Cytological Comparison between Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma by Image Analysis Software Using Touch Smear Samples of Surgically Resected Specimens.

To investigate useful cytological features for differential diagnosis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), this study cytologically compared HCC to ICC using image analysis software. Touch smear specimens of surgically resected specimens were obtained from a total of 61 nodules of HCC and 16 of ICC. The results indicated that the major/minor axis ratio of ICC is significantly larger than that of HCC (1.67 ± 0.27 vs. 1.32 ± 0.11, p < 0.0001) in Papanicolaou staining. This result means that the nucleus of HCC is close to round and the nucleus of ICC is close to an oval. This significant difference in the major/minor axis ratio between ICC and HCC was consistently observed by the same analyses using clinical samples of cytology (4 cases of HCC and 13 cases of ICC) such a fine-needle aspiration, brushing and ascites (ICC: 1.45 ± 0.13 vs. HCC: 1.18 ± 0.056, p = 0.004). We also confirmed that nuclear position center-positioned nucleus (p < 0.0001) and granular cytoplasm (p < 0.0001) are typical features of HCC tumor cells compared to ICC tumor cells. The research study found a significant difference in the nuclear morphology of HCC (round shape) and ICC (oval shape) in Papanicolaou-stained cytology specimens. This simple and objective finding will be very useful for the differential cytodiagnosis of HCC and ICC.

Cytological Appearances of Ovarian Seromucinous Borderline Tumor in Ascites: Presentation of 2 Cases.

BACKGROUND: Seromucinous borderline tumor (SMBT) is a rare neoplasm which was newly defined in the 2014 WHO classification. Although the clinical and histopathological characteristics of SMBT have been well described, its cytological characteristics have not. We recently experienced 2 cases of SMBT which were defined by cytological findings of ascites. CASE PRESENTATION: Case 1 was a 65-year-old Japanese woman. Preoperative imaging studies revealed abundant ascites and a cystic tumor, with a solid component measuring 13 cm on the left ovary. Radical surgery was performed during the intraoperative diagnosis of ovarian borderline tumor, made by histological examinations of frozen tumor sections. The cytological smears of preoperatively and intraoperatively collected ascites showed many atypical cells resembling reactive mesothelial cells. Alcian-blue staining of cell block sections revealed intracytoplasmic mucin, and the results of immunohistochemistry were consistent with SMBT. The final pathological diagnosis of tumor was SMBT. Case 2 was a 28-year-old Japanese woman. Preoperative imaging studies revealed a small amount of ascites and cystic tumors with solid components in the bilateral ovaries. She initially underwent fertility preservation surgery. SMBT was suspected by cytological examination of smears of intraoperatively collected ascites and the findings of cell block. She underwent additional radical surgery based on a final pathological diagnosis of SMBT. CONCLUSION: In our experience, the tumor cells of SMBT in ascites mimicked reactive mesothelial cells. The nuclear atypia of SMBTs was intermediate between that of reactive mesothelial cells and serous carcinoma. The immunohistochemistry and mucin staining using cell block were very helpful for facilitating the cytodiagnosis of SMBT.

Combined effect of two-liquid silane-phosphate primer and single-liquid sodium sulfite primer on bonding between self-polymerizing resins and feldspathic ceramics.

The purpose of this study is to investigate the combined effect of two-liquid silane-phosphate primer and single-liquid sodium sulfite primer on bonding between self-polymerizing resins and feldspathic ceramics, and to promote the polymerization behavior of self-polymerizing resins at the bonding interface. The silane-phosphate primer (Super-Bond PZ Primer; PZ) and the sodium sulfite primer (Teeth Primer; TP) were used as the surface treatment agents for bonding the feldspathic ceramics and the self-polymerizing resins (MMA-TBB resin and 4-META/MMA-TBB resin). Combined PZ and TP showed high shear bond strengths. The peak of the differential scanning calorimetry curve was shown to occur early through the addition of TP. These results indicated that additional TP promoted the conversion in the initial polymerization of resin, and the firmly bond was obtained at the interface. PZ+TP treatment can be regarded as an effective treatment for a temporary splint used in teeth restoration.

Effect of a self-etching primer containing 4-META and sodium sulfite after phosphoric acid etching on bonding strength of MMA-TBB resin to human enamel.

