Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation

Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.

Do adolescents use choice to learn about their preferences? Development of value refinement and its associations with depressive symptoms in adolescence

Independent decision making requires forming stable estimates of one's preferences. We assessed whether adolescents learn about their preferences through choice deliberation and whether depressive symptoms disrupt this process. Adolescents aged 11-18 (N = 214; participated 2021-22; Female: 53.9%; White/Black/Asian/Mixed/Arab or Latin American: 26/21/19/9/8%) rated multiple activities, chose between pairs of activities and re-rated those activities. As expected, overall, participants uprated chosen and downrated unchosen activities (dz = .20). This value refinement through choice was not evident in younger participants but emerged across adolescence. Contrary to our predictions, depressive symptoms were associated with greater value refinement. Despite this, more depressed adolescents reported lower value certainty and choice confidence. The cognitive processes through which choice deliberation shapes preference develop over adolescence, and are disrupted in depression.

Low-Voltage Hydrogen Production via Hydrogen Peroxide Oxidation Facilitated by Oxo Ligand Axially Coordinated to Cobalt in Phthalocyanine Moiety

A cobalt phthalocyanine having an electron-poor CoN4 (+δ) in its phthalocyanine moiety was presented as an electrocatalyst for hydrogen peroxide oxidation reaction (HPOR). We suggested that hydrogen peroxide as an electrolysis medium for hydrogen production and therefore as a hydrogen carrier, demonstrating that the electrocatalyst guaranteed high hydrogen production rate by hydrogen peroxide splitting. The electron deficiency of cobalt allows CoN4 to have the highly HPOR-active monovalent oxidation state and facilitates HPOR at small overpotentials range around the onset potential. The strong interaction between the electron-deficient cobalt and oxygen of peroxide adsorbates in Co─OOH- encourages an axially coordinated cobalt oxo complex (O═CoN4 ) to form, the O═CoN4 facilitating the HPOR efficiently at high overpotentials. Low-voltage oxygen evolution reaction guaranteeing low-voltage hydrogen production is successfully demonstrated in the presence of the metal-oxo complex having electron-deficient CoN4 . Hydrogen production by 391 mA cm-2 at 1 V and 870 mA cm-2 at 1.5 V is obtained. Also, the techno-economic benefit of hydrogen peroxide as a hydrogen carrier is evaluated by comparing hydrogen peroxide with other hydrogen carriers such as ammonia and liquid organic hydrogen carriers.

Layer-Controlled Perovskite 2D Nanosheet Interlayer for the Energy Storage Performance of Nanocomposites

Polymer-based nanocomposites are desirable materials for next-generation dielectric capacitors. 2D dielectric nanosheets have received significant attention as a filler. However, randomly spreading the 2D filler causes residual stresses and agglomerated defect sites in the polymer matrix, which leads to the growth of an electric tree, resulting in a more premature breakdown than expected. Therefore, realizing a well-aligned 2D nanosheet layer with a small amount is a key challenge; it can inhibit the growth of conduction paths without degrading the performance of the material. Here, an ultrathin Sr_1.8 Bi_0.2 Nb₃ O₁₀ (SBNO) nanosheet filler is added as a layer into poly(vinylidene fluoride) (PVDF) films via the Langmuir-Blodgett method. The structural properties, breakdown strength, and energy storage capacity of a PVDF and multilayer PVDF/SBNO/PVDF composites as a function of the thickness-controlled SBNO layer are examined. The seven-layered (only 14 nm) SBNO nanosheets thin film can sufficiently prevent the electrical path in the PVDF/SBNO/PVDF composite and shows a high energy density of 12.8 J cm^-3 at 508 MV m^-1 , which is significantly higher than that of the bare PVDF film (9.2 J cm^-3 at 439 MV m^-1 ). At present, this composite has the highest energy density among the polymer-based nanocomposites under the filler of thin thickness.

Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes

BACKGROUND

Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes.

OBJECTIVE

To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes.

MATERIALS AND METHODS

For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen.

RESULTS

The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group.

CONCLUSION

Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.

Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes

BACKGROUND

Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes.

OBJECTIVE

To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes.

MATERIALS AND METHODS

For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen.

RESULTS

The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group.

CONCLUSION

Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.

Natural History of Isolated Below-Knee Vein Thrombosis in Patients with Spinal Cord Injury

In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0–74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.

Immune response to hepatitis B vaccination and factors associated with poor immune response among healthcare workers

Background

Hepatitis B virus (HBV) infection is a major global health problem, and healthcare workers (HCWs) are at high risk for HBV infection. Current guidelines strongly recommend immunization and screening for high-risk groups.

Aims

We evaluated immunization and screening for HBV vaccination, assessed post-vaccination immune status of HCW's and characterized potential risk factors associated with poor immune response.

Materials and Methods

From January 2010 to December 2018, we retrospectively analyzed comprehensive health checkup data for a total of 303 HCWs who received an HBV vaccination. After vaccination, HBV surface antibody (anti-HBs) titers were collected and the distribution of immune response types was determined. Risk factors for poor immune responses were identified using logistic regression.

Results

A total of 213 HCWs were analyzed after exclusion based on the exclusion criteria. In total, 28 (13.2%) HCWs had anti-HBs titers <100 mIU/mL (hyporesponsive/nonresponsive groups), and 185 (86.8%) had anti-HBs titers ≥100 mIU/mL (hyperresponsive group). Follow-up observations found that 75% (21/28) of the hyporesponsive/nonresponsive groups did not have increased anti-HBs titers or did not maintain an increased response. A multivariate analysis showed that HBV antibody titers at the time of employment were a significant risk factor (OR, 6.12; CI, 1.34-27.93; P = 0.019).

