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Background and Objectives: Although cholangiolocellular carcinoma is considered a combined hepatocellular and cholangiocarcinoma, we feel that this classification is not appropriate. Therefore, we compared the diagnostic imaging findings, surgical prognosis, and pathological features of cholangiolocellular carcinoma with those of other combined hepatocellular and cholangiocarcinoma subtypes, hepatocellular carcinoma, and cholangiocarcinoma., Methods: The study patients included 7 with classical type combined hepatocellular and cholangiocarcinoma; 8 with stem cell feature, intermediate type combined hepatocellular and cholangiocarcinoma; 13 with cholangiolocellular carcinoma; 58 with cholangiocarcinoma; and 359 with hepatocellular carcinoma. All patients underwent hepatectomy or living-related donor liver transplantation from 2001 to 2014., Results: cholangiolocellular carcinoma could be distinguished from hepatocellular carcinom, other combined hepatocellular and cholangiocarcinoma subtypes, and cholangiocarcinoma by the presence of intratumoral Glisson's pedicle, hepatic vein penetration, and tumor-staining pattern on angiography-assisted CT. Cholangiolocellular carcinoma was associated with a significantly lower SUV-max than that of cholangiocarcinoma on FDG-PET. Hepatocellular carcinoma, classical type, and cholangiolocellular carcinoma had significantly better prognoses than stem cell feature, intermediate type and cholangiocarcinoma. A cholangiocarcinoma component was detected in cholangiolocellular carcinoma that progressed to the hepatic hilum, and the cholangiocarcinoma component was found in perineural invasion and lymph node metastases., Conclusions: From the viewpoint of surgeon, cholangiolocellular carcinoma should be classified as a good-prognosis subtype of biliary tract carcinoma because of its tendency to differentiate into cholangiocarcinoma during its progression, and its distinctive imaging and few recurrence rates different from other combined hepatocellular and cholangiocarcinoma subtypes.

Both co-trimoxazole and pentamidine are used for the treatment of pneumocystis pneumonia (PCP) and are known to cause hypoglycemia as an adverse drug reaction. Here, we describe a rare case of a late-diagnosed female patient with acquired immunodeficiency syndrome (AIDS) who developed the first hypoglycemic attack as an adverse effect of co-trimoxazole, followed by a second hypoglycemic attack as an adverse effect of pentamidine. Physicians caring for patients with AIDS and PCP should be aware of possible hypoglycemia in patients with many risk factors.

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients after initiating antiretroviral therapy usually involves worsening manifestations of overt infectious disease. Here, we describe a sporadic case of a late-diagnosed HIV-positive man who developed Graves' disease as the first noninfectious IRIS followed by immune thrombocytopenic purpura as the second noninfectious IRIS.

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Particle size of apoB-48 carrying lipoproteins in remnant-like lipoprotein particles (RLP) in postprandial plasma has not been well characterized., Methods: Plasma lipids, lipoproteins and apolipoproteins in 12 healthy subjects were analysed after an oral fat load. RLP isolated by immunoaffinity gel from plasma of a normolipidaemic and a hyperlipidaemic subject in four hours after an oral fat load was fractionated by high-performance liquid chromatography (HPLC) and monitored by total cholesterol (TC), triglycerides (TG), apoB-48 and apoB-100., Results: TC, low-density lipoprotein (LDL)-C and apoB did not change after an oral fat load, while TG, RLP-C, RLP-TG and apoB-48 increased significantly in postprandial plasma. HPLC profiles monitored by TC and TG revealed that major lipoproteins increased in RLP after an oral fat load was VLDL size particles. The percentage of RLP-TG in total TG and the ratio of RLP-TG/RLP-C were significantly increased in four hours after an oral fat load compared with the fasting state (P < 0.01). RLP in four hours after an oral fat load fractionated by HPLC and monitored by TC, TG, apoB-48 and apoB-100 revealed that VLDL size or smaller particles were the major lipoproteins., Conclusions: ApoB-48 carrying lipoproteins in RLP isolated from a normolipidaemic and a hyperlipidaemic subject after an oral fat load showed a similar particle size with apoB-100 carrying VLDL remnants. Therefore, the most apoB-48 carrying particles found in postprandial RLP can be classified as CM remnants. The majority of remnants in the postprandial state were not CM remnants, but VLDL remnants.

