Typical fibrolamellar hepatocellular carcinoma in a Japanese boy: report of a case.

We report a case of typical fibrolamellar hepatocellular carcinoma (FL-HCC) in a 16-year-old Japanese boy. This is very rare malignancy in Japan. The patient was referred for investigation of a large hepatic tumor and the results of tests for hepatitis B virus surface antigen and hepatitis C virus antibody were negative. Liver function test results and serum alpha-fetoprotein (AFP) levels were normal; however, the prothrombin induced by vitamin K absence/antagonist II was elevated. Computed tomography (CT) showed a large lobulated heterogeneously enhanced tumor in the posterior section of the liver. We diagnosed FL-HCC and performed posterior sectionectomy of the liver. The resected specimen contained a light brown and green tumor with a central fibrous scar, 10.0 cm in diameter. Microscopic and electron microscopic examinations revealed the typical features of FL-HCC. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, but negative for CK19 and AFP. The patient was alive without recurrence 48 months after surgery. Following this case report, we summarize the clinical features of the Japanese cases documented in the literature.

Interaction of acoustic pressure and heat release rate fluctuations in a model rocket engine combustor.

We experimentally clarify the interaction of acoustic pressure and heat release rate fluctuations during a transition to high-frequency combustion instability in a model rocket engine combustor. The dynamical state of acoustic pressure fluctuations undergoes a transition from high-dimensional chaotic oscillations to strongly correlated limit cycle oscillations. The coherent structure in the heat release rate field emerges with the initiation of weakly correlated limit cycle oscillations. The effect of the heat release rate on acoustic pressure fluctuations predominates during high-dimensional chaotic oscillations. In contrast, the effect of acoustic pressure on the heat release rate fluctuations markedly increases during the correlated limit cycle oscillations. These are reasonably shown by an ordinal pattern-based analysis involving the concepts of information theory, synchronization, and complex networks.

Preparation of alkyl-modified silicon nanosheets by hydrosilylation of layered polysilane (Si6H6).

Alkyl-modified crystalline silicon nanosheets 2 were synthesized and maintained the crystal structure of a Si(111) plane, in which the dangling silicon bond is stabilized by capping with the alkyl group. 2 was characterized using UV-vis, Fourier transform-infrared, and X-ray photoelectron spectroscopies; X-ray diffraction; and X-ray absorption near edge structure analysis. A model structure is proposed that has a periodicity through the nanosheet surface.

Synthesis and modification of silicon nanosheets and other silicon nanomaterials.

Silicon nanomaterials and nanostructures exhibit different properties from those of bulk silicon materials based on quantum confinement effects. They are expected to lead to the development of new applications of silicon, in addition to wide use in semiconductor devices. Aside from industrial interest, intriguing issues of academic interest still remain with respect to the origins of their characteristic properties. Zero- and one-dimensional crystalline silicon nanomaterials have been synthesized, to date, by using many methods and there has been rapid progress in size control and modification procedures. However, there have been only a few examples of silicon nanomaterials with atomic-order thickness akin to carbon nanomaterials, such as two-dimensional silicon nanosheets. Moreover, mass production of silicon nanomaterials with relatively low cost is not easily achievable, due to the typically severe conditions required for fabrication, such as high temperature and ultralow pressure. Recently, we have developed a soft synthetic method for silicon nanosheets with chemical surface modification in a solution process. This review provides methods for the synthesis and modification of silicon nanosheets and other silicon nanomaterials with examples of their potential applications.

Tumor Vascular Microenvironment of Colorectal Hepatic Metastasis and Chemotherapy Response.

BACKGROUND: The tumor vascular microenvironment has an important role in tumor progression and metastasis. The objective of this study was to assess the significance of metastatic hepatic tumor vascular microenvironment in relation to the response to systemic fluorouracil-based chemotherapy [folinic acid/fluorouracil/oxaliplatin (FOLFOX) or folinic acid/fluorouracil/irinotecan (FOLFIRI)]. PATIENTS AND METHODS: A total of 48 consecutive patients with colorectal cancer (CRC) with hepatic metastasis were retrospectively reviewed, and factors such as metastatic tumor vascular microenvironment, chemotherapy response and hepatic resection, were analyzed. Tumor angiogenesis was microscopically evaluated by microvessel density (MVD) in sections stained immunochemically with antibody to CD34 in patients with hepatic resection. Angiogenesis in the tumor microenvironment in association with ring enhancement (RE) on computed tomography (CT) was also examined. RESULTS: Microscopic examination revealed that peripheral RE on CT of the metastatic tumor was associated with tumor angiogenesis by MVD. The overall response rate after six courses of first-line chemotherapy for liver metastasis with RE on CT was 64% (23/36), whereas the response rate for those without RE was 25% (3/12), which was significantly lower, although the survival of patients with RE-positive and RE-negative tumors did not differ significantly. CONCLUSION: Peripheral RE of metastatic hepatic tumor on CT was associated with angiogenesis in the tumor microenvironment and higher chemotherapy response.