Conclusions

More attention should be paid to groups that are hyporesponsive/nonresponsive after vaccination and to those with low anti-HBs titers at the beginning of employment. HCWs can be further protected from HBV if their results are discussed at postvaccination follow-ups.

Enhanced microbial fuel cell (MFC) power outputs through Membrane Permeabilization using a branched polyethyleneimine

This study demonstrates the impact outer membrane permeability has on the power densities generated by E. coli-based microbial fuel cells with neutral red as the mediator, and how increasing the permeability improves the current generation. Experiments performed with several lipopolysaccharide (LPS) mutants (ΔwaaC, ΔwaaF and ΔwaaG) of E. coli BW25113 that increase the outer membrane permeability found the power generated by two of the truncated LPS mutants, i.e., ΔwaaC and ΔwaaF, to be significantly higher (5.6 and 6.9 mW/m², respectively) than that of the wild-type E. coli BW25113 (2.6 mW/m²). Branched polyethyleneimine (BPEI, 400 mg/L), a strong chemical permeabilizer, was more effective, however, increasing the power output from E. coli BW25113 cultures to as much as 29.7 mW/m², or approximately 11-fold higher than the control MFC. BPEI also increased the activities of the mutant strains (to between 10.6 and 16.3 mW/m²), as well as when benzyl viologen was the mediator. Additional tests found BPEI not only enhanced membrane permeability but also increased the zeta potential of the bacterial cells from a value of -43.4 mV to -21.0 mV. This led to a significant increase in auto-aggregation of the bacterial cells and, consequently, better adherence of the cells to the anode electrode, as was demonstrated using scanning electron microscopy. In conclusion, our study demonstrates the importance of outer membrane permeabilities on MFC performances and defines two benefits that BPEI offers when used within MFCs as an outer membrane permeabilizer.

Piezoelectric Energy Harvesting Design Principles for Materials and Structures: Material Figure-of-Merit and Self-Resonance Tuning

Piezoelectric energy harvesters (PEHs) aim to generate sufficient power to operate targeting device from the limited ambient energy. PEH includes mechanical-to-mechanical, mechanical-to-electrical, and electrical-to-electrical energy conversions, which are related to PEH structures, materials, and circuits, respectively; these should be efficient for increasing the total power. This critical review focuses on PEH structures and materials associated with the two major energy conversions to improve PEH performance. First, the resonance tuning mechanisms for PEH structures maintaining continuous resonance, regardless of a change in the vibration frequency, are presented. Based on the manual tuning technique, the electrically- and mechanically-driven self-resonance tuning (SRT) techniques are introduced in detail. The representative SRT harvesters are summarized in terms of tunability, power consumption, and net power. Second, the figure-of-merits of the piezoelectric materials for output power are summarized based on the operating conditions, and optimal piezoelectric materials are suggested. Piezoelectric materials with large k_ij , d_ij , and g_ij values are suitable for most PEHs, whereas those with large k_ij and Q_m values should be used for on-resonance conditions, wherein the mechanical energy is directly supplied to the piezoelectric material. This comprehensive review provides insights for designing efficient structures and selection of proper piezoelectric materials for PEHs.

Synergistic antibacterial activity of gold nanoparticles caused by apoptosis-like death

AIMS

Metal nanoparticles are promising materials for the management of infectious diseases as known to have various antimicrobial activities in pathogenic micro-organisms. Among them, gold nanoparticles (AuNPs) are used in a wide range of fields such as photodynamic therapy, molecular diagnostics and drug delivery because of their unique physicochemical properties. However, little is known about the synergistic antibacterial activity and mechanism of AuNPs on pathogenic bacteria.

METHODS AND RESULTS

Combinations of AuNPs and cefotaxime and ciprofloxacin showed synergistic interaction against all Salmonella species, however the combination with kanamycin exhibited no interaction. We determined that AuNPs and in combinations with antibiotics exert its antibacterial effect through bacterial apoptosis-like death. AuNPs caused collapse of intracellular divalent cation homeostasis, and conventional antibiotics caused accumulation of reactive oxygen species, which induced apoptotic hallmarks such as membrane depolarization, caspase-like protein activation, cell filamentation and phosphatidylserine externalization.

CONCLUSIONS

The cation homeostasis disruption by AuNPs and the accumulation of reactive oxygen species by conventional antibiotics synergistically affected bacterial cell death and induced apoptosis-like death in Salmonella cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

The synergistic activity between AuNPs and antibiotics propose that the AuNPs are a potential antibacterial agent and adjuvant for antimicrobial chemotherapy.

Metal@SiO2 Core-Shells with Self-Arrested Migrating Core

Developing easy and customizable strategies for the directional structure modulation of multicomponent nanosystems to influence and optimize their properties are a paramount but challenging task in nanoscience. Here, we demonstrate highly controlled eccentric off-center positioning of metal-core in metal@silica core-shells by utilizing an in situ generated biphasic silica-based intraparticle solid-solid interface. In the synthetic strategy, by including Ca²⁺-ions in silica-shell and successive oxidative and reductive annealing at high temperature, a unique hairline-biphasic interface is evolved via the heat-induced concentric radial segregation of calcium silicate phase at the interior and normal silica phase at the exterior of core-shell, which can effectively arrest the outwardly migrating metal-core within rubbery calcium silicate phase, affording various eccentric core-shells, where core-positions are flexibly controlled by the annealing time and amounts of initially added Ca²⁺-ions. In the structure-property correlation study, the strategy allows fine-tuning of dipolar interaction-based blocking temperatures and magnetic anisotropies of different eccentric core-shells as the function of variable off-center distance of magnetic core without changing the overall size of nanoparticles. This work demonstrates the discovery and potential application of biphasic solid-solid media interface in controlling the heat-induced migration of metal nanocrystals and opens the avenues for exploiting the rarely studied high-temperature solid-state nanocrystal conversion chemistry and migratory behavior for directional nanostructure engineering.

