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Nail gun injuries usually occur at the extremities due to working accidents. Intracranial or intrathoracic injuries are relatively rare, and cases combined with both injuries are even rarer. Such situations pose challenges for surgeons due to their uniqueness during operation. Radiologic imaging findings in our case were significant in indicating surgical findings. Herein, we report a patient who shot himself using a nail gun, damaging his brain and heart. Keywords: Nail gun injury, Computed tomography, Trauma

Background Chemoradiotherapy (CRT), which might affect the autonomic system, is the mainstay therapy for advanced esophageal squamous cell carcinoma (ESCC). Autonomic dysfunction has been found to possibly lead to cancer mortality in those with elevated resting heart rates (RHR). Skin sympathetic nerve activity (SKNA) is a new method of stimulating electrical signals in skin to evaluate autonomic function from sympathetic tone. In this study, we investigated the association between changes in RHR and autonomic function and ESCC mortality. Methods Thirty-nine stage II-IV ESCC patients receiving CRT between March 2019 and November 2020 were prospectively enrolled and carefully selected, followed up and received the same meticulous supportive care. Serial RHR was recorded every two weeks from before CRT to eight weeks after CRT and average SKNA were recorded before and four weeks after CRT. All-cause mortality was defined as primary outcome. Results We found the RHR of ESCC patients to be significantly elevated and peaking at four weeks after CRT (p Conclusions Increased pre-treatment sympathetic tone and elevated RHR after CRT are alarm signs of poor ESCC outcome. Further exploration of the mechanisms underlying these associations could potentially lead to intervention strategies for reducing mortality. Trial registration This study is registered with ClinicalTrials.gov, identifier: NCT03243448.

Objective To report a case and review published cases of large cell neuroendocrine carcinoma (LCNEC) of the endometrium. Case report A 51-year-old female presented with postmenopausal bleeding and a palpable pelvic mass. An endometrial biopsy showed a malignant mixed Mullerian tumor (MMMT). Suboptimal debulking surgery was performed. The final pathology revealed stage IVB endometrial LCNEC. Post-operative adjuvant chemotherapy with cisplatin and etoposide was administered. Two months after discontinuing adjuvant chemotherapy, salvage chemotherapy with cisplatin and ifosfamide was administered due to tumor progression; however, obstructive ileus was noted 2 months later. A segmental small bowel resection and palliative colostomy were performed. She died secondary to a post-operative infection 8 days after the operation. Conclusion Endometrial LCNEC is a rare but aggressive disease. If diagnosed, combined therapies, including staging surgery, following by adjuvant radiotherapy and chemotherapy, should be performed.

In this work, a numerical simulation has been conducted to investigate the effect of superbiphilic surface on boiling using the volume of fluid (VOF) method. The boiling curve has been used to study the heat transfer efficiency and boiling dynamics which gain more physical insights into the underlying mechanisms. By adjusting the mixed hydrophilic and hydrophobic surface, two types of surface prpoerties have been investigated in this work: the superhydrophilic and superhydrophobic networks. The superhydrophilic network is found to achieve a larger critical heat flux and delay the occurrence of film boiling, while the superhydrophobic network can reach the critical heat flux at a comparatively lower superheat. The superbiphilic surface can enhance the heat transfer efficiency, and the critical heat flux obtained is 55 % greater than the hydrophilic/hydrophobic surface with a uniform contact angle. For the first time, the effect of superbiphilic contact angle on the complete boiling curve is shown. The numerical predictions demonstrate good agreement with prior experimental and theoretical studies. This work provides a better understanding of contact angle effect in boiling dynamics, and it serves a good indicator for designing a smarter heat exchanger which might greatly benefit the whole energy industry.

SummaryWe report a case of pseudolymphoma of the liver in a 49-year-old woman without an underlying disease except for liver hemangioma. A 20-mm nodule was incidentally found in segment 2 of the liver by abdominal ultrasonography during a regular follow-up of the hepatic hemangioma. After a series of radiological examinations, a left lateral sectionectomy was performed because malignant hepatic tumor could not be excluded. The patient was discharged uneventfully 7 days after the operation. The pathology examination revealed a pseudolymphoma. No recurrence of the tumor was found 5½ years after the operation. To the best of our knowledge, only 46 cases of pseudolymphoma of the liver have been reported to date. A review of the literature showed that pseudolymphomas occur predominantly in females (89.4%), usually occur as a single tumor (80.4%), are no more than 20 mm in size (90.6%), and are frequently associated with either autoimmune disease or chronic liver disease. Because an accurate diagnosis is difficult to establish, vigilant follow-up is indicated, and surgical intervention is the choice of treatment once the suspiciousness of malignancy has been raised.