Physico-chemical modifications of hydroxyapatite (HAp) materials are considered as pre-requisites for the development of new bioactive carrier materials for drug delivery and tissue engineering applications. Since acidic amino acids have well-documented affinities to both HAp and basic proteins, HAp modified by aspartic acid (Asp, acidic amino acid) might be one of the candidate substrates for a basic protein carrier. Here, we synthesized HAp in the presence of various concentrations of Asp and observed that HAp crystallinity and other physico-chemical properties were effectively modulated. Detailed studies indicated that Asp was not incorporated in the HAp crystal lattice, but rather was trapped in HAp crystals. Protein adsorption studies indicated that the HAp particles modified by Asp had a selective loading capacity for basic protein. Therefore, HAp particles containing Asp might have potential in drug delivery applications, especially as the carrier of basic proteins including bFGF and BMP.

A non-steroidal anti-inflammatory drug, diclofenac, acts efficiently against inflammation; however, down-regulation of diclofenac on bone remodeling has raised concerns. The inhibitory mechanisms of diclofenac are poorly understood. We hypothesized that diclofenac down-regulates osteoclast differentiation and activation via inhibition of the translocation of phosphorylated nuclear factor kappa B (NFkappaB). When osteoclasts prepared from mouse hematopoietic stem cells were treated with diclofenac, tartrateresistant acid phosphatase-positive multinucleated cells decreased in a concentration-dependent manner. Pit formation assay revealed the abolition of osteoclastic bone resorption; levels of cathepsin K transcripts, an osteoclastic resorption marker, were down-regulated time-dependently. Diclofenac induced the accumulation of the inhibitor of kappa B in cytosol, which led to suppression of the nuclear translocation of NFkappaB and phosphorylated NFkappaB. These results suggest that the novel mechanism of diclofenac for bone remodeling is associated with phosphorylated NFkappaB reduction, which regulates osteoclast differentiation and activation.

Functional monomers in adhesive systems can improve bonding by enhancing wetting and demineralization, and by chemical bonding to calcium. This study tested the hypothesis that small changes in the chemical structure of functional monomers may improve their bonding effectiveness. Three experimental phosphonate monomers (HAEPA, EAEPA, and MAEPA), with slightly different chemical structures, and 10-MDP (control) were evaluated. Adhesive performance was determined in terms of microtensile bond strength of 4 cements that differed only for the functional monomer. Based on the Adhesion-Decalcification concept, the chemical bonding potential was assessed by atomic absorption spectrophotometry of the dissolution rate of the calcium salt of the functional monomers. High bond strength of the adhesive cement corresponded to low dissolution rate of the calcium salt of the respective functional monomer. The latter is according to the Adhesion-Decalcification concept, suggestive of a high chemical bonding capacity. We conclude that the adhesive performance of an adhesive material depends on the chemical structure of the functional monomer.

Background: No previous report has described the level of the origin of the right inferior phrenic artery (RIPA) based on an analysis of the relationships between the level of the RIPA, the celiac artery (CA), the superior mesenteric artery (SMA), and the right renal artery (RRA) in a series of cases., Purpose: To evaluate the origin of the RIPA by retrospectively analyzing angiographic findings in 178 patients with hepatocellular carcinoma (HCC) who underwent transcatheter arterial chemoembolization (TACE) via the RIPA., Material and Methods: In patients treated with intraarterial chemoembolization for HCC, additional superselective chemoembolization of the RIPA branches was necessary in 178 cases. We analyzed the level of the origin of the RIPA in these patients according to the relationships between the level of the origin of the RIPA, the CA, the SMA, and the RRA on angiography., Results: Among the 178 cases, the RIPA arose from 1) the aorta directly in 102 cases (57%), 2) the CA in 53 (30%), 3) the left gastric artery (LGA) in three (2%), 4) the dorsal pancreatic artery (DPA) in one (1%), and 5) the RRA in 19 (11%). The level of the origin of the RIPA that originated directly from the aorta was supraceliac in 56 cases (32%), between the CA and the SMA in 31 (17%), and between the SMA and the RRA in 15 (8%)., Conclusion: In our study, the RIPA originated from the aorta between the CA and the SMA directly in 17% of cases. When it is difficult to identify the origin of the RIPA, we must keep in mind that the RIPA may originate from the right part of the aorta within the small distance between the SMA and the CA.

