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Background/Aim: Distant metastasis has a strong influence on prognosis in patients with soft tissue sarcoma (STS). While various risk factors have been reported for distant metastases, risk factors for distant metastases early after treatment of primary tumor have not been investigated. This study aimed to evaluate the factors of early distant metastasis after primary tumor resection in patients with STS. Patients and Methods: We retrospectively identified patients with STS involving the extremities or trunk without any metastasis at the first visit. Data on clinical information and detailed assessment were collected. We evaluated clinical information as a risk factor for distant or lung metastases. Additionally, we evaluated risk factors for metastases in patients with distant metastases as early as 6 months after the initial resection of the primary tumor. Results: A total of 337 patients were included in the study. Multivariate analysis revealed that the size of the primary tumor (p=0.0011 and p=0.0167), consultation in a short period after onset (p=0.0325 and p=0.0402), histological high grade (p=0.0006 and p=0.0002), and inadequate surgical margin (p=0.0151 and p=0.0055) were significant predictors for poor prognosis for all distant and lung metastases, respectively. However, the only risk factor for early metastases within 6 months was young age (p=0.0148). Conclusion: The only risk factor for early distant metastasis after primary tumor resection in patients with STS was young age, even though large tumor diameter and histological high grade were risk factors for distant metastasis.

Even when treated comprehensively by surgery, chemotherapy, and radiotherapy, soft-tissue sarcoma has an unfavorable outcome. Because soft-tissue sarcoma is rare, it is the subject of fewer clinicopathological studies, which are important for clarifying pathophysiology. Here, we examined tumor-associated macrophages in the intratumoral and marginal areas of sarcomas to increase our knowledge about the pathophysiology. Seventy-five sarcoma specimens (not limited to a single histological type), resected at our institution, were collected, and the number of CD68-, CD163-, and CD204-positive macrophages in the intratumoral and marginal areas was counted. We then performed statistical analysis to examine links between macrophage numbers, clinical factors, and outcomes. A high number of macrophages positive for all markers in both areas was associated with worse disease-free survival (DFS). Next, we divided cases according to the FNCLCC classification (Grade 1 and Grades 2/3). In the Grade 1 group, there was no significant association between macrophage number and DFS. However, in the Grade 2/3 group, high numbers of CD163- and CD204-positive macrophages in the marginal area were associated with poor DFS. By contrast, there was no significant difference between the groups with respect to high or low numbers of CD68-, CD163-, or CD204-positive macrophages in the intratumoral area. Multivariate analysis identified the number of CD163- and CD204-positive macrophages in the marginal area as an independent prognostic factor. Macrophage numbers in the marginal area of soft-tissue sarcoma may better reflect clinical behavior.

This study evaluated the effect of haematogenous administration of acridine orange (AO) alone and in combination with zoledronate (ZOL) on bone metastases.E0771 cells (1.0×10At 4 weeks, the bone destruction rate was lower in the AO+ZOL group than in the radiation group. At 6 weeks, the AO+ZOL group had a lower bone destruction rate than the control and radiation groups; the ZOL group had a lower rate than the radiation group. The AO and AO+ZOL groups had suppressed tumour weight and volume compared to the control and radiation groups. The number of extraosseous apoptotic cells was higher in the AO+ZOL group than in all other groups except the AO group.In a model of local bone metastasis of breast cancer, haematogenous administration of AO reduced tumour size and more so when combined with ZOL.

Background: Giant cell tumor of the bone (GCTB) occurs most often in younger individuals aged between 20 and 40 years. However, it also occurs in a small proportion of elderly people. Therefore, it is necessary to determine the clinical characteristics of GCTB in elderly people, as only few reports have completely examined the characteristics of GCTB in elderly patients. Methods: This retrospective study enrolled 69 patients with benign GCTB. Patients’ information on age, sex, anatomical location and size, Campanacci grade, pathological fracture, treatment for primary tumors, local and distant relapse, and outcome was collected. We compared these clinical courses between the younger and older groups. We divided the age groups into three subgroups: ≤54 years and ≥55 years, ≤59 years and ≥60 years, and ≤64 years and ≥65 years. We compared the two groups in each subgroup. In addition, we examined factors affecting local recurrence and distant metastasis. Results: Tumor size was significantly larger in the older group between the two subgroups of 55 and 60 years. Kaplan-Meier curves for local recurrence-free survival and distant metastasis-free survival between the two subgroups of 65 years showed significant differences (p = 0.0183 and p = 0.0014). In the multivariate logistic regression analyses, female sex, curettage-only surgical procedure, and denosumab usage before surgery affected local recurrence. Conclusion: Age is unlikely to affect local recurrence and distant metastases in GCTB patients, but local recurrence and distant metastases may be noted in elderly patients aged ≥65 years with GCTB.

Granulocytic sarcoma is a rare solid malignant tumor that occurs in patients with acute myeloid leukemia. As such, granulocytic sarcoma without leukemia occurring in long bones is quite rare. This case report describes an isolated granulocytic sarcoma of the right humerus in an 82-year-old woman in the absence of acute myeloid leukemia. The patient was admitted to our hospital with a pathological fracture of the right humerus. An incisional biopsy was performed, and the pathological diagnosis was granulocytic sarcoma. Radiotherapy (45 Gy) to the humerus resulted in a good clinical outcome with no evidence of myeloid leukemia at 9.5 years of follow-up. Radiotherapy was effective for pain relief and maintenance of good quality of life in this patient. Although laboratory evaluation has not revealed any abnormalities 9.5 years after radiotherapy, periodic observation is required.