Müllerian adenosarcomas are malignant gynecologic neoplasms. Advanced staging and sarcomatous overgrowth predict poor prognosis. Because the genomic landscape remains poorly understood, we conducted this study to characterize the genomewide copy number variations in adenosarcomas. Sixteen tumors, including eight with and eight without sarcomatous overgrowth, were subjected to a molecular inversion probe array analysis. Copy number variations, particularly losses, were significantly higher in cases with sarcomatous overgrowth. Frequent gains of chromosomal 12q were noted, often involving cancer-associated genes CDK4 (six cases), MDM2, CPM, YEATS4, DDIT3, GLI1 (five each), HMGA2 and STAT6 (four), without association with sarcomatous overgrowth status. The most frequent losses involved chromosomes 13q (five cases), 9p, 16q and 17q (four cases each) and were almost limited to cases with sarcomatous overgrowth. MDM2 and CDK4 amplification, as well as losses of RB1 (observed in two cases) and CDKN2A/B (one case), was verified by FISH. By immunohistochemistry, all MDM2/CDK4-coamplified cases were confirmed to overexpress both encoded proteins, whereas all four cases with (plus an additional four without) gain of HMGA2 overexpressed the HMGA2 protein. Both cases with RB1 loss were negative for the immunostaining of the encoded protein. Chromothripsis-like copy number profiles involving chromosome 12 or 14 were observed in three fatal cases, all of which harbored sarcomatous overgrowth. With whole chromosome painting and deconvolution fluorescent microscopy, dividing tumor cells in all three cases were shown to have scattered extrachromosomal materials derived from chromosomes involved by chromothripsis, suggesting that this phenomenon may serve as visual evidence for chromothripsis in paraffin tissue. In conclusion, we identified frequent chromosome 12q amplifications, including loci containing potential pharmacological targets. Global chromosomal instability and chromothripsis were more frequent in cases with sarcomatous overgrowth. To our knowledge, this is the first time that evidence of chromothripsis has been demonstrated in paraffin-embedded clinical tissues and in adenosarcomas.

A 16-year-old male was brought to our hospital presenting with acute onset of a painful protruding left neck mass within a day, associated with left upper-arm tenderness. Chest computed tomography revealed high attenuation masses at the left supraclavicular and mediastinal regions, suspected of being venous vascular tumors. Surgery was arranged and then ruptured venous tumor was noted, with pathology results determining a venous malformation.

The high temperature deformation behavior of a 6069 Al alloy was examined on a Gleeble 3500 thermal–mechanical simulation machine at temperatures ranging from 300 °C to 550 °C and strain rates varying between 0.001 s −1 and 10 s −1 . The strain-hardening and dynamic softening mechanisms of the alloy were analyzed. Strain-hardening behavior was investigated using Kocks–Mecking type plots. Stage III hardening behavior occurred immediately after yielding under the deformation conditions performed in this study. Microstructural evolution analysis indicated that the softening mechanism at high strain rates or low temperatures proceeded via dynamic recovery. The net flow stress required for the onset of dynamic recovery increased with increasing strain rate or decreasing temperature. Partial dynamic recrystallization enhanced the softening effect at high temperatures with low strain rates. The microstructural evolution analyzed via electron backscatter diffraction showed that the operating mechanism of dynamic recrystallization was related to continuous dynamic recrystallization. A relative softening factor was used to quantify the effect of flow softening. The variations in the relative softening value with strain may be associated with hot deformation conditions, in which the flow stress behavior correlated with different microstructures and dynamic softening mechanisms.

Recently, mutations of telomerase reverse transcriptase (TERT) promoter were found in several types of cancer. A few reports demonstrate TERT promoter mutations in ovarian clear cell carcinomas but endometrial clear cell carcinoma has not been studied. The aims of this study were to compare differences of molecular alterations and clinical factors, and identify their prognostic impact in endometrial and ovarian clear cell carcinomas. We evaluated mutations of the TERT promoter and PIK3CA, expression of ARID1A, and other clinicopathological factors in 56 ovarian and 14 endometrial clear cell carcinomas. We found that TERT promoter mutations were present in 21% (3/14) of endometrial clear cell carcinomas and 16% (9/56) of ovarian clear cell carcinomas. Compared with ovarian clear cell carcinomas, endometrial clear cell carcinomas showed older mean patient age (P0.001), preserved ARID1A immunoreactivity (P=0.017) and infrequent PIK3CA mutation (P=0.025). In ovarian clear cell carcinomas, TERT promoter mutations were correlated with patient age45 (P=0.045) and preserved ARID1A expression (P=0.003). In cases of endometrial clear cell carcinoma, TERT promoter mutations were not statistically associated with any other clinicopathological factors. In ovarian clear cell carcinoma patients with early FIGO stage (stages I and II), TERT promoter mutation was an independent prognostic factor and correlated with a shorter disease-free survival and overall survival (P=0.015 and 0.009, respectively). In recurrent ovarian clear cell carcinoma patients with early FIGO stage, TERT promoter mutations were associated with early relapse within 6 months (P=0.018). We concluded that TERT promoter mutations were present in endometrial and ovarian clear cell carcinomas. Distinct molecular alteration patterns in endometrial and ovarian clear cell carcinomas implied different processes of tumorigenesis in these morphologically similar tumors. In ovarian clear cell carcinoma of early FIGO stage, patients with TERT promoter mutation require close follow-up during the initial 6 months following chemotherapy.