We report two patients with complete callosal agenesis in whom Probst bundles in both hemispheres could be depicted by diffusion tensor tractography (DTT). While one patient had no associated telencephalic anomaly other than callosal agenesis, the other had cortical dysplasia in the right frontal lobe. Although Probst bundles in the three normal hemispheres were well developed, that in the hemisphere which was affected by cortical dysplasia was small and poorly developed. DTT also showed that the fibers from the frontal pole ran more on the inner side of the Probst bundle than those from a more caudal region of the frontal lobe. Furthermore, fibers from the orbital gyri ran along the outermost side of Probst bundle. The arrangement of these fiber tracts in Probst bundle may reflect the developmental process of callosal fibers in their normal formation.

Mild self-etch adhesives demineralize dentin only partially, leaving hydroxyapatite around collagen within a submicron hybrid layer. We hypothesized that this residual hydroxyapatite may serve as a receptor for chemical interaction with the functional monomer and, subsequently, contribute to adhesive performance in addition to micro-mechanical hybridization. We therefore chemically characterized the adhesive interaction of 3 functional monomers with synthetic hydroxyapatite, using x-ray photoelectron spectroscopy and atomic absorption spectrophotometry. We further characterized their interaction with dentin ultra-morphologically, using transmission electron microscopy. The monomer 10-methacryloxydecyl dihydrogen phosphate (10-MDP) readily adhered to hydroxyapatite. This bond appeared very stable, as confirmed by the low dissolution rate of its calcium salt in water. The bonding potential of 4-methacryloxyethyl trimellitic acid (4-MET) was substantially lower. The monomer 2-methacryloxyethyl phenyl hydrogen phosphate (phenyl-P) and its bond to hydroxyapatite did not appear to be hydrolytically stable. Besides self-etching dentin, specific functional monomers have additional chemical bonding efficacy that is expected to contribute to their adhesive potential to tooth tissue.

Periodontal ligament tissue is remodeled on both the tension and compression sides of moving teeth during orthodontic tooth movement. The present study was designed to clarify the hypothesis that the expression of MMP-8 and MMP-13 mRNA is promoted during the remodeling of periodontal ligament tissue in orthodontic tooth movement. We used the in situ hybridization method and semi-quantitative reverse-transcription/polymerase chain-reaction analysis to elucidate the gene expression of MMP-8 and MMP-13 mRNA. Expression of MMP-8 and MMP-13 mRNA transiently increased on both the compression and tension sides during active tooth movement in vivo. The gene expression of MMP-8 and MMP-13 was induced by tension, while compression indirectly promoted the gene expression of MMP-8 and MMP-13 through soluble factors in vitro. Thus, we concluded that the expression of MMP-8 and MMP-13 is differentially regulated by tension and compression, and plays an important role in the remodeling of the periodontal ligament.

Ineffective silane coupling between filler and matrix within dental composites is prone to accelerated in vivo degradation. In this study, we examined to what degree a procedure involving chemical decontamination of filler prior to silanization could improve the filler-matrix bonding, and thus the physico-mechanical properties, of composites. X-ray photoelectron spectroscopy revealed that filler-matrix coupling largely depended upon siloxane bridge (Si-O-Si) formation between the silica surface and the silane molecule, rather than on intermolecular bonding between adjacent silane molecules. Pre-silanization decontamination based upon boiling silica in 0.05-5% sodium peroxodisulfate, followed by ultrasonic rinsing in acetone, most effectively decontaminated filler. Consequently, it significantly improved the bonding of silane molecules to silanol groups at the silica surface. Experimental composites produced following pre-silanization decontamination of filler revealed a diametral tensile strength that was resistant to degradation by thermocycling.

Fundamental to the processes of decalcification of or adhesion to mineralized tissues is the molecular interaction of acids with hydroxyapatite. This study was undertaken to chemically analyze the interaction of 1 mono-, 2 di-, 1 tri-, and 2 polycarboxylic acids with hydroxyapatite in an attempt to elucidate the underlying mechanism. Maleic, citric, and lactic acid decalcified hydroxyapatite, in contrast to oxalic acid and the two polycarboxylic acids that were chemically bonded to hydroxyapatite. Solubility tests showed that the calcium salts of the former were very soluble, whereas those of the latter could hardly be dissolved in the respective acid solutions. Based on these data, an adhesion/decalcification concept was advanced that predicts that carboxylic acids, regardless of concentration/pH, either adhere to or decalcify hydroxyapatite, depending on the dissolution rate of the respective calcium salts in the acid solution. This contrasting behavior of organic acids most likely results from their differential structural conformations.

Male breast cancer is a rare disease with an incidence between 0.5% and 2.4% of that in women. We report a case of intracystic papillary carcinoma of the breast in a 75-year-old Japanese man. The macroscopic features of the carcinoma could be accurately demonstrated by pneumocystography and ultrasonography preoperatively.