PURPOSE: The aim of this study was to evaluate the shear bond strength and durability of MMA-TBB resin to human enamel applied a self-etching primer with phosphoric acid etching. METHODS: A self-etching primer (Teeth primer, TP) containing 4-methacryloyloxyethyl trimellitate anhydride (4-META) and sodium sulfite and two etchants having different phosphoric acid concentrations (K-etchant gel, KE, 35-45%: Red gel, RG, 20-25%) were used as treatment agent, and MMA-TBB resin was used as luting agent. Enamel surfaces were treated with six methods which were as follow: KE, RG, TP, KE+TP, and RG+TP. After enamel specimens were bonded with MMA-TBB resin and stored in distilled water for 24h, the shear bond strength test was done at 0 thermocycling or 20,000 thermocycling. These results were statistically verified with Steel-Dwass multiple comparisons and Man-Whitney U test. RESULTS: The shear bond strength of TP group, KE+TP group, and RG+TP group were significantly higher than KE group and RG group in pre-thermocycling. KE+TP group and RG+TP group were significantly higher than other groups in post-thermocycling. CONCLUSIONS: Applying TP with phosphoric acid etching can increased shear bond durability despite difference of phosphoric acid concentrations (35-45% or 20-25%).

Difficulty in the Cytodiagnosis of Mammary Analogue Secretory Carcinoma: Survey of 109 Cytologists with a Case Originating from a Minor Salivary Gland.

BACKGROUND: Mammary analogue secretory carcinoma (MASC) of the salivary gland shows morphologic similarities and shares an immunophenotype and characteristic ETV6-NTRK3 translocation with secretory carcinoma of the breast. We present a buccal case of MASC along with a survey-based debate about its cytologic diagnosis by fine-needle aspiration (FNA). CASE: FNA of the buccal nodule of a 58-year-old Japanese man was initially performed by 3 cytologists who gave different assessments of the Papanicolaou classification (i.e., class II, III, and V). To investigate the potential for discrepant diagnosis of MASC on a larger scale, we distributed a survey with questions about the cytological diagnosis of the present case to cytologists at other institutions. A total of 109 cytologists completed the survey, providing varying assessments of the Papanicolaou classification: class I/II (14%), class III (53%), and class IV/V (33%). Most of the respondents (72%) could not identify a particular tumor or disease. Even the respondents who identified a particular tumor suggested widely differing diagnoses, from a benign lesion to various malignant tumors. Only 2 respondents correctly identified MASC. CONCLUSION: Our experience and the results of the survey suggest difficulty in the cytodiagnosis of MASC.

Identification of Plants That Inhibit Lipid Droplet Formation in Liver Cells: Rubus suavissimus Leaf Extract Protects Mice from High-Fat Diet-Induced Fatty Liver by Directly Affecting Liver Cells.

Fatty liver disease is a condition in which abnormally large numbers of lipid droplets accumulate in liver cells. Fatty liver disease induces inflammation under conditions of oxidative stress and may result in cancer. To identify plants that protect against fatty liver disease, we examined the inhibitory effects of plant extracts on lipid droplet formation in mouse hepatoma cells. A screen of 98 water extracts of plants revealed 4 extracts with inhibitory effects. One of these extracts, Rubus suavissimus S. Lee (Tien-cha or Chinese sweet tea) leaf extract, which showed strong inhibitory effects, was tested in a mouse fatty liver model. In these mouse experiments, intake of the plant extract significantly protected mice against fatty liver disease without affecting body weight gain. Our results suggest that RSE directly affects liver cells and protects them from fatty liver disease.

Eleven-year clinical performance of a mandibular natural tooth pontic bonded with modified tri-n-butylborane initiated adhesive resin.

This clinical report describes the bonding procedure and clinical course of a natural tooth pontic in a 65-year-old male patient. A mandibular lateral incisor was extracted due to severe marginal periodontitis. The root of the tooth was amputated and a pontic structure was formed by filling acrylic resin into the coronal pulp chamber space. The enamel surface of the pontic and the adjacent abutment teeth were etched with phosphoric acid gel. The pontic was bonded with a modified tri-n-butylborane initiated adhesive resin (Super-Bond Quick). The connecters fractured 11 years after bonding when the patient accidentally bit a metallic chopstick. Recurrence of the fracture, however, did not occur, and the re-seated pontic has been functioning for more than 1 year. Although proper maintenance of both the periodontal tissue and splinted dentition is required, this minimally invasive technique can be applied in selected patients suffering from periodontal diseases.