Background/aim Local recurrence in soft tissue sarcoma (STS) is a risk factor of worse prognosis. Although a few studies have shown that adjuvant therapy with acridine orange (AO) is effective for local control of primary STS, there have been no reports examining its effectiveness for local recurrence. Patients and methods This retrospective study included 36 patients with first local recurrence of STS. Of them, 23 patients received wide excision without AO therapy (Wide group); the other 13 patients received marginal excision with AO therapy (AO group). We compared re-recurrence rates between these two groups. Results The total re-recurrence rate was 43.5% in the Wide group and 46.2% in the AO group. There was no significant difference in local re-recurrence-free survival and overall survival between the two groups. Conclusion Adjuvant AO therapy combined with a marginal excision suppresses local re-recurrence rates of individuals with local STS recurrence.

BackgroundThe aim of the present study was to evaluate the prevalence of non-ossifying fibroma (NOF) and fibrous cortical defect (FCD) in a Japanese pediatric population and the association between the lesion size and pain.MethodsThis retrospective study, conducted across 10 Japanese institutions, included patients aged 5–15 years who had undergone standard antero-posterior and lateral view radiography of the knee. Using these radiographs, we diagnosed the lesion as a NOF or FCD. Patient demographics, including age, sex, the size and location of the NOF, and chief complaint were recorded. The lesion size was determined using radiographs. Student’s t-test was used to compare the associations between the lesion size and spontaneous pain.ResultsA total of 6222 subjects (3567 boys and 2455 girls) were included in this study. The number of NOF and FCD cases was 143 and 437, respectively, and the prevalence of NOF and FCD was 2.3% and 7.0%, respectively. The average size of NOF and FCD was 22.1 mm (range: 4–102 mm) and 13.2 mm (range: 5–21 mm), respectively. Three patients (2.1%) had pathological fractures due to NOF. Of the 140 NOFs and 437 FCDs, we obtained complaints from the medical records of 126 and 393 patients, respectively. The number of patients with spontaneous pain or other problems with NOF was 68 (54%) and 58 (46%), respectively, that of patients with FCD was 195 (50%) and 198 (50%) patients, respectively. The lesion size was not associated with spontaneous pain in either lesion (p = 0.67 andp = 0.27, respectively).ConclusionThe prevalence of NOF and FCD around the knee was lower than that reported in previous studies. The prevalence of NOF increased and that of FCD decreased with advancing age. In both lesions, the lesion size may not be associated with pain.

Background/Aim: Local tumor injection models require complicated procedures. The purpose was to establish a simple local bone metastasis model using normal mice, and to study the usefulness of the model with bisphosphonates (BP). Materials and Methods: This study used a versatile C57BL/6 mouse model and E0771 cells. Tumor cells were injected into the right femur. Mice were divided into groups depending on the concentration of cells injected and the use of BP or not. The degree of bone destruction between the different conditions was compared using micro-computed tomography (μCT). Results: Bone destruction was confirmed in four mice in the high-concentration group at 3 weeks, and in all other mice at 4 and 6 weeks. At 6 weeks post-injection, bone destruction was significantly suppressed in the BP group (p

Background Few reports have investigated the effect of primary tumor resection on lung metastasis and prognosis in patients with bone and soft-tissue sarcoma, and we evaluated its effect on lung metastasis and prognosis. Patients and methods We retrospectively identified patients with lung metastasis from bone and soft-tissue sarcoma. We examined the factors affecting prognosis and the rate of lung metastasis increase. Results A total of 48 patients were included. The multivariate analysis revealed that poor prognosis was significantly associated with a large maximum diameter of lung metastasis at the first visit and a rapid rate of increase (p=0.0400 and p=0.0003, respectively). The multivariate logistic regression analysis revealed that the rate of increase of size of lung metastases was only significantly associated with a large maximum diameter at the first visit (p=0.0245). Conclusion Primary tumor resection of bone and soft-tissue sarcoma in patients with lung metastasis was not shown to affect their prognosis.

Background/aim It is important to perform early intervention on bone metastases using multidisciplinary approaches, however it is difficult to hold frequent meetings between patients and clinicians. We aimed to evaluate the usefulness of a specialized outpatient clinic on bone metastasis, instead of the multidisciplinary approach currently in practice. Patients and methods We included 31 patients with vertebral metastases of various carcinomas, undergoing surgical treatment by spine surgeons. We divided the patients into two groups before and after their visit to the specialized outpatient clinic (pre and post groups), and compared their clinical characteristics. Results The post group demonstrated a longer period from consulting the spine surgeon to the surgery than the pre group (p=0.0129). A multivariate logistic regression analysis revealed that the period from spine surgeon consultation to surgery was significantly associated with a specialized outpatient clinic visit (p=0.0460). Conclusion Specialized outpatient clinics on bone metastasis could possibly reduce the burden on spinal surgeons.

Pigmented villonodular synovitis (PVNS) is a relatively rare benign proliferative disorder of the synovium, and it commonly occurs in the knee joint. A unique case of huge PVNS originating around the elbow joint that required upper arm amputation is reported. A 74-year-old woman had a 5-month history of right elbow pain and noticed a mass measuring 8 × 5 cm on the olecranon side. She had a past history of undergoing tumor resection and flap surgery 9 years earlier, diagnosed as a giant cell tumor involving the right elbow region. She had chronic renal failure, with a shunt on the right forearm. On magnetic resonance imaging, the tumor around the elbow joint showed low signal intensity on T1-weighted images and low to high intensity on T2-weighted images. It was thought that it was difficult to preserve the limb because of the size of the tumor and the shunt blood vessel. Therefore, upper arm amputation was performed. The histological diagnosis was PVNS. There was no recurrence of PVNS postoperatively. In the treatment of PVNS, initial surgery with complete resection of the synovial membrane and careful postoperative follow-up are considered important. J Med Cases. 2020;11(7):201-203 doi: https://doi.org/10.14740/jmc3503