Solid-State Conversion Chemistry of Multicomponent Nanocrystals Cast in a Hollow Silica Nanosphere: Morphology-Controlled Syntheses of Hybrid Nanocrystals

During thermal transformation of multicomponent nanocrystals in a silica nanosphere, FeAuPd alloy nanocrystals migrate outward and thereby leave a cavity in the silica matrix. Oxidation then converts these nanocrystals back into phase-segregated hybrid nanocrystals, AuPd@Fe3O4, with various morphologies. The FeAuPd-to-AuPd@Fe3O4 transformation was cast by the in situ generated hollow silica mold. Therefore, the morphological parameters of the transformed AuPd@Fe3O4 are defined by the degree of migration of the FeAuPd in the hollow silica nanoshell. This hollow silica-cast nanocrystal conversion was studied to develop a solid state protocol that can be used to produce a range of hybrid nanocrystals and that allows for systematic and sophisticated control of the resulting morphologies.

A novel mouse model of diabetes mellitus using unilateral nephrectomy

Diabetes mellitus (DM) is a major cause of morbidity and mortality worldwide, and its complications are prominent public health issues. Many experimental models of streptozotocin (STZ)-induced and high-fat diet (HF)-induced DM have been used to study this disease. Studies have indicated that unilateral nephrectomy (UN) accelerates the development of diabetic nephropathy. We hypothesized that UN stimulates HF and STZ combination-induced DM in mice. Seventy-two female C57BL/6J mice were divided into four treatment groups: HF; HF + STZ120 (HF and STZ, 120 mg/kg); UN + HF + STZ120 (UN, HF and STZ, 120 mg/kg); and HF + STZ200 (HF and STZ, 200 mg/kg). Onset of DM, survival rate, blood pressure, urine glucose level, and pancreatic histology were investigated. Additionally, renal function was evaluated in the UN + HF + STZ120 group after STZ injection. DM was induced in the UN + HF + STZ120 and HF + STZ200 groups within one week. The UN + HF + STZ120 group had lower mortality than the HF + STZ200 group and greater pancreatic destruction than the HF and HF + STZ120 groups. Two weeks after STZ injection, blood pressure was not significantly different among the groups. Nephrotoxicity associated with the combination of UN and STZ was not observed. In conclusion, the combination of these three techniques – UN, HF and STZ induced DM rapidly and effectively.

Epidemiology of invasive fungal diseases among patients with haematological disorders in the Asia-Pacific: a prospective observational study

We conducted a 2-year multicentre prospective observational study to determine the epidemiology of and mortality associated with invasive fungal diseases (IFDs) among patients with haematological disorders in Asia. Eleven institutions from 8 countries/regions participated, with 412 subjects (28.2% possible, 38.3% probable and 33.5% proven IFDs) recruited. The epidemiology of IFDs in participating institutions was similar to Western centres, with Aspergillus spp. (65.9%) or Candida spp. (26.7%) causing the majority of probable and proven IFDs. The overall 30-day mortality was 22.1%. Progressive haematological disorder (odds ratio [OR] 5.192), invasive candidiasis (OR 3.679), and chronic renal disease (OR 6.677) were independently associated with mortality.

Effectiveness of intra-articular steroid injection for atlanto-occipital joint pain

OBJECTIVES

The aims of this study were to evaluate the role of intra-articular joint injection for atlanto-occipital (AO) joint pain and to determine pain referral sites from that joint.

DESIGN

Prospective observational study.

METHOD

We evaluated 29 patients with chronic refractory neck pain and/or headache, and limited range of lateral bending with rotation at the AO joint on physical examination. Of the 24 patients who consented to undergo diagnostic injections, 20 patients had at least 50% relief from pain and underwent two AO intra-articular injections of mixture of local anesthetic and steroid approximately 1 week apart. Patients completed pain drawings, visual analog scales (VASs) for pain, and neck disability index (NDI) for level of function. Patients were evaluated for 2 months after the first injection.

RESULT

There was headache in 14/20 (70%), posterior neck pain (PNP) in 20, and referred pain in 17 (85%). The average VAS values for headache, PNP, and other referred pains were reduced significantly from 5.64, 5.70, and 5.41, respectively, before treatments to 0.64, 2.30, and 1.71, respectively, two months after injection (P < 0.01). The average NDI value was reduced significantly from 39.95% at pretreatment to 20.40% at 2 months after treatment (P < 0.01).

CONCLUSION

AO intra-articular steroid injection appears effective for the short-term control of chronic refractory pain arising from the AO joint.

Adaptive compressed sensing for the fast terahertz reflection tomography

In this paper, an adaptive compressed sensing is proposed in order to enhance the performance of fast tetrahertz reflection tomography. The proposed method first acquires data at random measurement points in the spatial domain, and estimates the regions in each tomographic image where much degradation is expected. Then, it allocates additional measurement points to those regions, so that more data are acquired adaptively at the regions prone to degradation, thereby improving the quality of the reconstructed tomographic images. The proposed method was applied to the T-ray reflection tomography system, and the image quality enhancement by the proposed method, compared to the conventional method, was verified for the same number of measurement points.