Effect of sodium sulfite, carboxylic monomer, and phosphoric acid etching on bonding of tri-n-butylborane initiated resin to human enamel.

The purpose of the present study is evaluation of bonding durability of tri-n-butylborane (TBB) initiated resin without 4-methacryloyloxyethyl trimellitate anhydride (4-META) joined to human enamel. Ground human enamel was bonded with TBB resin under six surface conditions: 1) as ground, 2) primed with Teeth Primer, 3) sodium sulfite solution, 4) 4-META solution, 5) acetone-water, and 6) phosphoric acid etching. Pre- and post-thermocycling bond strengths and change in strength after thermocycling were compared. Etching enamel with 35-45% phosphoric acid enhanced bonding durability between enamel and TBB-initiated resin. Priming with Teeth Primer or 4-META solution improved bond strength between enamel and TBB-initiated resin. Sodium sulfite had little effect on enamel bonding in the present bonding systems.

Effect of a self-etching primer and phosphoric acid etching on the bond strength of 4-META/MMA-TBB resin to human enamel.

The purpose of this study was to evaluate the shear bond strength and durability of 4-META/MMA-TBB resin to human enamel. A self-etching primer that contained 4-META (Teeth Primer, TP) and 35-45% or 60-65% concentrations of phosphoric acid (K-Etchant Gel, KE, and Super Bond C&B Red Activator, RA) were used as the surface treatment agents. A methyl methacrylate (MMA)-based self-polymerizing resin (Super-Bond C&B) was used as a luting agent. The shear bond strength was determined both pre and post thermocycling. The results were statistically analyzed with a non-parametric procedure. The post-thermocycling shear bond strength of the TP group was significantly higher than that of other groups, and that of the KE group was significantly higher compared with the RA group. These results demonstrated that 4-META was effective. Furthermore, when the degree of tooth demineralization was compared, surface treatment with less demineralization using TP was the most effective treatment.

Defensive function of persecutory delusion and discrepancy between explicit and implicit self-esteem in schizophrenia: study using the Brief Implicit Association Test.

BACKGROUND: If delusions serve as a defense mechanism in schizophrenia patients with paranoia, then they should show normal or high explicit self-esteem and low implicit self-esteem. However, the results of previous studies are inconsistent. One possible explanation for this inconsistency is that there are two types of paranoia, "bad me" (self-blaming) paranoia and "poor me" (non-self-blaming) paranoia. We thus examined implicit and explicit self-esteem and self-blaming tendency in patients with schizophrenia and schizoaffective disorder. We hypothesized that patients with paranoia would show lower implicit self-esteem and only those with non-self-blaming paranoia would experience a discrepancy between explicit and implicit self-esteem. METHODS: Participants consisted of patients with schizophrenia and schizoaffective disorder recruited from a day hospital (N=71). Participants were assessed for psychotic symptoms, using the Brief Psychiatric Rating Scale (BPRS), and self-blaming tendency, using the brief COPE. We also assessed explicit self-esteem, using the Rosenberg Self-Esteem Scale (RSES), implicit self-esteem, using Brief Implicit Association Test (BIAT), and discrepancy between explicit and implicit self-esteem. RESULTS: Contrary to our hypothesis, implicit self-esteem in paranoia and nonparanoia showed no statistical difference. As expected, only patients with non-self-blaming paranoia experienced a discrepancy between explicit and implicit self-esteem; other groups showed no such discrepancy. CONCLUSION: These results suggest that persecutory delusion plays a defensive role in non-self-blaming paranoia.

The 24-year clinical performance of porcelain laminate veneer restorations bonded with a two-liquid silane primer and a tri-n-butylborane-initiated adhesive resin.

