The mechanism of this environment-based value learning is unknown. To address this question, we created an environment-based value task in which the value of each object was reversed depending on the two scene-environments (X and Y). After experiencing this task repeatedly, the monkeys became able to switch the choice of object when the scene-environment changed unexpectedly. When we blocked the inhibitory input from fast-spiking interneurons (FSIs) to medium spiny projection neurons (MSNs) in the striatum tail by locally injecting IEM-1460, the monkeys became unable to learn scene-selective object values. We then studied the mechanism of the FSI-MSN connection. Before and during this learning, FSIs responded to the scenes selectively, but were insensitive to object values. In contrast, MSNs became able to discriminate the objects (i.e., stronger response to good objects), but this occurred clearly in one of the two scenes (X or Y). This was caused by the scene-selective inhibition by FSI. As a whole, MSNs were divided into two groups that were sensitive to object values in scene X or in scene Y. These data indicate that the local network of striatum tail controls the learning of object values that are selective to the scene-environment. This mechanism may support our flexible switching behavior in various environments.

Cage production and laying hen welfare

Although many factors affect the welfare of hens housed in cage and non-cage systems, welfare issues in cage systems often involve behavioural restrictions, whereas many welfare issues in non-cage systems involve health and hygiene. This review considers and compares the welfare of laying hens in cages, both conventional and furnished cages, with that of hens in non-cage systems, so as to highlight the welfare implications, both positive and negative, of cage housing. Comparisons of housing systems, particularly in commercial settings, are complex because of potentially confounding differences in physical, climatic and social environments, genetics, nutrition and management. Furthermore, some of the confounding factors are inherent to some specific housing systems. Nevertheless, research in commercial and experimental settings has indicated that hens in conventional and furnished cages have lower (or similar), but not higher, levels of stress on the basis of glucocorticoid concentrations than do hens in non-cage systems. Furthermore, caged hens, generally, have lower mortality rates than do hens in non-cage systems. However, the behavioural repertoire of laying hens housed in conventional cages is clearly more compromised than that of hens in non-cage systems. In contrast to conventional cages, furnished cages may provide opportunities for positive emotional experiences arising from perching, dust-bathing, foraging and nesting in a nest box. Some have suggested that the problems with modern animal production is not that the animals are unable to perform certain behavioural opportunities, but that they are unable to fill the extra time available with limited behaviours when they have no need to find food, water or shelter. Environmental enrichment in which objects or situations are presented that act successfully, and with a foreseeable rewarding outcome for hens by also providing regular positive emotional experience, is likely to enhance hen welfare. Research on cage systems highlights the importance of the design of the housing system rather than just the housing system per se.

Ketogenic Diet: A Dietary Modification as an Anxiolytic Approach?

Anxiety disorders comprise persistent, disabling conditions that are distributed across the globe, and are associated with the high medical and socioeconomic burden of the disease. Within the array of biopsychosocial treatment modalities—including monoaminergic antidepressants, benzodiazepines, and CBT—there is an unmet need for the effective treatment of anxiety disorders resulting in full remission and recovery. Nutritional intervention may be hypothesized as a promising treatment strategy; in particular, it facilitates relapse prevention. Low-carbohydrate high-fat diets (LCHF) may provide a rewarding outcome for some anxiety disorders; more research is needed before this regimen can be recommended to patients on a daily basis, but the evidence mentioned in this paper should encourage researchers and clinicians to consider LCHF as a piece of advice somewhere between psychotherapy and pharmacology, or as an add-on to those two.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Evaluation of Self Contentment with Dental Appearance and Preference to Treatment to Improve Esthetics

Introduction: Oral health not only comprises of mere absence of oral disease and dysfunction but also includes dental appearance for overall facial beauty as it has influence on person’s self confidence and social life. Dental aesthetic comprises of tooth color, shape, alignment and position of the teeth in the dental arches. For the rewarding outcome of the treatment, clinician need to understand the root of dissatisfaction with present aesthetic and desired treatment to enhance the aesthetic that will assist in development of treatment plan.
 Materials and Methods: Pre-tested structured questionnaire was used in 349 subjects from previous studies with slight modification for data collection. The questionnaire was divided into three parts, first part recorded the demographic data, second part consisted of the patients’ view regarding satisfaction of the dental appearance and third part consist of the Likert scale where participants will rate the satisfaction level regarding their general appearance.
 Results: A relationship between gender (P<0.05), education (P=0.006) and overall satisfaction of the general appearance of the teeth was seen. Males were found to be more satisfied than females and people with higher education were more satisfied with their general dental appearance. For majority of the participants, choice of treatment to improve the aesthetic was teeth whitening (37.25%) followed by orthodontic treatment (29.80%), then dental crown, veneers (27.29%). The least favoured treatment by the participants is denture (5.16%) to improve the aesthetic.
 Conclusions: Dissatisfaction with the color, alignment, teeth appearance and condition are the main reasons for the patients to seek aesthetic treatment.

IgG4 Related Peri-aortitis: A Case Diagnosed in Combined Military Hospital, Dhaka

IgG4 related disease is a multi-organ immune-mediated condition which links many disorders previously regarded as isolated, a single-organ disease without any known underlying systemic condition. It may mimic anymalignant, infectious and inflammatory disorders. It was recognized as a unified entity only 10 years ago. Histopathology is the key to diagnosis. The three central pathology features of IgG4 related disease are lymphoplasmacytic infiltration, stroriform fibrosis, and obliterative arteritis. It is important to promptly diagnose IgG4 related disease because this disease commonly manifests as swelling of the affected organs, which must be differentiated from true neoplasms. Periaortitis or periarteritis is one of the clinical features of IgG4 related diseases. IgG4 related arterial lesions occur mainly in the aorta and its main branches and radiologically characterized by homogeneous arterial wall thickening corresponding to pathological features of IgG4 related sclerosing inflammation in the adventitia. There are 5 types of IgG4 related peri-aortitis, out of which Type 2 is most common. IgG4 related peri-aortitis generally respond to glucocorticoids in its inflammatory stage, but recurrent or refractory cases are common. Greater awareness of this disease is needed to ensure earlier diagnoses to prevent severe organ damage. A 38-year-old male was diagnosed as Type 2 IgG4 related periaortitis 2 years ago in CMH, Dhaka. He was treated with oral steroid and Azathioprine with a rewarding outcome.
 Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 217-219