Purpose: To evaluate hydraulic thrombectomy using a saline-jet aspiration thrombectomy catheter in the treatment of venous thrombosis., Material and Methods: Ten patients underwent 12 hydraulic thrombectomy procedures using 2.7 or 4.0 mm catheters. The site of the thrombus was either central, peripheral or in portal veins. The age of the thrombi was between 2 and 60 days (mean 19.7 days). The efficacy of hydraulic thrombectomy was evaluated based on the aspirated thrombus ratio (ATR), i.e. the volume of the thrombus aspirated divided by the volume of the thrombus before thrombectomy. ATR was estimated by comparing the angiograms of the lesion before and after thrombectomy., Results: Soft thrombi were usually rapidly removed. ATR was >2/3 in 3, 2/3-1/3 in 2, 1/3-0 in 4, and 0 in 1 patient. The activation time of the injector was 23-224 s (mean 102 s) and the volume of aspirated blood was 30-680 ml (mean 250 ml). Compensatory infusion of saline was performed for blood loss, and 400 ml of packed red blood cells was transfused in 1 patient. No complications of the hydraulic thrombectomy were observed. Thrombolysis or additional treatment were performed in 9 patients., Conclusion: Hydraulic thrombectomy using this catheter can contribute to the treatment of venous thrombosis.

Biological apatites present in the mineral phases of normal and pathological calcifications contain magnesium, Mg, and carbonate, CO3. As a consequence of fluctuations in the composition of the micro-environment, these apatites may sometimes form by heterogeneous precipitation. The purpose of this study was to investigate the properties of (Mg, CO3)-apatites formed heterogeneously in the presence of fluoride, F. Two types of fluoridated (Mg, CO3)-apatites formed from solutions with low and high levels of Mg were prepared at 80 degrees C, pH 7.4. We prepared FMgCO3-MgCO3AP (Type 1) by adding the F-containing solution to those containing calcium, Mg, and phosphate ions during the first half of the precipitation period. We prepared MgCO3-FMgCO3Ap (Type 2) by adding the F-containing solution during the final half of the period. The apatites were analyzed by x-ray diffraction (XRD), infrared absorption spectroscopy, and scanning electron microscopy (SEM). SEM and XRD analyses showed evidence of mixed crystals in the heterogeneous apatites. The presence of Mg inhibits, while F promotes, apatite crystal growth. In addition, Mg incorporation increased with increasing fluoride concentration. The extent of dissolution in acid buffer of both types of heterogeneous apatites increased with Mg: Type 1 > Type 2. These results suggest that the crystal and dissolution properties of heterogeneous fluoridated (Mg, CO3)-apatites are greatly affected by the mode of F incorporation and Mg concentrations in the environment.

The planum temporale of the supratemporal plane is important for language function and shows left-right asymmetry in most brains. To estimate the size and allow side comparison of the planum temporale, we developed a new technique for 3-D MR analysis of the supratemporal plane using a personal computer and computer-aided graphics. The temporal lobes of 5 human cadavers were imaged by MR in the sagittal plane, at a slice thickness of 2 mm. The images of the supratemporal plane were entered into a personal computer using the original software to determine the positions of anatomic landmarks and the size of the planum temporale. The data were then transferred to a supercomputer to reconstruct the 3-D surface image of the supratemporal plane. Computer images of the supratemporal plane agreed with macroscopic observations. The positions of anatomic landmarks and the size of the planum temporale also agreed with macroscopic measurements. Thus, the present technique provides valuable anatomic data on the supratemporal plane which should be useful for further clarification of the anatomic basis of language function.

Carbonate-containing fluoridated apatites were synthesized with two different modes of fluoride incorporation: by supplying F-free solution initially, followed by a F-containing solution; and with the order of supply of these solutions reversed. Both of these heterogeneously synthesized fluoridated CO3 apatites showed typical apatitic x-ray diffraction patterns; and both had similar total fluoride contents (0.87 +/- 0.07 and 0.94 +/- 0.03 mmol/g, respectively), i.e., half of the maximum fluoride content of fluorapatite. However, they differed considerably in their crystallographic properties. The 300 reflection peaks of both apatites were split, and their patterns were slightly different. In the former, SEM observation revealed capsule-like crystals with a rounded hexagonal shape. However, the latter had many small crystals, similar to those of homogeneous CO3 apatite, adhering to the larger hexagonal crystals, which were also similar to homogeneous fluorCO3 apatite. Wavelength-dispersive spectroscopy attached to the SEM showed a higher fluoride intensity in the former spectrum than the latter. These results suggest that two different types of heterogeneous fluoridated CO3 apatites were formed, CO3 apatite covered with fluorCO3 apatite, and fluorCO3 apatite covered with CO3 apatite. The simple two-step supply system used in this study is helpful for the study of complicated heterogeneous formation of apatites.