This report describes the bonding technique and clinical course of porcelain laminate veneer restorations applied to discolored maxillary incisors and canines. The patient was an 18-year-old woman, and tooth reduction was limited to the enamel. Laminate veneer restorations were made with a feldspathic porcelain material (Cosmotech Porcelain). After try-in, enamel surfaces were etched with 65% phosphoric acid gel, and a tri-n-butylborane-initiated resin (Super-Bond C&B) was applied as a bonding agent. The inner surface of the restorations was etched with 5% hydrofluoric acid gel (HF Gel) and treated with a two-liquid silane primer (Porcelain Liner M), after which the Super-Bond resin was applied. Each restoration was seated with a dual-activated composite luting agent (Cosmotech Composite). After 24 years and 8 months, the restorations are functioning satisfactorily. The luting system and bonding technique described in this report are an option for seating laminate veneer restorations made of silica-based tooth-colored ceramics.

[The feasibility of reduced port surgery for sigmoid colon and rectal (Rs) cancer].

Laparoscopic surgery for colorectal cancer has the advantage of being less invasive and delivering better cosmetic appearance. Although single-incision laparoscopic surgery produces excellent cosmetic results, it is considered very difficult to perform. We performed reduced port surgery (single-incision plus one or 2 ports) on 42 patients in our institute. The operation time, number of dissected lymph nodes, morbidity rates, and length of hospital stay after the operation were not inferior to those in conventional laparoscopic surgery. The estimated blood loss in reduced port surgery was less than in conventional laparoscopic surgery. In conclusion, the procedure of reduced port surgery should be further standardized to make it safer and more feasible, and to provide a favorable cosmetic result for selected patients.

[Laparoscopic hemi-double stapling and reduced-port laparoscopic distal gastrectomy for gastric cancer].

INTRODUCTION: The hemi-double stapling method (HDS) is typically used for extracorporeal Billroth-I anastomosis. We used HDS for reduced-port surgery. Laparoscopic HDS is used for intracorporeal Billroth-I anastomosis after laparoscopic distal gastrectomy. We performed reduced-port laparoscopic distal gastrectomy for gastric cancer. METHODS: Reduced-port laparoscopic distal gastrectomy was performed using the multi-trocar method with 5mm and 3mm ports. Laparoscopic HDS was performed using an umbilical incision and a left upper abdominal incision. A total of 17 patients underwent reduced-port laparoscopic distal gastrectomy. A D1+or D1 lymph node dissection was performed, and laparoscopic HDS was used for reconstruction. RESULTS: The patients had no short-term complications. CONCLUSIONS: Laparoscopic HDS and reduced-port laparoscopic distal gastrectomy are safe and feasible procedures.

[A case of an adenocarcinoma in a duplication cyst of the esophagogastric junction].

Duplication cysts of the esophagogastric junction are an extremely rare disease entity. Computed tomography showed a cystic lesion in the wall of the esophagogastric junction ofa 75-year-old man. The cystic tumor gradually increased in size from 40 mm to 60 mm in diameter within 6 months. On the basis of magnetic resonance cholangiopancreatography and positron emission tomography, it was described as a cystic pathological alteration enclosing a solid lesion. The pre-operative diagnosis was a gastrointestinal stromal tumor in the stomach cardia, and we performed proximal gastrectomy under laparotomy. Histological findings showed gastric mucosa in the internal mucosa of the cyst and an adenocarcinoma inside the cyst. We diagnosed the cystic tumor as a duplication cyst of the esophagogastric junction with adenocarcinoma. It is important to carefully choose the procedure to be used for resection of cystic tumors adjacent to the alimentary canal.

[A case of long-term survival of small intestinal adenocarcinoma treated by resection and chemotherapy].

A 60-year-old man had visited our hospital a few times due to vomiting since July 2008. In January 2009, because he was no longer able to eat, he was hospitalized to receive close examination. Single balloon enteroscopy revealed jejunal adenocarcinoma. After examination of the whole body, as there was no distant metastasis, jejunum partial resection was performed in February 2009. One dissemination nodule was recognized on the serosa near the main tumor. We obtained the final pathological diagnosis as Stage IV. From April 2009, adjuvant chemotherapy with combination of oxaliplatin, 5-fluorouracil and Leucovorin (mFOLFOX6) was performed 8 times. In April 2009, a small metastatic lesion appeared in the upper lobe of the right lung. We started administering combination of irinotecan, 5-fluorouracil and Leucovorin (FOLFIRI) from January 2010, but stopped because of side effects after the second cycle. Administration of capecitabine was started in March 2010. The metastatic lesion had diminished for a time but was found to be enlarged in March 2011. Thus, a partial right lung resection was performed in April 2012. After lung resection, systemic chemotherapy was not performed. The patient remains alive without a recurrence 3 years after lung resection and over 5 years after detection of the small intestinal adenocarcinoma.