BACKGROUND/AIM Although few studies have shown the effectiveness of adjuvant therapy with acridine orange (AO) for soft tissue sarcoma (STS) patients, no study has investigated this among cases with marginal resection. The aim of the study was to evaluate the effectiveness of AO therapy directly by comparing it to marginal resection cases that did not receive AO. PATIENTS AND METHODS This retrospective study included 19 and 33 patients with STS who received AO therapy (AO group) and marginal resection without AO therapy (non-AO group), respectively. The patients' clinical information was collected, and the clinical courses were compared. RESULTS The local recurrence rate in the AO group was significantly lower than that in the non-AO group (p

Postmenopausal osteoporosis and dyslipidemia are well-known skeletal and metabolic changes in middle-aged women. We investigated the effects of combined treatments with a selective estrogen receptor modulator (SERM) and exercise on bone and fat parameters in ovariectomized (OVX) rats. Sixteen-week-old female Sprague–Dawley rats underwent bilateral ovariectomy, and rats were randomized to BZA (bazedoxifene at 0.3 mg/kg/day), Exe (treadmill exercise at 12–15 m/min, 60 min/day, 5 days/week), Comb (BZA and Exe), and Cont (control treated with vehicle and no exercise) groups 8 weeks after ovariectomy. After 4 or 8 weeks of treatment, bone mineral density (BMD) of the total femur and lumbar spine and whole-body percentage fat mass were determined by dual-energy X-ray absorptiometry, and mechanical testing of the femoral shaft, and bone and fat histomorphometric analyses of the proximal tibia were performed. Treadmill exercise had decreased bone marrow adipocytes from 4 weeks of treatment and whole-body percentage fat mass at 8 weeks. BZA increased BMD at the lumbar spine and decreased the whole-body percentage fat mass from 4 weeks and bone marrow adipocytes at 8 weeks. Combination therapy increased BMD for the lumbar spine and decreased bone marrow adipocytes and whole-body percentage fat mass from 4 weeks. Combination therapy with BZA and exercise appears effective to improve bone and fat parameters in OVX rats.

We investigated the effects of ibandronate, a bisphosphonate; eldecalcitol, an active vitamin D3 analogue; and combination treatment with both agents on secondary osteoporosis and arthritis using rats with adjuvant-induced arthritis. Arthritis was induced in 8-week-old male Lewis rats. Rats were randomized into four treatment groups and an untreated normal control group: ibandronate, eldecalcitol, ibandronate + eldecalcitol, vehicle, and control. Paw thickness was measured to evaluate arthritis. Joint destruction was evaluated histomorphometrically by the ankle joint stained with Fast Green and safranin O. The femur and lumbar spine were scanned using dual-energy X-ray absorptiometry, and the distal femur was scanned using micro-computed tomography for bone mineral density (BMD) and trabecular microstructural evaluations. Ibandronate and/or eldecalcitol increased BMD in both the lumbar vertebrae and femur and improved several microstructural parameters (bone volume/total volume, structure model index, trabecular number, and trabecular separation of the distal femur). In addition, there was an additive effect of combination treatment compared with single treatments for most trabecular parameters, including BMD and bone volume. However, ibandronate and/or eldecalcitol did not inhibit arthritis and joint destruction. Combination treatment with ibandronate and eldecalcitol may be effective for secondary osteoporosis associated with arthritis.

Background Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. Methods The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). Results Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. Conclusions Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.

Objectives: Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovium, progressive erosion of the articular cartilage, and joint destruction. RA also causes secondary osteoporosis and muscle wasting. We investigated the effects of ibandronate (IBN), a bisphosphonate; eldecalcitol (ELD), an active vitamin D3 derivative; and combination treatment with both agents on secondary osteoporosis and muscle wasting using adjuvant-induced arthritis rats. Methods: Arthritis was induced in 8-week-old male Lewis rats. Rats were randomized into 4 treatment groups and an untreated normal control group: IBN (subcutaneously, once every 2 weeks, 10 μg/kg), ELD (orally, once daily, 30 ng/kg/day), IBN + ELD, vehicle, and control. Paw thickness measurements were performed for evaluation of arthritis. The femur was scanned using dual-energy X-ray absorptiometry. Cross-sectional areas of left tibialis and anterior muscle fibers and the expression of MuRF1, atrogin-1, MyoD, and myogenin in the gastrocnemius muscle were measured to evaluate muscle wasting. Results: IBN and/or ELD increased bone mineral density (BMD) in the femur. In addition, there was an additive effect of combination treatment compared with single treatments for BMD. However, IBN and/or ELD did not inhibit muscle wasting in adjuvant-induced arthritis rats. Conclusions: Combination treatment with IBN and ELD may be effective for secondary osteoporosis associated with RA. Other treatments are necessary for muscle wasting associated with RA. Studies in humans are needed to confirm these findings. Keywords: Rheumatoid arthritis, Vitamin D, Bisphosphonate

Background: Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities.Patients and Methods: The variables were evaluated as potential recurrence factor using Fisher’s exact test. The 5-year recurrence-free survival (RFS) rate was calculated using the Kaplan-Meier method, and differences in survival were assessed using a log-rank test in univariate analyses. Results: Sixty-two patients were identified, including 29 men and 33 women. The median age was 63.7 years (range, 34–82 years). The average maximum tumor diameter was 15.9 cm (range, 5–28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.049). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5–161 months).Conclusions: Tumor diameter ≥20 cm was identified as a risk factor for recurrence.