A particle-in-cell (PIC) simulation tool, OOPD1, is wrapped in the Python programming language, enabling automated algorithmic optimization of physical and numerical parameters. The Python-based environment exposes internal variables, enabling modification of simulation parameters, as well as run-time generation of new diagnostics based on calculations with internal data. For problems requiring an iterative optimization approach, this enables a programmable interactive feedback loop style simulation model, where the input to one simulation is a programmable function of the output of the previous one. This approach is applied to field-emission of electrons in a diode, in order to explore space charge effects in bipolar flow. We find an analytical solution for maximizing the space-charge limited current through a diode with an upstream ion current, and confirm the result with simulations, demonstrating the efficacy of the feedback scheme. We also demonstrate and analyze a modeling approach for scaling the ion mass, which can shorten simulation time without changing the ultimate result. The methods presented can be generalized to handle other applications where it is desirable to evolve simulation parameters based on algorithmic results from the simulation, including models in which physical or numerical parameter tuning is used to converge or optimize a system in one or more variables.

Objective To report a case of isolated omental peritoneal carcinoma without peritoneal carcinomatosis. Case report A 60-year-old female with abdominal distention was found to have a pelvic mass. Under the impression of ovarian cancer, laparotomy was performed only to show one isolated mass over omentum. Serial examination and pathology study including immunochemical staining indicated primary peritoneal serous carcinoma. Conclusion Isolated omental peritoneal carcinoma without peritoneal carcinomatosis and ascites is rare, and whether this represented a unique entity with different chemotherapy response and treatment outcome from the disseminated form of primary peritoneal carcinoma needs to be reviewed in the future.

► Malignant struma ovarii can result in cerebral ischemic stroke and Trousseau's syndrome. ► The combination of anti-neoplastic and anti-coagulant therapy should be undertaken to treat and correct the malignancy-associated coagulopathy.

In the crystal bulk of group IV covalent semiconductors such as germanium (Ge), simple analytic models for the valence band structure can provide fast, accurate computations of hole mobility for moderate energy ranges up to a few eV. On the surfaces of these materials, such as on Ge-vacuum or Ge–GeO2 interfaces, the transport rates differ significantly from the bulk. This can be problematic for both point contact and segmented Ge gamma ray detectors, that require accurate carrier drift rates for computing signal basis sets, which themselves are necessary for the precise determination of gamma-ray induced compton scattering events. While several techniques exist for computing surface hole mobilities, more often than not, these methods are complex to implement, require significant computational resources, and lack the simplicity of bulk models for interpreting results. This paper presents a new technique for computing Ge surface hole mobility that can give a first estimate for the surface transport rates after tuning a physically based computational parameter. This model is used in conjunction with particle-in-cell (PIC) simulations for modeling hole-dynamics inside a Ge p-type point contact detector. The results of our calculations agree with experimental data gathered from Ge p-type point contact detectors at Oak Ridge National Laboratory.