Synthesis and optical properties of monolayer organosilicon nanosheets.

The synthesis of silicon nanosheets for fabricating electronic devices, without using conventional vacuum processes and vapor deposition, is challenging and is anticipated to receive significant attention for a wide range of applications. Here, we report the synthesis of oxygen-free, phenyl-modified organosilicon nanosheets with atomic thickness. In organic solvents, a consequence of this new silicon structure is its uniform dispersion and the possibility of exfoliation into unilamellar nanosheets. Light-induced photocurrent in [Si(6)H(4)Ph(2)] was observed, leading to the possibility of various organosilicon nonamaterials with useful properties.

Silicon nanosheets and their self-assembled regular stacking structure.

Silicon nanomaterials are encouraging candidates for application to photonic, electronic, or biosensing devices, due to their size-quantization effects. Two-dimensional silicon nanosheets could help to realize a widespread quantum field, because of their nanoscale thickness and microscale area. However, there has been no example of a successful synthesis of two-dimensional silicon nanomaterials with large lateral size and oxygen-free surfaces. Here we report that oxygen-free silicon nanosheets covered with organic groups can be obtained by exfoliation of layered polysilane as a result of reaction with n-decylamine and dissolution in an organic solvent. The amine residues are covalently bound to the Si(111) planes. It is estimated that there is ca. 0.7 mol of residue per mole of Si atoms in the reaction product. The amine-modified layered polysilane can dissolve in chloroform and exfoliate into nanosheets that are 1-2 microm wide in the lateral direction and with thicknesses on the order of nanometers. The nanosheets have very flat and smooth surfaces due to dense coverage of n-decylamine, and they are easily self-assembled in a concentrated state to form a regularly stacked structure. The nanosheets could be useful as building blocks to create various composite materials.

An extremely rare combination of choledochocele and bile duct duplication escalating severe acute pancreatitis and cholangitis: A case report.

BACKGROUND: Combination of choledochocele and extra-hepatic duct duplication is an extremely rare congenital abnormality. CASE PRESENTATION: The patient was an 81-year-old Japanese man. He visited the emergency room for severe abdominal colic pain. He was diagnosed with severe pancreatitis with cholelithiasis and treated conservatively by percutaneous trans-hepatic gallbladder drainage (PTGBD) for 4 months. Thereafter, he was transferred to our institute and cholangiography was performed via the PTGBD tube, revealing cholecysto- and choledocho-lithiasis. The cystic-duct joined the right hepatic duct with extra-hepatic bile duct duplication and the terminal bile duct flowed into the cystic papilla of Vater. The main pancreatic duct also joined into the cystic papilla. These observations confirmed choledochocele with extra-hepatic bile duct duplication. Surgical exploration was performed, and hepatico-jejunostomy with hepatic-ductplasty and cholecystectomy with choledocholithotomy were carried out. He was discharged and his course was uneventful. CONCLUSION: A very rare combined case of choledochocele with bile duct duplication, which would escalate the pancreatitis and cholangitis, was successfully treated. Their pathogeneses in relation to pancreaticobiliary maljunction is discussed.

Facile Exfoliation and Noncovalent Superacid Functionalization of Boron Nitride Nanosheets and Their Use for Highly Thermally Conductive and Electrically Insulating Polymer Nanocomposites.

There is an increasing demand for highly thermally conductive and electrically insulating polymer materials for next-generation electronic devices, power systems, and communication equipment. Boron nitride nanosheets (BNNSs) are insulating materials with extremely high thermal conductivity. However, BNNSs suffer from the lack of facile and low-cost methods for producing large volumes of BNNSs, and extremely low through-plane thermal conductivities of BNNS/polymer composites as compared to the in-plane thermal conductivities. Herein, highly soluble, noncovalently functionalized boron nitride nanosheets (NF-BNNSs) with chlorosulfonic acid (CSA) were prepared by extremely facile and low-cost direct exfoliation of hexagonal boron nitrides (h-BNs), and acted as excellent nanofillers for dramatically improving both in- and through-plane thermal conductivities of insulating polymers. CSA is a cheap and versatile superacid with a large production volume. CSA showed strong physical adsorption on h-BN surfaces, giving few-layered NF-BNNSs in high yields (up to ∼25%). The crystallinity of the NF-BNNS was perfectly maintained even after CSA treatment. The physical adsorption of CSAs imparted high solubility for BNNSs in various organic solvents, yielding NF-BNNS uniformly dispersed-thermoplastic polymer composite films through a simple wet-process using predispersed NF-BNNS solutions. Random dispersion of NF-BNNSs in thermoplastic polymer films dramatically enhanced both the in- and through-plane thermal conductivities (>10 W m-1 K-1). The through-plane thermal conductivity of the NF-BNNS/polybutylene terephthalate (PBT) composite films was much greater (up to 11.0 W m-1 K-1) than those previously reported for BNNS/thermoplastic polymer composites (≤2.6 W m-1 K-1). These results are also due to an increase of interactions between the BNNS and polymer matrices, caused by physical adsorption of CSAs on BNNS surfaces. Moreover, the volume resistivity of the NF-BNNS/PBT composite films was significantly improved compared with pristine PBT. The NF-BNNS/polymer composites are very promising as highly thermally conductive and electrically insulating materials in various applications.