Background/Aim: Few studies have examined the prognostic significance of histological subtypes in patients with soft tissue sarcoma (STS) and distant metastasis, and we evaluated the relationship between the histological subtypes and clinical outcomes. Patients and Methods: This retrospective study evaluated the histological subtypes of 105 patients with STS and distant metastasis. The STS histological subtypes were compared based on the clinical information. Results: The Kaplan-Meier curves for overall survival revealed that myxoid liposarcoma had a significantly better prognosis compared to Malignant Peripheral Nerve Sheath Tumor (MPNST) (p=0.0221). In the multivariate logistic regression analyses, the independent predictors of a poor prognosis were: i) large size, ii) advanced stage, and iii) non-surgical treatment for metastasis (p

It is challenging to know at the first which patients with desmoid fibromatosis (DF) are better suited to conservative or aggressive treatment. To investigate whether the low signal intensity bundles on T1- or T2-weighted images (WI), termed the "black fiber sign (BFS)," can predict non-progressive behavior in the conservative approach.This retrospective study included 59 patients with primary DF managed with wait-and-see approach from 2005 to 2018 and serial MR images were analyzed. Three observers blinded to the patient information verified the presence or absence of BFS on baseline T1 or T2WI. The likelihood of progression-free survival (PFS) after ascertaining the presence or absence of the BFS was estimated using the Kaplan-Meier method and analyzed with the log-rank test.PFS was significantly higher in cases with BFS than without BFS on T1WI (p 0.01), but there was no significant difference in PFS between cases with and without BFS on T2WI. Multivariable Cox proportional hazards analysis revealed that the absence of BFS on T1WI was a high-risk factor for progression (hazard ratio, 14.9; p 0.01). Drastic tumor regression was apparent with significantly increased low-signal area in cases with BFS on T1WI. Intra- and interobserver reliabilities of BFS on T1WI were in almost-perfect agreement (κ 0.8).Our retrospective observational data support that presence of BFS in baseline MRI may be a predictor for progression-free survival of DF. BFS on T1WI is easily identifiable and can be utilized clinically in patients with DF.• We proposed a new imaging marker for prediction of desmoid fibromatosis progression. • The absence of black fiber sign predicted a high risk of disease progression.

Soft tissue sarcoma (STS) mainly occurs in middle-aged and senior citizens. Although a poorer prognosis has been reported for older patients, few studies have examined advanced elderly excessive older patients. We evaluated the clinical features of advanced elderly patients with STS. One hundred and forty-four patients were included in this retrospective study, and we divided them into two groups based on a cut-off age of 85 (older and younger groups). The patients’ information, including age, tumor type, location, size, presence of metastasis, AJCC stage, FNCLCC classification, treatment-related factors, local and distant relapse, and outcome, was collected. We compared the clinical courses between the 2 groups. In all patients, the frequency of chemotherapy in the older group was significantly lower than in the younger group (P

Purpose: A clinical feature of myxofibrosarcoma is local recurrence, but knowledge about distant metastasis is sparse. We evaluated the tendency of clinical and histological features of metastasis in myxofibrosarcoma patients. Methods: Fifty-eight patients with myxofibrosarcoma were treated in our hospitals, and a total of 16 consecutive patients with distant metastases were included in this retrospective study (9 males and 7 females, with a mean age of 77 years). Because there was no patient complicated by both lung and lymph node metastases, we compared the age, sex, tumor size and location, French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade, American Joint Committee on Cancer (AJCC) stage, and times of the first metastasis from the initial examination between the lung and lymph node groups. In addition, we examined factors affecting the prognosis. Results: The median follow-up period was 42.9 months (range 8–142). Eleven of 16 patients developed pulmonary metastases. The sites of extra pulmonary metastases were the lymph nodes in 5 patients, bone in 1, subcutaneous in 1, intramuscular in 1, and peritoneum in 1. The median time for patients to develop distant metastases was 17.4 months (range 0–59). The time until the onset of the first metastasis in the lung metastasis group was significantly shorter than in the lymph node group (p

A novel method to fabricate uniform epitaxial graphene on C-face SiC substrates was investigated. Graphene was grown on the C-face 6H-SiC substrates with a sputtered SiC film by annealing temperatures ranging from 1400 to 1900 °C under an Ar ambient. The fractional area of the graphene having the layer number of two was about 95% in a 75×75 μm square by a Raman mapping and a low energy electron microscopy. Graphene on the C-face SiC fabricated by this method is quite uniform compared to that made by a conventional method without the sputtered SiC films and is thus suitable for high frequency analog devices.

Objectives: Soft tissue metastasis (STM) is an uncommon condition in carcinoma. Although various case series related to STM have been reported, few reports have examined prognostic factors. This study aimed to evaluate the characteristics of STM and the factors affecting its prognosis. Materials and Methods: Patients with STM from carcinoma were retrospectively studied. The patients’ information, including age, sex, primary tumor, metastasis location, size of the metastatic tumor, presence of pain, histological classification, history of primary tumor treatment, and other metastasis at diagnosis of STM were collected and associated with prognosis. Results: Overall, 16 patients with a mean age of 68.7 years were evaluated. The overall survival rate was not significantly different between lung cancer and non-lung cancer patients. The overall survival rate was significantly better in patients undergoing definitive treatment for the primary tumor than in those without history of treatment (p = 0.046). The overall survival rate of STM patients with no metastasis was significantly better than those with other metastasis at the diagnosis of STM (p = 0.041). On multivariate analysis, no history of primary tumor treatment and STM without pain were risk factors for prognosis (p = 0.0340 and 0.0474, respectively). None of the patients who developed STM under the skin experienced pain, while 92.3% of the patients who developed STM in the deep layer had pain. Conclusion: The risk factors for poor diagnosis of STM were no past treatment of the primary tumor and absence of pain. STM in the deep layer is prone to pain.