Fifteen-year clinical performance of a resin-bonded fixed partial denture seated with a thione primer and a tri-n-butylborane-initiated luting agent.

This article reports the clinical performance of a resin-bonded fixed partial denture (FPD) made of type IV gold alloy. The retainers were air-abraded with alumina particles and primed with a single-liquid thione priming agent (Metaltite). The FPD was then seated with a tri-n-butylborane-initiated adhesive resin (Super-Bond). After 15 years, the FPD is still functioning satisfactorily. The present materials and techniques are applicable to minimally invasive fixed prosthodontic treatments.

Relationship between patients' quality of life and coercion in psychiatric acute wards.

The influence of coercion on quality of life (QoL) was investigated in 202 patients in acute psychiatric wards. There was no correlation between either subjective or objective coercion and QoL. Global Assessment of Functioning scores on improvement and insight were correlated with QoL.

[A case of transverse colon cancer mimicking urachal cancer].

A 55-year-old man was admitted to our hospital because of abdominal distension. Computed tomography revealed an abscess in the anterior abdominal wall and invasion of the large intestine. Biopsy of the large intestine revealed adenocarcinoma. Immunohistochemically, the antigen expression profile of the tumor was positive for cytokeratin 7, cytokeratin 903 (34ßE12), and cytokeratin 20. We diagnosed the tumor as urachal cancer and performed surgery. Examination of the resected specimen showed that the tumor was located in the transverse colon. Finally, the patient was diagnosed as having transverse colon cancer with urachal abscess.

[A case of combined resection of multiple adjacent organs in a patient with locally advanced residual gastric cancer].

A 69-year-old man with a history of distal gastrectomy for early gastric cancer consulted our department concerning a possible diagnosis of sigmoid colon cancer. After detailed examination, he was diagnosed with type 3 advanced sigmoid colon cancer with colonic stenosis and large type 3 gastric cancer in the residual stomach with gross infiltration of the adjacent organs. The patient first underwent sigmoidectomy and then received a regimen of neoadjuvant combination chemotherapy with S-1, cisplatin( CDDP), and Lentinan( LNT)( S-1 80 mg/m2, CDDP 60 mg/m2, and LNT 2 mg/body twice weekly for 2 weeks) for gastric cancer( cT4b[ SI, liver, pancreas], N2M0H0, Stage IIIC). After 2 courses of treatment, the gastric tumor had reduced in size but had penetrated the transverse colon. We performed total resection of the gastric remnant, D2 lymph node dissection, and en bloc resection of the transverse colon, partial liver, pancreas body and tail, partial diaphragm, and pericardium. S-1/CDDP (a total of 11 courses) followed by single-agent S-1 therapy was continued as adjuvant chemotherapy. With a follow-up time of 3 years and 10 months, no recurrence was noted following total resection of the gastric remnant.

[A case of locally advanced residual gastric cancer treated with combined resection of multiple adjacent organs].

A 60-year-old man was diagnosed as having type 3 advanced gastric cancer in the gastric antrum and multiple liver metastases( S2, S3, S4, and S7)( cT3[ SS] N0M0H1, Stage IV). The patient received combined neoadjuvant chemotherapy with S-1 and cisplatin( CDDP). S-1( 80 mg/body/day) was administered orally for 3 weeks followed by 2 drug-free weeks as a course, and CDDP (60 mg/m2) was administered by intravenous infusion on day 8. The gastric tumor reduced in size and the liver metastases improved after 5 courses of treatment. Distal gastrectomy, D2 lymph node dissection, and partial liver resection( 4 sites) were performed. S-1 alone was continued as adjuvant chemotherapy; no recurrence was detected in 2 years and 2 months after surgery. Although there is insufficient evidence to support the benefit of surgical resection in patients with advanced gastric cancer with liver metastases, chemotherapy combined with surgical resection would improve the survival time without deterioration of quality of life of these patients. This case suggests that neoadjuvant chemotherapy is effective against advanced gastric cancer even with multiple liver metastases.