Feasibility and Validation of Single-Port Laparoscopic Surgery for Simple-Adhesive or Nonadhesive Ileus.

A single incisional laparoscopic surgery (SILS) approach is increasingly being used, taking advantage of the minimally invasive technique. The aim of this study was to evaluate the feasibility and the validation of SILS procedure for small bowel obstruction (SBO). Sixteen consecutive patients with SBO who underwent SILS release of ileus between April 2010 and March 2015 were compared with the conventional multiport laparoscopic treatment group of 16 patients matched for age, gender, and surgical procedure. Laparoscopic treatment was completed in a total of 14 patients in SILS group and 13 in multiport laparoscopic group. Two cases and 3 cases were converted to multiport laparoscopic surgery or open surgery. Eight patients with nonscar and nonadhesive ileus, such as internal hernia, obturator hernia, gallstone ileus, and intestinal invagination, were treated successfully in the laparoscopic procedure. There was no mortality in either of the groups. The mean procedural time was 105  minutes in the SILS group and 116  minutes in the multiport laparoscopic group. The mean amount of blood loss was not statistically different in either of groups (15  ml vs. 23  ml). Patients resumed oral intake after a mean of 2 days in the SILS and 3 days in the multiport groups with the statistically difference. The length of hospital stay was shorter in the SILS group (5 days vs. 7 days) with no statistically difference. Perioperative morbidity was seen in 2 patients in the SILS group and 3 patients in the multiport group. SILS approach has superior and/or similar perioperative outcomes to multiport approach for SBO. SILS release of ileus as an ultra-minimal invasion technique is feasible, effective, and offers benefits with cosmesis in simple adhesive or scar-less nonadhesive ileus patients.

A high-yield ionic liquid-promoted synthesis of boron nitride nanosheets by direct exfoliation.

Boron nitride nanosheets (BNNSs) with micron-sized edges were prepared in high yields by direct exfoliation of bulk hexagonal boron nitrides using ionic liquids (ILs). The ILs strongly attached onto BNNS surfaces, and dramatically enhanced the exfoliation, giving highly concentrated BNNS dispersions (∼1.9 mg mL(-1)) and yields reaching ∼50%.

Small-cell carcinoma manifesting systemic lymphadenopathy combined with adenocarcinoma in the gallbladder: aggressiveness and sensitivity to chemotherapy.

Small-cell carcinoma of the gallbladder is a very rare tumor. In this report, we describe a patient with small-cell carcinoma combined with adenocarcinoma in the gallbladder. The patient was a 70-year-old man, who clinically manifested systemic lymphadenopathy. An incisional biopsy of Virchow's lymph node revealed small-cell carcinoma. Abdominal computed tomography (CT) showed massive multiple paraaortic lymph node swelling and a round mass in the gallbladder, although chest CT did not show any abnormal masses in the lung. After two courses of chemotherapy (PVP therapy; cisplatin [CDDP], 80 mg/m(2), day 1, intravenous injection; and etoposide [VP-16], 50 mg/m(2), every day, per oral intake; given every 3 weeks) were performed, the systemic lymphadenopathy had completely diminished and only the gallbladder tumor remained on clinical examinations. Endoscopic retrograde cholangiopancreatography (ERCP) revealed nodular tumors in the gallbladder fundus. Cholecystectomy with partial resection of the liver was performed. Pathological examination revealed small-cell carcinoma combined with adenocarcinoma of the gallbladder. We discuss the characteristics and the treatment of this rare tumor.

A case of male noninvasive intracystic papillary carcinoma forming a tumor in the nipple duct.