Background/aim Abnormal expression of CD44 may promote cancer invasion. However, a limited number of studies have investigated the expression of CD44 in soft tissue sarcoma such as myxofibrosarcoma. We evaluated the relationship between expression of the standard form of CD44 (CD44s) and the clinical course of myxofibrosarcoma. Materials and methods Forty-four myxofibrosarcoma patients were retrospectively enrolled. Patient information including the proportion of CD44s-positive cells was collected, and multivariate analyses were conducted to determine the relationship between CD44s expression and clinicopathological factors. Results Although CD44s did not affect prognosis, multivariate analysis indicated that high expression of CD44s predicted poor event-free survival (p=0.004) and local recurrence (p=0.049). CD44s expression was not associated with the occurrence of distant metastasis but was significantly higher in those with lung metastasis (p=0.044). Conclusion Increased expression of CD44s predicted poor event-free survival and local recurrence and was observed in myxofibrosarcoma patients with lung metastasis.

Objectives: Osteosarcoma is the most common malignant bone tumor in childhood. Although a poorer prognosis has been described in older patients, few reports have focused solely on primary osteosarcoma. We evaluated the clinical features of elderly patients with primary osteosarcoma. Materials and Methods: Ninety-four patients were included in this retrospective study, and we divided them into 2 groups (older patients and younger patients) based on a cut-off age of 40 years. The patients’ information, including age, tumor type, location, presence of metastasis, American Joint Committee on Cancer (AJCC) stage, treatment-related factors, local and distant relapse, and outcome, was collected. We compared the clinical courses between the 2 groups in all and only deceased patients. Results: In all patients, the frequency of chemotherapy in the older group was significantly lower than in the younger group (p < 0.001), and tumors were more frequent in axial bone in the older patients (p = 0.041). Only in patients with surgical treatment, histological effectiveness after chemotherapy in the older group was lower than in the younger group (p = 0.041). The older patients showed a poorer prognosis (p = 0.031). However, the 5-year overall survival rate in the older patients was more favorable than that in the younger patients only among deceased patients (p =0.032). Only the existence of metastasis affected the prognosis in older patients (p = 0.012). Conclusion: Primary osteosarcoma in elderly patients showed a high incidence of axial bone involvement, a low rate of chemotherapy, and resistance to chemotherapy. Although the final life prognosis is poor, survival may be relatively prolonged.

Background No echocardiographic indices for predicting the need for preterm patent ductus arteriosus (PDA) surgery have been tested with an adequate sample size. We tested the hypothesis that some echocardiographic indices have better predictive ability for the need for PDA surgery. Methods We prospectively collected data from infants with gestational ages between 23 and 29 weeks at 34 Japanese neonatal intensive care units over 14 months. Data points were 1, 3, 7, and 14 days of age and, if applicable, before PDA surgery. We assessed five echocardiographic indices. Volume and dimension indices were adjusted for birth body weight (BBW). For each echocardiographic index, the worst value among all data points in nonsurgical patients or the value just before surgery in surgical patients was used. Multivariate logistic regression was applied with adjustment for clinical status. Results In total, 691 patients were analyzed, of whom 61 (8.8%) underwent surgery, as guided using the criteria in the protocol. The areas under the receiver-operating characteristic curve for PDA diameter (0.86) and PDA diameter/BBW (0.86) were the largest, followed by those of left pulmonary artery end-diastolic velocity (LPAedv) (0.80), and left atrial volume/BBW (0.80). Conclusions Considering the measurement's easiness and independence of body size, PDA diameter and LPAedv may serve as useful indices for assessing the need for PDA surgery in early preterm infants.

The goal of treatment for distal humeral fractures in patients with rheumatoid arthritis (RA) is to obtain sufficient bone union and good elbow function. However, treating comminuted distal humeral fractures in patients with RA and osteoporosis is challenging. We present the case of a 58-year-old woman with RA and osteoporosis who suffered a comminuted distal humeral fracture and was successfully treated with the Ilizarov technique. The Ilizarov technique is minimally invasive compared with conventional open surgery, can obtain good stabilization, and allows earlier rehabilitation, even if the fractured bone is severely osteoporotic. The patient exhibited good elbow function and alignment at the final follow-up examination (18 postoperative months). To the best of our knowledge, the present case is the first in which a comminuted distal humeral fracture in a patient with RA and severe osteoporosis was successfully treated with an Ilizarov external fixator. Keywords: Distal humeral fracture, Rheumatoid arthritis, Ilizarov technique

Detailed analysis on the planar defects in rotated 3C-SiC() films grown on Si(110) substrates have been conducted by using X-ray diffraction and cross-sectional transmission electron microscopy. While the film mostly consists of a rotated region, a portion was found in its nonrotated (3C-SiC(110)) configuration, forming domain boundaries in between. Inplane twins were also found to exist within both the rotated and nonrotated regions. Their origins and their impacts on the epitaxial graphene formation on the 3C-SiC film are discussed.

Dialysis treatment is known to lead to reduced quality of life (QOL) among patients. This decreased QOL is believed to influence medication compliance, although this effect has not yet been clarified. In this study, we investigated whether decreased QOL due to dialysis treatment does in fact influence medication compliance. Participants were 92 patients who self-managed their medication and were receiving dialysis treatment at Secomedic Hospital or Chiba Central Medical Center. We surveyed their age, sex, dialysis period, and medication management situation, and administered the EQ-5D and Kidney Disease Quality of Life Instrument–Short Form. A multiple logistic regression analysis with medication compliance as the dependent variable and QOL as the independent variable was conducted. The recovery rate and effective response rate were both 100%. The results indicated that patients with good sleep QOL (mean or above) had higher odds of medication compliance (odds ratio, 3.36; 95% confidence interval, 1.26–8.96; P = 0.016). Therefore, improving the quality of sleep of dialysis patients might help to improve their medication compliance.