Ovarian cancer with bone metastasis is relatively rare(about 1.2%) [1], compared with direct extension,transperitoneal seeding and lymphatic spread. Bonemetastasis of ovarian cancer is mostly found duringrecurrence, and is very rare at the initial diagnosis withonly a few cases reported [2]. We report a case withthe initial diagnosis of advanced ovarian cancer withthoracispinal metastasis, and discuss the differentialdiagnosis and clinical course.A 48-year-old women gravida 2, para 1, had sufferedfrom mid-back pain for 4 months. She had iron-deficiency anemia because of menorrhagia. She visiteda gynecologic clinic for regular Papanicolaou tests andpelvic examinations annually. The only abnormal findingwas adenomyosis using ultrasound in October 2005.She did not have changes in appetite, decreased bodyweight or bowel movement changes. However, her backpain had been present since October 2005. She visited aneurologic clinic in our hospital in February 2006, andan osteolytic lesion in the pedicle of T7 was noticed onan X-ray film of the spine. High signals in the pediclesof T7 and L3 and soft tissue around T7 on magneticresonance imaging were found (Figure 1). Her CA 125level was 102.22U/mL and CA 199 was 98.3U/mL.She underwent T2–T8 laminectomy and excision of atumor in February 2006. Pathologic findings revealedmetastatic poorly differentiated carcinoma with glan-dular differentiation. Postoperative follow-up revealednormal findings on chest X-ray, panendoscopy andcolonofiberscopy, and a large left ovarian multicystictumor measuring approximately 15×10cm adheredto her uterus and adenomyosis of the uterus on thecomputed tomography scan (Figure 2).In March 2006, she underwent exploratory laparo-tomy, and a left ovarian cystic tumor measuring approx-imately 14 ×11×8cm, which adhered to her uterus,bowel, retroperitoneum and left fallopian tube, andsome ascites, were found intraoperatively. The frozenpathology during the operation revealed ovarian malig-nancy. Abdominal total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissectionand infracolic omentectomy were performed. There wasno residual tumor in the abdominal and pelvic cavityafter surgery. Grossly, the left ovary showed a hugeunilocular cystic tumor, which measured 6.5×5.0×2.0cm after cystic content evacuation, with a polypoidsolid nodule protruding from the cystic wall into thecystic cavity. The final microscopic finding showed: (1)left ovarian adenosarcoma with predominant rhab-domyosarcomatous differentiation over the solid part,and grade I endometrioid adenocarcinoma with squa-mous differentiation over the cystic part with deep,irregular invasion over the gland (Figure 3); (2) multiplelymph node metastasis; and (3) carcinoma

Squamous morules are a common component of premalignant glandular lesions that are followed by glandular, rather than squamous, carcinomas. We tested the hypothesis that the appearance of glands associated with morules predicts cancer risk, and undertook molecular testing to determine the clonal and hormonal response properties of admixed squamous and glandular elements. A total of 66 patients with squamous morules in an index endometrial biopsy had follow-up clinical data (average follow-up: interval 31 months, 2.5 biopsies) showing development of carcinoma in 11% (7/66) of cases. The histological appearance of morule-associated glands in the index biopsy was significantly associated with this clinical outcome, with the majority (71%, 5/7) of cancer occurrences following an overtly premalignant lesion (endometrial intraepithelial neoplasia) with squamous morules. Eight endometrial intraepithelial neoplasias with squamous morules were examined by immunohistochemistry for estrogen and progesterone receptors and mitotic activity (Ki-67 antigen percent stained). Glandular components had abundant estrogen and progesterone receptors, and high levels of mitotic activity in all cases. In sharp contrast, all squamous morules were devoid of sex hormone receptors and had undetectable or extremely low-proliferation rates. When mutated, the same specific PTEN mutation was detected in squamous and glandular elements, indicating that both are of common lineage. The clinical and laboratory data are consistent with a model of morule biology in which squamous morules are a hormonally incompetent subpopulation of endometrial glandular lesions. Isolated morules might result from artifactual displacement from their native glandular context, or selective hormonally induced regression of the glandular but not squamous components over time. Subsequent cancer risk, as promoted by estrogens, is greatest when the glandular component has the appearance of endometrial intraepithelial neoplasia. Even isolated morules should be carefully followed, however, to exclude a coexisting undersampled, or occult, glandular lesion.

A simple time-dependent model is presented to investigate lifetimes of the quasibound states in coupled quantum wells (CQWs). The transfer matrix approach is employed to discretize the conduction-band profile of the heterostructure and form a dispersion equation whose zeros correspond to the complex eigenenergies. Both the bound and quasibound states are extracted numerically in the complex plane by Newton's method. The lower and higher well subbands are found to have negative and positive energy shift, respectively, as following the no level crossing theorem. Besides, the decay rate of the quasibound state is approximately proportional to the absolute energy shift. The quasibound states, which have larger energy shift, have shorter lifetime and decay more quickly. Furthermore, the differences in lifetime between the quasibound states in CQWs can be easily realized as all the wave functions are specially adjusted to form the relative probability density distributions.

An analytical approach is presented to achieve the fast design of high-power waveguide windows. The analytical calculation is compared with the result of numerical simulation via the finite-element code high frequency structure simulator and the experiments of W-band waveguide windows performed at the Stanford Linear Accelerator Center (SLAC), Stanford University, Stanford, CA. The closed form has been carried out to enhance the accuracy and efficiency, and the exact calculation agrees with the experimental results and the numerical simulation very well.