Surface-specific deposition of catalytic metal nanocrystals on hollow carbon nanospheres via galvanic replacement reactions of carbon-encapsulated MnO nanoparticles

This paper reports the findings of our efforts toward gaining a more complete understanding and utilization of galvanic replacement reactions involving manganese oxide with noble metals. It was revealed that the site of metal deposition is significantly affected by the variable oxidation state of manganese oxide. The use of carbon-encapsulated MnO nanoparticles as a reaction template led to metal growth specifically on the outermost surfaces of the carbon shells rather than on the MnO cores, which allowed for the selective decoration of the external surfaces of hollow carbon nanospheres with catalytic nanocrystals of various noble metals, including Pt, Pd, Rh, and Ir. By rearranging the sequence between carbon-shell coating and galvanic replacement processes, the deposited metal nanocrystals could be placed on the interior surfaces of hollow carbon nanospheres and, moreover, separately on the internal and the external surfaces, which may enable the respective control of the catalytic functionalities of each specific surface.

Acute bleeding in the head and neck: angiographic findings and endovascular management

BACKGROUND AND PURPOSE

Life-threatening bleeding in the head and neck requires urgent management. This study evaluated the angiographic findings related to head and neck bleeding and presents endovascular management techniques.

MATERIAL AND METHODS

Sixty-one consecutive patients who presented with acute bleeding in the head and neck areas and subsequently underwent endovascular therapy between January 2002 and October 2012 were included in our study. We evaluated the angiographic findings, techniques, and results of endovascular management.

RESULTS

Contrast leakage (n = 10), pseudoaneurysm (n = 20), or both (n = 10) were the most common life-threatening angiographic findings (66%) and were the foci of immediate embolization or endoluminal vessel reconstruction. Seventeen patients (28%) had hypervascular staining of the tumor or mucosa, and 4 patients (6%) did not have any abnormal findings. The acute bleeding was successfully controlled by endovascular management according to the bleeding foci. Carotid arterial lesions, so-called "carotid blowout," required reconstructive or deconstructive therapy. Bleeding of the external carotid artery required specific branch embolization by a combination of various embolic materials. No procedure-related complications occurred except in 1 patient who experienced acute infarction caused by thromboemboli from the covered stent. Seventeen patients (28%) were retreated due to rebleeding after the mean 20-month follow-up.

CONCLUSIONS

Contrast leakage or a pseudoaneurysm or both seen on angiography are active bleeding foci and targets for therapy in patients with acute bleeding in the head and neck area. Despite different bleeding-control strategies according to vessel involvement, endovascular treatment is safe and effective for controlling hemorrhage.

Mn(2+)-doped silica nanoparticles for hepatocyte-targeted detection of liver cancer in T1-weighted MRI

With an aim to examine the possibility of developing a liver-specific MRI contrast agent that takes advantages of brightly enhanced MR images by Mn²⁺ whilst making up the limitations of the pre-developed contrast agent, the Mn²⁺-doped SiO₂ nanoparticles (Mn-SiO₂) were synthesized and their characteristics as MR contrast agents were investigated. The in vitro and in vivo investigations showed that Mn-SiO₂ has unique MR contrast-enhancing characteristics that activate positive contrast enhancement in T1-weighted MR images only under low pH conditions by liberating Mn²⁺ ions from MR inactive nanoparticles. The administration of Mn-SiO₂ to an orthotopic xenograft model of human hepatocellular carcinoma (HCC) resulted in a differentiation of enhancement periods between HCC and normal parenchyma tissues on T1-weighted MR images and consequently presented the duplicates of the highly contrast-enhanced liver image with an equal liver-to-HCC contrast ratio but opposite contrast. The Mn-SiO₂-enhanced MR imaging therefore allowed for the repetitive detection of the HCC within a single MR imaging session, which can help us to achieve more reliable diagnosis and characterization of liver lesions than is possible with any currently used Mn²⁺-based contrast agent. In addition, the in vivo biodistribution study also supported the effectiveness of Mn-SiO₂ nanoparticles as a liver-specific MRI contrast agent, which efficiently delivers and releases the T1-contrasting Mn²⁺ ions to targeted hepatocytes.

Effect of laser-induced temperature field on the characteristics of laser-sintered silver nanoparticle ink

Laser sintering of metal nanoparticles is a key technology for high-performance printed electronics fabricated on heat-sensitive substrates such as glass or plastic. Although laser-sintered electronic devices have been successfully fabricated, the role of the induced temperature field in the laser sintering process has not been reported thus far. In this work, the effect of temperature on the laser sintering process is described for the first time using a two-dimensional transient heat conduction equation for inkjet-printed silver nanoparticle ink. The in situ electrical resistance was measured to estimate the transient thermal conductivity and hence the temperature of the sintered ink during the laser sintering process. To verify the estimated laser sintering temperature, the morphology of furnace-sintered silver nanoparticle ink was compared with that of laser-sintered ink. The electrical characteristics and surface morphology of laser-sintered ink are found to be related to the process temperature.

Clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia in children with febrile neutropenia

PURPOSE

This retrospective study was performed in order to investigate the clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia (VSB) in febrile neutropenic children in the context of the increase in incidence and antibiotic resistance of VSB.

METHODS

We conducted this study among neutropenic children with underlying hematology/oncology diseases who were diagnosed with VSB at a single institution from April 2009 to June 2012. Clinical and laboratory characteristics of the children as well as antibiotic susceptibility of the causative viridans streptococci were evaluated.