Epithelial tumors forming a mass in the male nipple are very rare. Paget's disease, adenoma of the nipple (AON), and breast cancer must be considered for differential diagnosis. This report presents a 72-year-old man with spontaneous serous nipple discharge and an enlarged nipple measuring 2 cm in diameter. Ultrasonography provided no useful information regarding the nipple lesion. Nipple discharge cytology was negative and without any inflammatory cells. Since it is extremely uncommon for Paget's disease and breast cancer to cause tumor in the nipple, AON was suggested. However, histopathological examination of the nipple resection revealed noninvasive intracystic papillary carcinoma of the nipple. Biopsy of the nipple is often necessary to diagnose this disease. Moreover, excisional biopsy of the tumor is recommended when possible, since it can accomplish both diagnosis and treatment in cases of AON or noninvasive intracystic papillary carcinoma.

Single-port laparoscopic adhesiolysis for torsion ileus.

Single-incisional laparoscopic surgery (SILS) has emerged as an attempt to further enhance the cosmetic benefits and reduce the morbidity of minimally invasive surgery. We present an approach of SILS adhesiolysis to adhesive strangulated ileus. A 70-year-old female patient, who had undergone laparoscopic low anterior resection 6 years before, underwent SILS adhesiolysis to a midline surgical incision wound adhesion site. The surgery was performed with only a 2.5-cm left-side transrectus incision using the SILS port. Laparoscopy revealed intestinal torsion and congestion with adhesion of the ileum to the previous surgical incision wound. SILS adhesiolysis was successfully carried out. The patient was discharged 4 days after surgery. SILS adhesiolysis is a feasible and efficient procedure in certain cases.

Invasive ductal carcinoma arising from an ectopic pancreas in the gastric wall: a long-term survival case.

A case of invasive ductal carcinoma of an ectopic pancreas in the stomach in a 74-year-old woman is presented. A 4.0 cm gastric submucosal tumor (SMT) was resected surgically. Histologically, the tumor showed cystic tissue consisting of an ectopic pancreas with foci of a moderately differentiated tubular adenocarcinoma. In this tumor, small pancreatic tissues, acini, Langerhans islets, and ductular cells were detected in the gastric SMT. The patient has experienced long-term survival. The incidence of pancreatic cancer of an ectopic pancreas is rare, and the etiology of this disease is discussed in the literature.

Hemosuccus Pancreaticus following a Puestow Procedure in a Patient with Chronic Pancreatitis.

Hemosuccus pancreaticus is an unusual cause of gastrointestinal bleeding that occurs as a complication of chronic or acute pancreatitis. We report a case of extremely acute-onset hemosuccus pancreaticus occurring in a patient with chronic pancreatitis over a long-term follow-up after a Puestow procedure (side-to-side pancreaticojejunostomy). The patient was admitted to our hospital due to severe anemia and tarry stools indicative of gastrointestinal bleeding. Emergent endoscopy, including gastrointestinal fiberscopy and colon fiberscopy, showed no abnormal findings. Abdominal contrast-enhanced computed tomography and hemorrhagic scintigraphy did not detect a hemorrhagic lesion. Although interventional radiology was considered for diagnosis and treatment, conservative therapy seemed sufficient to affect hemostasis. Two weeks later, however, acute intestinal bleeding with hemodynamic shock occurred, and exploration was performed without delay. Intraoperative endoscopy through an incision of the reconstructed jejunal loop in the close proximal end revealed a site of active bleeding from the side-to-side anastomotic pancreatic duct. Following a longitudinal incision of the jejunal loop, a bleeding point was sutured and ligated on direct inspection. The patient showed a good postoperative course.

Successful management of a blunt pancreatic trauma by endoscopic stent placement.

The present study reports a case involving a 17-year-old man who was brought to the emergency department of our hospital with severe upper abdominal pain following a blow received in a rugby game. Emergency computed tomography (CT) revealed severe pancreatic neck injury, and the patient was subsequently given conservative treatment in the High Care Unit. Forty-eight hours later, follow-up enhanced CT revealed that the pancreas was clearly lacerated and the amount of peripancreatic fluid was increasing; furthermore, serum amylase and elastase levels were elevated. Endoscopic retrograde pancreatography revealed that contrast medium in the main pancreatic duct (MPD) had leaked to the parenchyma, indicating an MPD injury. To prevent traumatic pancreatitis from worsening, a stent was inserted endoscopically to a site distal to the injured portion of the MPD. Thereafter, the patient's condition dramatically improved, and his serum amylase levels returned to normal. CT revealed that the apparent pancreatic edema and peripheral fluid were also decreased. During a short-term follow-up period of 6 months, removal of the stent was uneventfully carried out and the patient did not develop any exocrine or endocrine insufficiency. We suggest that, in some cases, endoscopic management of traumatic pancreatic duct disruption is feasible and effective.