Background. Few studies have addressed in detail the genetic alterations that occur in vulvar squamous carcinomas (VSCC) and their precursor lesions. In a previous study, we determined the most common chromosomal loci for allelic imbalance (AI) in HPV-positive and -negative VSCCs. The present study was designed to determine whether AI and the microsatellite instability phenotype (MIN) were present in epithelial lesions known to be associated with VSCC. Design. Fifty-seven epithelial loci were analyzed, including HPV-positive (classic) and -negative (differentiated) vulvar intraepithelial neoplasms (VINs), lichen sclerosus (LS), and nonatypical hyperplasias. Thirty-one epithelial loci (55%) were obtained from patients with associated invasive vulvar carcinoma. HPV status was determined by polymerase chain reaction analysis. AI and MIN were determined by comparisons of microdissected target tissues with stromal controls, targeting 11 chromosomal loci. Results. AI was identified in all epithelial categories, involving at least one chromosomal locus in 67, 53, 50, and 43% of classic VIN, differentiated VIN, hyperplasia, and LS. MIN was infrequent (10–13%), but confined to HPV-negative epithelial changes. HPV-positive lesions generally scored for AI more frequently, but certain loci scored nearly equally in both HPV-positive and -negative lesions, including 8p, 11q, and 17p. There were no differences in frequency of AI between epithelia with and without associated invasive carcinoma. Conclusions. The presence of allelic imbalance in vulvar hyperplasia and LS supports the hypothesis that these alterations are at greater risk for neoplasia despite the absence of conspicuous cellular atypia. A model is proposed in which these changes represent monoclonal expansion and are at empirically greater risk for subsequent "critical events" leading to morphologic atypia (VIN). The possibility that these early genetic changes influence both HPV-positive and -negative pathways merits further study.

Vulvar squamous cell carcinoma (VSCC) is a biologically and morphologically diverse disease, consisting of human papillomavirus (HPV)-positive and -negative tumors that differ in their morphological phenotypes and associated vulvar mucosal disorders. This study analyzed the frequencies of allelic loss (loss of heterozygosity (LOH)) in HPV-positive and -negative VSCCs to identify potential targets for the study of preinvasive diseases, to determine whether HPV status influenced patterns of LOH, and to determine whether these patterns differed from HPV-positive tumors of another genital site, cervical squamous cell carcinomas (CSCC). DNA extracted from microdissected archival sections of two index tumors, one each HPV negative and positive, was analyzed for LOH at 65 chromosomal loci. Loci scoring positive with either sample were included in an analysis of 14 additional cases that were also typed for HPV. Frequencies of LOH at loci were computed in a panel of HPV-positive and -negative VSCCs. Twenty-nine loci demonstrated LOH on the initial screen and were used to screen the remaining 14 tumors. High frequencies of LOH were identified, some of which were similar to a prior karyotypic study (3p, 5q, 8p, 10q, 15q, 18q, and 22q) and others of which had not previously been described in VSCC (1q, 2q, 8q, 10p, 11p, 11q, 17p, and 21q). With the exception of 5q and 10p, there were no significant associations between frequency of LOH and HPV status in VSCC. LOH at 3p and 11q were frequent in both VSCC and CSCC; however, allelic losses at several sites, including 5q, 8q, 17p, 21q, and 22q, were much more common in VSCC. VSCCs exhibit a broad range of allelic losses irrespective of HPV status, with high frequencies of LOH on certain chromosomal arms. This suggests that despite their differences in pathogenesis, both HPV-positive and -negative VSCCs share similarities in type and range of genetic losses during their evolution. Whether the different frequencies of LOH observed between VSCC and CSCC are real or reflect differences in stage and/or tumor size remains to be determined by further comparisons. The role of these altered genetic loci in the genesis of preinvasive vulvar mucosal lesions merits additional study.

Corrigendum to ‘‘Effect of a surface channel on the performance of a P-type Point Contact HPGe detector’’ [Nuclear Instruments and Methods in Physics Research A 680 (2012) 48–55] R.J. Cooper , D.C. Radford , E. Hull , K. Lagergren , P. Mullowney , M.-C. Lin , K. Paul , C. Ahrens , M. Loh d a Joint Institute for Heavy Ion Research, Oak Ridge National Laboratory, Oak Ridge, TN 37831-6371, USA b Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831-6371, USA c PHDs Co., 3011 Amherst Road, Knoxville, TN 37921, USA d Tech-X Corporation, 5621 Araphoe Avenue, Suite A, Boulder, CO 80303, USA