RESULTS

Fifty-seven episodes of VSB were diagnosed in 50 children. Severe complications occurred in four children (7.0%), and a death of one child (1.8%) was attributable to VSB. Acute myeloid leukemia was the most common underlying disease (70.2% of all cases), and 71.9% of all cases received chemotherapy including high-dose cytarabine. VSB occurred at a median of 13 days (range 8-21 days) after the beginning of chemotherapy, and fever lasted for a median of 4 days (range 1-21 days). The C-reactive protein level significantly increased within a week after the occurrence of VSB (p < 0.001) and the maximum C-reactive protein level showed a positive correlation with fever duration (r = 0.362, p = 0.007). Second blood cultures were done before the use of glycopeptides in 33 children, and negative results were observed in 30 children (90.9%). Susceptibilities to cefotaxime, cefepime, and vancomycin were 58.9, 69.1, and 100%, respectively.

CONCLUSIONS

Severe complications of VSB in neutropenic febrile children were rare. We suggest glycopeptide use according to the results of blood culture and antibiotic susceptibility tests based on the susceptibility to cefepime and the microbiologic response to empirical antibiotic treatment not including glycopeptides in this study.

Proteomic and bioinformatic analysis of membrane proteome in type 2 diabetic mouse liver

Type 2 diabetes mellitus (T2DM) is the most prevalent and serious metabolic disease affecting people worldwide. T2DM results from insulin resistance of the liver, muscle, and adipose tissue. In this study, we used proteomic and bioinformatic methodologies to identify novel hepatic membrane proteins that are related to the development of hepatic insulin resistance, steatosis, and T2DM. Using FT-ICR MS, we identified 95 significantly differentially expressed proteins in the membrane fraction of normal and T2DM db/db mouse liver. These proteins are primarily involved in energy metabolism pathways, molecular transport, and cellular signaling, and many of them have not previously been reported in diabetic studies. Bioinformatic analysis revealed that 16 proteins may be related to the regulation of insulin signaling in the liver. In addition, six proteins are associated with energy stress-induced, nine proteins with inflammatory stress-induced, and 14 proteins with endoplasmic reticulum stress-induced hepatic insulin resistance. Moreover, we identified 19 proteins that may regulate hepatic insulin resistance in a c-Jun amino-terminal kinase-dependent manner. In addition, three proteins, 14-3-3 protein beta (YWHAB), Slc2a4 (GLUT4), and Dlg4 (PSD-95), are discovered by comprehensive bioinformatic analysis, which have correlations with several proteins identified by proteomics approach. The newly identified proteins in T2DM should provide additional insight into the development and pathophysiology of hepatic steatosis and insulin resistance, and they may serve as useful diagnostic markers and/or therapeutic targets for these diseases.

Effect of Intradiscal Methylene Blue Injection for the Chronic Discogenic Low Back Pain: One Year Prospective Follow-up Study

Objective

To evaluate the efficacy of intradiscal methylene blue (MB) injection in patients with chronic discogenic low back pain.

Method

Twenty patients with discogenic low back pain (4 males, 16 females; mean age 45.6 years) refractory to conservative management were recruited. All subjects underwent MB injection in target lumbar intervertebral discs confirmed by provocative discography. The clinical outcome was assessed by visual analog scale (VAS) and Oswestry disability index (ODI) at baseline and 1, 3, 6 and 12 months after treatment. Successful outcome was described as minimum of 2 points reduction in pain intensity compared with the baseline.

Results

VAS and ODI significantly decreased after one injection. The average VAS and ODI were reduced significantly from 5.1 and 38.0 at baseline to 3.2 and 27.4 at 3 months after injection (p<0.05). However, the mean score of VAS at 12 month follow-up was 4.5 and we could not observe any difference between 12 months after injection and pretreatment. Eleven of twenty patients (55%) reported successful outcomes after intradiscal MB injection at 3 month follow up and the average VAS was reduced by 3.3±1.1 (p<0.05). At the time of 12 month follow up, pain had relapsed in 6 patients who have had satisfactory effect at 3 month follow up. Successful outcome was maintained in only 5 patients (20%) for 1 year.

Conclusion

The intradiscal MB injection is a short-term effective minimally invasive treatment indicated for discogenic back pain but it may lose its effectiveness long-term.

H⁺-myo-inositol transporter SLC2A13 as a potential marker for cancer stem cells in an oral squamous cell carcinoma

Cancer Stem Cells (CSCs) from tumors of different phenotypes possess a marked capacity for proliferation, self-renewal, and differentiation. They also play a critical role in cancer recurrence. Although CSC has been regarded as a new target for cancer therapy, the fundamental questions in the CSC study have not been resolved mainly due to the lack of proper CSC markers. To find new CSC markers for oral squamous cell carcinoma (OSCC), we cultured the primary tumor cells from OSCC patients the regular culture condition and the sphere-forming culture condition to enrich primary tumor cells and potential CSCs. We compared gene expression profiles between sphere-forming and non-forming cells, thus identifying that 23 membrane protein-coding genes were over-expressed in the sphere-forming cells. Among them, 8 belonged to the solute carrier (SLC) protein family. H⁺-myo-inositol transporter SLC2A13 and monocarbohydrate transporter SLC16A6 genes that were consistently increased in the sphere-forming cells in the primary cultures of OSCC samples. Confocal microscopy revealed that SLC2A13-expressing cells were embedded in the limited areas of tumor tissue as a cluster, while SLC16A6 was uniformly detected in hyperplastic epithelium. Moreover, SLC2A13 an expression was induced in human breast adenocarcinoma MCF7 cells after serum starvation. Taken together, our results suggest that SLC2A13 can be a potential markers for CSC in various tumors.

Long-term effect of pulsed radiofrequency on chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections

OBJECTIVE

The article aims to evaluate the long-term effectiveness and safety of pulsed radiofrequency (PRF) on the dorsal root ganglion (DRG) in patients with chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections (TFESIs).

DESIGN

This is a prospective observational study.