The cubic polytype of SiC (3C-SiC) is the only one that can be grown on silicon substrate with the thickness required for targeted applications. Possibility to grow such layers has remained for a long period a real advantage in terms of scalability. Even the relatively narrow band-gap of 3C-SiC (2.3eV), which is often regarded as detrimental in comparison with other polytypes, can in fact be an advantage. However, the crystalline quality of 3C-SiC on silicon has to be improved in order to benefit from the intrinsic 3C-SiC properties. In this project new approaches for the reduction of defects will be used and new compliance substrates that can help to reduce the stress and the defect density at the same time will be explored. Numerical simulations will be applied to optimize growth conditions and reduce stress in the material. The structure of the final devices will be simulated using the appropriated numerical tools where new numerical model will be introduced to take into account the properties of the new material. Thanks to these simulations tools and the new material with low defect density, several devices that can work at high power and with low power consumption will be realized within the project.

Large contributions of the thermal conductivity due to spins, κspin, in low-dimensional spin systems are expected to be utilized as highly thermal conducting materials. One-dimensional spin system RbFeCl3 with ferromagnetic chains and CsFeBr3 with antiferromagnetic chains in magnetic fields have been prepared in order to observe the contribution of κspin to the value of thermal conductivity. The temperature dependence of the thermal conductivity parallel to spin chains along the c-axis, κ//c, of RbFeCl3 enhanced around 3 K and 10 K by the application of magnetic field. In the thermal conductivity perpendicular to c-axis, κ⊥c, of RbFeCl3, on the other hand, it has been found that only one peak around 3 K is enhanced by the application of magnetic field. Since κ⊥c is mainly owing to the thermal conductivity due to phonons, κphonon, it has been concluded the peak of κ//c around 10 K in magnetic fields is due to the contribution of κspin. For CsFeBr3, it has been found that κ//c shows two peaks around 3 K and 25 K while κ⊥c shows one peak around 12 K in zero field. This indicates that there is a marked contribution of κspin to κ//c. κ⊥ However, the details of the marked contribution of κspin to κ//c are not yet clear, since κ//c has been suppressed by the application of magnetic field in contrast with the enhancement of the thermal conductivity in RbFeCl3.

Reports on the incidence of persistent left superior vena cava (PLSVC) in the normal population are limited to studies involving pacemaker implantation candidates and cadavers. The incidence in patients with congenital heart diseases (CHDs) is estimated to be higher than that in the normal population; however, the details are unclear. To investigate the incidence of PLSVC in the normal population and in patients with CHDs, subjects were examined prospectively using echocardiography. Normal subjects consisted of 2841 successive neonates without intra-cardiac or congenital anomalies born in Gifu Prefectural General Medical Center. Additionally, 1920 patients with CHDs were evaluated. The incidence of PLSVC in normal neonates was 0.21% (95% confidence interval 0.042-0.38%). A high incidence (more than 7.0 times the incidence in normal subjects) was observed in all CHD patients. The high incidence group included coarctation of the aorta (CoA) (23.7%) and double outlet right ventricle (DORV) patients (24.6%). The second group consisted of CHD patients with ventricular septal defect (VSD), with an incidence ranging from 5.1 to 6.1%. The low incidence group comprised patients with other CHDs, with an incidence between 1.5 and 3.1%. The incidence of PLSVC in trisomy 21 and atrial septal defect patients was significantly higher than that in normal neonates. The incidence of PLSVC in the normal population and in patients with CHDs was systematically evaluated for the first time. The incidence in CHD patients appeared to be positively influenced by the type of CHD, particularly by DORV, CoA, and VSD.

Background The indications for ductus arteriosus ligation in very-low-birth-weight infants (VLBWIs) with persistent ductus arteriosus (PDA) are unclear. Increased left ventricular end-diastolic dimension (LVDd) is commonly found in patients with PDA. Here, the enlargement of LVDd in term and preterm neonates without congenital heart disease was estimated by two-dimensional echocardiography. Methods The value of the measured LVDd was divided by the normal LVDd as an index (LVDd ratio) to compare 30 patients who underwent PDA ligation with 30 patients treated with indomethacin and 30 patients who did not undergo radical therapy. Results An LVDd ratio between 122% and 197% (mean, 142%) was considered to be an indication for the ligation procedure. The proportion of patients exceeding 130% in the LVDd ratio was 87% (26/30) in those patients who underwent ligation. Catecholamines and/or vasodilators were required in 83% patients for the treatment of low ejection fraction or hypertension after operations, suggesting that patients had been in preload and/or afterload remodeling failure during the operation. The percentage of patients with less than 115% in the LVDd ratio was 90% in the non-radical-therapy patients. The LVDd ratios of 130% and 115% were regarded as cut-off values for surgical ligation and indomethacin treatment. Conclusion The LVDd ratio is a useful measure to determine the treatment of VLBWIs with PDA.

Spondylocostal dysostosis (SCD) is a very rare syndrome characterized by vertebral malformation and rib deformity. Some of the patients with SCD have other birth defects in the central nervous system, the genitourinary tract, diaphragm or heart and so forth. There have been reported SCD with complex congenital heart disease, such as pulmonary atresia, double outlet right ventricle, and d-transposition of great arteries. However, there have been no reported SCD patients with confirmed tetralogy of Fallot (TOF). Here, a patient with SCD having a very rare combination of rib defects on the right side and left-sided scoliosis, tetralogy of Fallot, and diaphragmatic spleen herniation, which had not been reported before, was described.