METHODS

We retrospectively reviewed data on 112 subjects who had received repeated TFESIs for cervical radicular pain. Twenty-nine of those 112 patients continued to complain of persistent cervical radicular pain, despite an average of three repeated TFESIs. Among 29 patients with sustained arm pain of over 4 on the numerical rating scale (NRS), a total of 21 patients were included prospectively. Those 21 patients underwent PRF on the symptomatic cervical DRG and were evaluated carefully for neurologic deficits and side effects. The clinical outcomes were measured via NRS for arm pain before treatment, and 1, 3, 6, and 12 months after treatment. Successful pain relief was defined as a 50% or more reduction in the NRS score as compared with the pretreatment score. After 12 months, patients' satisfaction levels with treatment were determined.

RESULTS

Fourteen of the 21 patients (66.7%) after cervical PRF stimulation reported pain relief of 50% or more at the 3-month and 12-month follow-up periods, respectively. Fifteen of the 21 patients (71.4%) were satisfied with their outcome at 12 months' posttreatment. No serious adverse effects were observed.

CONCLUSION

Application of PRF to the DRG appears to be an effective and relatively safe intervention technique for chronic cervical radicular pain refractory to repeated TFESIs.

Endoscopic submucosal resection of esophageal subepithelial lesions using band ligation

Subepithelial lesions (SELs) are occasionally found in the esophagus during upper endoscopy. Sometimes endoscopic resection is needed for accurate diagnosis or in the rare cases of malignant transformation of SELs. In this case series, we evaluated the usefulness of endoscopic submucosal resection with a ligation device (ESMR-L) in esophageal SELs. Twenty-three patients with 25 esophageal SELs that were no larger than 13 mm and were localized within the muscularis mucosae or submucosa were enrolled. ESMR-L was successfully performed in all 25 SELs. The en bloc resection rate was 100% (25/25), and histologically complete resection was achieved in 24 lesions (24/25, 96%). After resection of the lesion by snare, minor immediate bleeding occurred in four cases, but there was no delayed bleeding or perforation.

CT features of lobular capillary hemangioma of the nasal cavity

BACKGROUND AND PURPOSE

Lobular capillary hemangioma is a benign capillary proliferation of unknown etiology. To our knowledge, no comprehensive review of imaging findings of LCHNC has been presented. Thus, we investigated characteristic CT features of LCHNC.

MATERIALS AND METHODS

This retrospective study included 6 patients (2 men and 4 women; age range, 30-65 years; mean age, 49.2 years) with histologically proved LCHNC. We evaluated the size, site of origin, attenuation on NECT, degree and pattern of enhancement, and bony changes.

RESULTS

The LCHNC lesion was 13.0-45.0 mm (average, 25.0 mm) in diameter. These lesions arose from the inferior turbinate in 5 (83.3%) patients and the anterior nasal septum in 1 (16.7%). Compared with the masticator muscles, the LCHNC lesion was hypoattenuating in 2 (33.3%) and isoattenuating on NECT in 4 (66.7%) patients. In 5 (83.3%) patients, the LCHNC lesion consisted of 2 distinct areas on CECT: a lobular intensely enhancing mass and an iso- or hypoattenuating cap of variable thickness around the intensely enhancing mass. Bony changes included erosion in 3 (50.0%) and displacement in 2 (33.3%) patients.

CONCLUSIONS

CT features of LCHNC consist of an intensely enhancing mass and an iso- or hypoattenuating cap on CECT. The inferior turbinate seems to be a common site of origin, and bony changes are not uncommon features of LCHNC. CT is useful not only in identifying the site of origin and assessing the extent but also in suggesting the nature of LCHNC.

Clear cell carcinoma of the pancreas--a case report and review of the literature

Most of the malignant neoplasms of the pancreas demonstrate features that are consistent with adenocarcinoma. According to the WHO classification, primary clear cell carcinoma of the pancreas is rare and it is classified as a "miscellaneous" carcinoma. In addition, there is not an adequate systematic overview that can demonstrate its true existence as a definable entity. We report here on an unusual case of primary pancreatic clear cell carcinoma, which is the first such reported case in Korea. A 66 year old woman presented with abdominal pain and significant weight loss over the previous three weeks. On the abdominal computed tomography (CT), we detected an abdominal mass involving the pancreas tail and liver, and clear cell carcinoma with rhabdoid feature was seen on the histologic evaluation. The tumor cells showed well defined cell membranes, clear cytoplasm and prominent cell boundaries. The immunohistochemical stains showed positive reactions to antibodies against pan-cytokeratin, cytokeratin 7, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). On the other hand, there was a negative reaction for cytokeratin 20, chromogranin, synaptophysin, smooth muscle actin and HMB-45. She was diagnosed with a primary pancreatic clear cell carcinoma with hepatic metastasis and she received palliative gemcitabine chemotherapy. The patient died one month later of pancreatic cancer progression.

Dimethylarginine dimethylaminohydrolase in rat penile tissue: reduced enzyme activity is responsible for erectile dysfunction in a rat model of atherosclerosis

Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), is mainly metabolized by N(G),N(G)-dimethylarginine dimethylaminohydrolase (DDAH). We investigated whether altered cavernosal ADMA-DDAH metabolism might cause impairment of erection in rat model of atherosclerosis (AS). Male Sprague-Dawley rats (3 months old) were divided into an AS group and a normal control (Con) group (n=20 in each group). The AS rats received AS-prone treatment (6 weeks of 1% cholesterol diet plus early 2 weeks of N(G)-nitro-L-arginine methyl ester (3 mg ml(-1) per day) treatment). After 6 weeks, rats underwent cavernosometry measuring the maximal intracavernosal pressure/mean arterial pressure (ICP/MAP) ratios as a surrogate marker of erectile function. The amount of cavernosal ADMA was assessed by immunoblot analysis and correlated with the ICP/MAP. Isoform-specific DDAH expression was compared by immunohistochemistry. Cavernosal DDAH and NOS activity were measured. Cavernosal malondialdehyde levels were assayed to determine the degree of lipid peroxidation. Compared to the controls, the AS rats had signs of impaired erectile function. Higher cavernosal ADMA was observed in the AS rats. The cavernosal ADMA had a moderately negative correlation with the ICP/MAP. Immunohistochemistry revealed the expression of both isoforms was not affected by the presence of AS. However, significantly diminished DDAH as well as NOS activity was observed in the AS group. In addition, elevated cavernosal malondialdehyde levels were noted in the AS rats. Our study showed that decreased cavernosal DDAH activity is the cause of cavernosal ADMA accumulation leading to reduced cavernosal NOS activity and impairment of erectile function.

A report of the Malaysian dialysis registry of the National Renal Registry, Malaysia

The Malaysian National Renal Registry was set up in 1992 to collect data for patients on renal replacement therapy (RRT). We present here the report of the Malaysian dialysis registry. The objectives of this papar are: (1) To examine the overall provision of dialysis treatment in Malaysia and its trend from 1980 to 2006. (2) To assess the treatment rate according to the states in the country. (3) To describe the method, location and funding of dialysis. (4) To characterise the patients accepted for dialysis treatment. (5) To analyze the outcomes of the dialysis treatment. Data on patients receiving dialysis treatment were collected at initiation of dialysis, at the time of any significant outcome, as well as yearly. The number of dialysis patients increased from 59 in 1980 to almost 15,000 in 2006. The dialysis acceptance rate increased from 3 per million population in 1980 to 116 per million population in 2006, and the prevalence rate from 4 to 550 per million population over the same period. The economically advantaged states of Malaysia had much higher dialysis treatment rates compared to the less economically advanced states. Eighty to 90% of new dialysis patients were accepted into centre haemodialysis (HD), and the rest into the chronic ambulatory peritoneal dialysis (CAPD) programme. The government provided about half of the funding for dialysis treatment. Patients older than 55 years accounted for the largest proportion of new patients on dialysis since the 1990s. Diabetes mellitus has been the main cause of ESRD and accounted for more than 50% of new ESRD since 2002. Annual death rate averaged about 10% on HD and 15% on CAPD. The unadjusted 5-year patient survival on both HD and CAPD was about 80%. Fifty percent of dialysis patients reported very good median QoL index score. About 70% of dialysis patients were about to work full or part time. There has been a very rapid growth of dialysis provision in Malaysia particularly in the older age groups. ESRD caused by diabetes mellitus, despite being a preventable and treatable cause of ESRD--has increased and accounted for more than 50% of incident dialysis patients. Death and survival rates on dialysis are comparable to those from other countries.

Wave-front phase measurements of high-order harmonic beams by use of point-diffraction interferometry

We report the wave-front phase measurement of high-order harmonics employing point-diffraction interferometry. The high-order harmonics generated in a gas-filled hollow tube showed excellent spatial coherence over nearly the whole cross section of the harmonic beams. Using this coherent harmonic source in the extreme-ultraviolet-soft-x-ray region, we have demonstrated the operation of a point-diffraction interferometer and measured the wave-front phase of high-order harmonics.

Inhibitory effect of methanol extract of Euonymus alatus on matrix metalloproteinase-9

Various extracts prepared from stems of Euonymus alatus were tested for cytotoxic activity on human hepatocellular carcinoma cell line, Hep3B cells using the XTT assay method. Also, the extracts were investigated the inhibitory effects on matrix metalloproteinase (MMP)-9 activity using gelatin zymography. The methanol extract, hexane and ethyl acetate fraction exhibited weak cytotoxic activity (IC(50) of >100 microg/ml). However, butanol (IC(50)=65 microg/ml) and chloroform (IC(50)=85 microg/ml) fraction exhibited strongly cytotoxic activity. Gelatin zymography showed that the Hep3B cells secreted matrix metalloproteinase (MMP), probably including MMP-9, which may be involved in tumor cell invasion and metastasis. The butanol fraction showed stronger inhibitory effect of proteolytic activity than other fractions. Also, the butanol fraction was able to decrease the proteolytic activity of MMP-9 in a concentration-dependent manner on zymography. These results suggest that the butanol fraction from E. alatus has highly inhibitory effect on MMP-9 in comparatively low cytotoxicity.

ERK MAP Kinase is required in 1,25(OH)2D3-induced differentiation in human osteoblasts

Expression of alkaline phosphatase(ALP)activity represents a key event during the differentiation processes of osteoblasts, and the level of ALP activity has been routinely used as a relative measure of differentiation stages of osteoblasts. In human osteoblasts, we showed that vitamin D3 analogue, 1,25(OH)2D3, had a stimulatory effect on ALP activity after 3 days, compared with control. The treatment of PD098059, an ERK MAP Kinase inhibitor, had a reducing effect on ALP activity, a differentiation marker in 1,25(OH)2D3-treated primary human osteoblasts. However, SB203580, a potent p38 MAP Kinase inhibitor, had no effect on the differentiation in this system. This indicates that ERK, not p38, is directly related to 1,25(OH)2D3-stimulated ALP activity in primary human osteoblasts. These results also show that the vitamin D3 analogue stimulates ERK1 activation in primary human osteoblasts. This finding provides one of signaling pathways for differentiation in primary human osteoblasts.

Coherent control of high-order harmonics with chirped femtosecond laser pulses

High-order harmonics were coherently controlled using chirped femtosecond laser pulses for the production of sharp and strong harmonics. As the laser intensity was increased above the saturation intensity for optical-field ionization, the laser chirp needed to suppress harmonic chirp in the plateau region changed from positive to negative. We showed that the modification of a laser chirp condition in a rapidly ionizing medium should be included for the proper coherent control of high-order harmonics, necessitating the integral treatment of the interaction between atoms and a driving laser pulse.

Utility of thyroid transcription factor-1 and cytokeratin 7 and 20 immunostaining in the identification of origin in malignant effusions

OBJECTIVE

To estimate the utility of thyroid transcription factor-1 (TTF-1) and the combined cytokeratin 7 (CK7) and 20 (CK20) immunoprofile as a marker for identifying the primary site of metastatic adenocarcinoma in effusions of the serous cavity.

STUDY DESIGN

Formalin-fixed, paraffin-embedded cell block specimens of pleural and peritonealfluid diagnosed as metastatic adenocarcinomas with known sites of origin were used for TTF-1, CK7 and CK20 immunohistochemistry. The primary sites of these cases were lung (16 cases), ovary (15), stomach (9), colon (8) and breast (8) and were confirmed by radiologic and/or histologic evaluation.

RESULTS

The lung adenocarcinomas showed TTF-1 positivity in 81% (13/16) of cases. All nonpulmonary adenocarcinomas lacked TTF-1 staining. The CK7-/CK20+ immunophenotype was seen in 63% of colonic adenocarcinomas and not seen in lung, ovary, stomach or breast adenocarcinomas. The CK7+/CK20- immunophenotype was seen in 100%, 88% and 87% of cases that originated in the lung, breast and ovary, respectively.

CONCLUSION

TTF-7 immunostaining is useful in the differentiation between pulmonary and nonpulmonary origin of adenocarcinomas in malignant effusions. The combination of CK7-/CK20+ immunostaining is useful in identifying colon adenocarcinomas.

Antibacterial, antitumor and hemolytic activities of alpha-helical antibiotic peptide, P18 and its analogs

The alpha-helical antibiotic peptide (P18: KWKLFKKIPKFLHLAKKF-NH2) designed from the cecropin A(1-8)-magainin 2 (1-12) hybrid displayed strong bactericidal and tumoricidal activity without inducing hemolysis. The effect of the Pro9 residue at central position of P18 on cell selectivity was investigated by Pro9 --> Leu or Pro9 --> Ser substitution. Either substitution markedly reduced the antibacterial activity of P18 and increased hemolysis, although it did not significantly affect cytotoxicity against human transformed tumor and normal fibroblast cells. These results suggest that a proline kink in alpha-helical antibiotic peptide P18 serves as a hinge region to facilitate ion channel formation on bacterial cell membranes and thus plays an important role in providing high selectivity against bacterial cells. Furthermore, to investigate the structure-antibiotic activity relationships of P18, a series of N- or C-terminal deletion and substitution analogs of P18 were synthesized. The C-terminal region of P18 was related to its antibiotic activity and alpha-helical conformation on lipid membranes rather than N-terminal one. Higher alpha-helicity of the peptides was involved in the hemolytic and antitumor activity rather than antibacterial activity. Except for [L9]-P18 and [S9]-P18, all the designed peptides containing a Pro residue showed potent antibacterial activity, although they did not induce a cytolytic effect against human erythrocyte and normal fibroblast cells at the concentration required to kill bacteria. In particular, P18 and some analogs (N-1, N-2, N-3, N-3L and N-4L) with potent bactericidal and tumoricidal activity and little or no normal cell toxicity may serve as an attractive candidate for the development of novel anti-infective or antitumor agents.

The kinetics of circulating cytokines including IL-6, TNF-alpha, IL-8 and IL-10 following allogeneic hematopoietic stem cell transplantation

Pro-inflammatory (IL-6, TNFalpha and IL-8) and anti-inflammatory (IL-10) cytokines were determined in weekly samples from 52 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). IL-6 increased immediately after transplant peaking at week +3, but IL-8 concentrations were elevated only during week +1. After a slight decrease in week +1, TNF-alpha significantly increased from week +2 and peaked at week +3, whereas, IL-10 values started to rise in week +2 and peaked during week +4. IL-6 and TNF-alpha were positively correlated from week +2 to week +4, and IL-6 levels at week +1 were related with fever and severe stomatitis. Serum levels of IL-6 at week +1 and IL-10 at week +4 were significantly higher in patients with early transplant-related complications, such as fever, severe stomatitis or acute GVHD > or = overall grade II than in those without the complications. We conclude that a high serum IL-6 level at week +1 may be an early predictor of transplant-related complications and that it seems to trigger pro- and anti-inflammatory cytokine release. Kinetic patterns of IL-6 and IL-10 were more exaggerated in those with complications after HSCT.

Sarcomatoid carcinoma of the colon: a case report

Sarcomatoid carcinoma is a rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. We report a rare case of sarcomatoid carcinoma of the colon. A 41-yr-old woman was hospitalized with a history of melena. Total colectomy was performed under the impression of colonic carcinoma. Histologically, the tumor was composed of differentiated adenocarcinoma in superficial portion and sarcomatoid spindle cells in deeper portion with a transitional area between the two portions. The sarcomatous areas revealed polygonal and spindle-shaped anaplastic malignant cells arranged in sheet, short fascicular or haphazard pattern. Immunohistochemically, tumor cells showed a positive immunoreaction for cytokeratin, epithelial membrane antigen, and vimentin. The histopathological and immunohistochemical transitions between the adenocarcinoma area and the spindle cell area suggested that the sarcomatous elements originated from the adenocarcinoma during tumor progression.