Available online 16 December 2013 This article has been retracted: please see Elsevier Policy on Article Withdrawal ( http://www.elsevier.com/locate/withdrawalpolicy ). This article has been retracted at the request of the authors because of a business decision by their employer.

Persistent conductivity in n-type 3C-SiC is investigated in a wide temperature range down to 3 K by Hall effect, admittance spectroscopy, low temperature photoluminescence (LTPL) and Raman spectroscopy. We propose a model, which clearly explains the persistent behavior of the electron density n below 50 K. It is experimentally verified that the persistent conductivity results from doped SF bunches, which can be considered as nanopolytype inclusions in 3C-SiC.

The nucleation of glide-set 90° partial dislocation from a sharp corner in 3C–SiC has been investigated by reaction pathway analysis. We focus on the core element effect and assert that both the stress-dependent activation energy and the athermal strain of C-core dislocation nucleation are higher than those of Si-core, while the gradient of the energy curve for C-core nucleation is lower than the Si-core counterpart, manifesting the greater thermal sensitivity of C-core dislocation. The results indicate that the nucleation of Si-core dislocation is more energy-favorable, while the C-core dislocation would nucleate with thermal assistance under high temperature, which explain the observation of core nature effects on dislocation performance in SiC by previous experiments. Estimation of dislocation nucleation behavior under high temperature has also been conducted. The free energy is obviously reduced at deposition temperature, implicating the much higher occurrence rate of dislocations with both C-core and Si-core during the crystal growth process. Moreover, from the viewpoint of different mobilities of boundary partial dislocations due to the core element effect, the distinct performances of stacking faults with Si-face and C-face exposure on the (0 0 1) surface during film deposition have been discussed, providing a reasonable explanation of our previous observation [1] , [2] .

BackgroundAwareness about normal cardiac volumes in the neonatal period is very important for understanding the cardiac function; however, the small cardiac size of neonates makes it difficult to perform invasive examinations. Three-dimensional echocardiography is used to evaluate cardiac volumes in children. However, no studies using this method have examined left ventricular volumes in neonates during the early neonatal period.MethodsThe study group consisted of 255 normal neonates. Comparisons of the stroke volume calculated according to the velocity–time integral and Pombo method were made.ResultsThe volumes in both end-diastole and end-systole and the stroke volume gradually decreased over time after birth. Participants with continuous a persistent ductus arteriosus flow had higher stroke volumes than those without persistent ductus arteriosus. The average end-diastolic volume per body surface area (m2) was 30.61 ml/m2 in boys and 29.80 ml/m2 in girls, whereas the ventricular end-systolic volume was 12.89 ml/m2 in boys and 12.80 ml/m2 in girls among the participants without persistent ductus arteriosus. The average stroke volume was 17.70 ml/m2 in boys and 17.00 ml/m2 in girls. Statistically significant gender differences were observed in the end-diastolic volume (p = 0.0053), stroke volume (p < 0.0001), and ejection fraction (p = 0.039). The cardiac index was calculated to be 2.04 L/minute/m2 in boys and 1.95 L/minute/m2 in girls, which was significantly lower than that calculated using the velocity–time integral and Pombo method (p < 0.0001).ConclusionsSignificant gender differences in the end-diastolic volume, stroke volume, and ejection fraction at birth were revealed. The cardiac index in the early neonatal period was found to be relatively smaller than what had previously been recognised.

In this study, we have used the microwave photoconductivity decay method to map excess carrier lifetimes in a n-type 3C-SiC wafer grown on an undulant Si substrate. We compared these lifetime maps with the distributions of strains and defects, which were observed using optical microscopy, Raman spectroscopy and pit distributions after molten NaOH etching. We found that excess carrier lifetimes in strained regions, which exhibit high densities of defects, are short. We also found that carrier lifetimes in strained regions at the cross sections of the 3C-SiC wafer are short. These results suggest that defects and strains in the wafer exhibit distributions similar to those of shortened carrier lifetimes. Excess carrier lifetime map for a 3C-SiC wafer.

It is an advantage for orthopaedic surgeons to remove an Ilizarov external fixator as early as possible after surgery. Although both teriparatide and low-intensity pulsed ultrasound (LIPUS) have been found to accelerate fracture-healing processes, the effect of the combination of teriparatide and LIPUS in clinical bone fracture management remains unclear.From among 721 patients with a lower limb fracture on admission to our department who underwent surgical treatment for a lower limb fracture with an Ilizarov external fixator, 38 patients over 60-year-old were investigated. Patients were either treated with an Ilizarov external fixator alone (IEF alone, n = 20) or an Ilizarov external fixator combined with teriparatide and LIPUS (IEF combination, n = 18). The patients' mean age was 64.1 years (range, 60-79 years) in the IEF alone group and 67.2 years (range, 60-83 years) in the IEF combination group. Teriparatide (20 μg subcutaneous injection daily or 56.5 μg subcutaneous injection once-weekly) and LIPUS (20 min/d) were started immediately after surgery for the IEF combination group in an attempt to accelerate healing of the lower limb fracture with the Ilizarov external fixator.The mean time to union was 111.9 days (range, 94-175 days) for IEF alone and 72.1 days (range, 68-141 days) for the IEF combination; it was significantly shorter with the IEF combination. Bone density (relative to young adult mean, YAM) was 61.3% (range, 38%-82%) for IEF alone and 52.1% (range, 30%-79%) for the IEF combination. The mean AOFAS score was 86.2 (range, 72-100) for IEF alone and 91.2 (range, 82-100) for the IEF combination.In elderly patients with lower limb fractures, combined therapy (teriparatide and LIPUS) showed a shorter mean duration of union than the Ilizarov external fixator alone. Combined therapy with teriparatide and LIPUS may become a useful option in the treatment of elderly patients with lower limb fractures.

Objective The mean closure time of the ductus arteriosus (DA) in full-term neonates is presumed to be 1–2 days after birth; however, whether this rate is accurate throughout the neonatal period is still unclear. In addition, the clinical determinants that influence DA closure remain unknown. Methods Echocardiography was performed 1826 times (897 in boys, 929 in girls) in 1442 participants (732 boys, 710 girls). An iE33 colour Doppler echocardiograph supplied by Philips Electronics was employed to examine DA flow. Data regarding sex, birth date, examination date, method of delivery, mother's age, past deliveries, neonatal body weight and body height were also collected. The Statistical Analysis System makes statistical clarification of these queries possible. We examined the persistence of DA in full-term neonates and appropriate for gestational age (AGA) neonates in the early neonatal period using colour Doppler echocardiography, and a subsequent analysis with SAS. Results After performing multivariable analyses, the median DA persistency times were 27.42 and 45.10 h after birth in boys and girls, respectively. A statistically significant sex difference was observed (p

We present a rare case of osteosarcoma involving the patella. A 30-year-old Japanese woman first consulted our out-patient clinic with a 2-year history of knee pain. Radiographs showed an enlargement of the patella with irregular distribution of both osteolytic and sclerotic lesions. Computed tomography and magnetic resonance imaging demonstrated soft tissue extension at the anterior part of the patella. Incisional biopsy showed abundant osteoid formation by spindle-shaped malignant cells, and the histological diagnosis was conventional osteosarcoma. The patient underwent preoperative chemotherapy, but there was no response. Furthermore, she developed a pathological fracture during chemotherapy. She underwent above-the-knee amputation with postoperative chemotherapy. She developed multiple metastases in the thoracic vertebrae 20 months after the surgery. At the most recent examination, she remains alive with multiple spinal metastases without paralysis 4 years after the surgery.

The channel mobility in 3C-SiC n-MOSFETs is investigated by current-voltage and Hall-effect measurements. For comparison, these techniques are also applied to 3C-SiC bulk rods. It turns out that the channel mobility depends on the orientation of the crystal and channel length. The observed results are traced back to the influence of Si-terminated stacking faults (Si-SFs), to the resistance of the drain/source contact and to the warping of the wafer caused by the special growth technique.

Transistor performances of lateral and vertical 3C-SiC MOSFETs are investigated in the temperature range of 25 °C to 300 °C. Both types of MOSFETs operate up to 300 °C and the lateral MOSFETs possess peak channel mobility of more than 100 cm2/(Vs) even at 300 °C for the [110]- and [-110]-channel directions. In both MOSFETs, on-currents decrease monotonically and threshold voltages shift negatively as the temperature increases. The temperature dependence of on-currents in the lateral MOSFETs is weaker than that in the vertical MOSFETs. The leakage current at the negative gate voltage increases at above 200 °C. The activation energies calculated from the leakage currents at 200 °C and 300 °C are about half of the 3C-SiC bandgap energy of 2.3 eV.

Technique of bulk-like 3C-SiC film (up to 300 µm) growth on undulant-Si substrate is known to be very effective to reduce stacking fault density as well as that of other planar defects. However, freestanding 3C-SiC wafer shows anisotropic warpage involving large convex curvature in the direction perpendicular to the ridge of undulation ([110] direction), and slight concave curvature in parallel direction ([-110] direction), i.e. saddle shape. In this paper the origin of the warpage of the 3C-SiC wafer is investigated. Ex-situ curvature measurements and stress calculation reveal that large compressive intrinsic stress is generated during high-temperature growth process (1623 K) in both parallel and perpendicular directions. In order to investigate the intrinsic stress distribution along the [001] direction, a reactive ion etching (RIE) is conducted for the 3C-SiC on Si substrate to observe the dependence of the SiC/Si system curvature as a function of 3C-SiC thickness. This observation shows that the intrinsic stress component perpendicular to the ridge of undulation presents nonuniform distribution in [001] direction. The remarkable change in the intrinsic stress is observed in the 50 µm-thick region from SiC/Si interface. A finite element method simulation using the obtained intrinsic stress distribution clearly explains that the anisotropic warpage of SiC wafer is induced by the intrinsic stress distribution in quantitative manner. Microstructure change induced by stacking fault reduction process (stacking fault collision) would be the cause of the intrinsic stress variation.

We carry out ab initio density functional theory calculations to investigate the fundamental mechanical properties of stacking faults in 3C-SiC, including the effect of stress and doping atoms (substitution of C by N or Si). Stress induced by stacking fault (SF) formation is quantitatively evaluated. Extrinsic SFs containing double and triple SiC layers are found to be slightly more stable than the single-layer extrinsic SF, supporting experimental observation. Effect of tensile or compressive stress on SF energies is found to be marginal. Neglecting the effect of local strain induced by doping, N doping around an SF obviously increase the SF formation energy, while SFs seem to be easily formed in Si-rich SiC.

A reliable method for reducing the stacking faults (SFs) is demonstrated on the 3C-SiC (001) surface. It is a practical method based on Monte Carlo (MC) simulations of SF propagation during 3C-SiC epitaxial growth, which showed that introducing some discontinuity on the (001) surface enhanced SF reduction. The method is implemented by patterning on the 3C-SiC (001) surface and subsequent homo-epitaxial growth, and this sufficiently reduced the SF density to less than 400 cm-1. A yield of 97.4 % was estimated for a device-ready area of 10 mm2 by statistical measurements of SF density on the entire epitaxial layer surface.