Twenty-one patients with hepatocellular carcinoma (HCC) accompanied by extensive celiac artery stenosis or obstruction were treated by chemoembolization via the inferior pancreaticoduodenal artery (IPDA). The tip of the catheter was placed in the arteries in front of the confluence with the proper hepatic artery in 12 patients (group A: the proximal portion of the IPDA in 10, and common hepatic artery in 2), and in the proper hepatic artery or branches of it (group B) in 9 using a coaxial catheter system. Transient hyperamylasemia was observed in 10 of the 12 patients in group A and in 3 of the 9 patients in group B after chemoembolization. Splenic infarction developed in 8 patients in group A and in none in group B. Intrapancreatic fluid collection was present in 2 patients in group A following chemoembolization. No fatal complications were encountered. The 1-, 2-, and 3-year survival rates of the 10 patients in group A treated by only chemoembolization were 90, 57, and 23%, respectively (mean survival 780 days). The 1- and 2-year survival rates of 9 patients in group B were 85.8 and 85.8% (mean 879 days), respectively. Considering the severity of complications and the survival rates in groups A and B, chemoembolization by superselective catheterization into the hepatic artery via the IPDA is the treatment of choice. However, chemoembolization from the arteries in front of the confluence with the proper hepatic artery seems to be acceptable in cases of hypervascular HCC which fail to be superselectively catheterized.

Emergent superselective embolization with a 3.0 F (1 mm) coaxial catheter and a steerable guidewire was performed in 27 patients with massive hemorrhage from a small-caliber splanchnic artery. Eight patients had intraperitoneal hemorrhage, 3 had hemobilia, 9 had gastric hemorrhage, and 7 had intestinal hemorrhage. Out of 27 patients, 7 had hemorrhage from a splanchnic artery pseudoaneurysm. Complete cessation of bleeding was obtained in all patients initially, but in 3 patients gastric hemorrhage recurred later. Otherwise, there was no rebleeding nor any major complication such as marked infarction of tissue or misplacement of embolic materials. This coaxial catheter system was highly reliable for achieving superselective catheterization in small-caliber arteries, minimizing the volume of infarcted tissue and allowing maximal preservation of splanchnic organic function. We conclude that this system represents a major advance in interventional radiology.

The usefulness of emergent embolotherapy was evaluated in 17 patients with life-threatening hemorrhage from 18 ruptured splanchnic artery pseudoaneurysms. Complete hemostasis was obtained in 16 out of 17 patients by embolotherapy. Of the 12 initial embolization procedures with permanent embolic materials including stainless steel coils, microcoils, and Ivalon, complete cessation of bleeding was obtained in 11. On the other hand, 6 out of 9 initial embolization procedures with Gelfoam particles failed to halt bleeding, and additional embolization with permanent embolic materials was required. Emergent embolization with permanent embolic materials using superselective catheterization should be considered the initial treatment of choice for ruptured splanchnic artery pseudoaneurysms.

Laser-Raman spectra of synthetic apatites containing from zero to 12.4 wt% carbonate ions and enamel apatite are reported. Special attention is paid to the correlation between the intensities of the carbonate, phosphate, and hydroxyl modes and the carbonate content in the apatites. The data presented here indicate that most of the CO2-3 incorporated in the apatite lattice substitutes for PO3-4 and suggest that a small amount of CO2-3 might be located in the OH- position.

Carbonate-containing apatites prepared from aqueous and non-aqueous media were investigated by ESR, IR, and X-ray diffraction. A typical asymmetric signal at g = 2.0, which many workers have observed in irradiated calcified tissues, is interpreted in terms of CO3(3)- and Co-2 and the trapped electron center, The CO3(3)- and CO2- ions originated from the carbonate which substitutes for the phosphate ion in the apatite crystalline structure. From the comparison of the data between the carbonate apatites prepared under the presence of Na+ and NH4+ ions, it is suggested that NH4+ ions contribute to the crystallographic parameters, either by substituting in the structure or by suppressing the CO3 incorporation into the structure, or by both. The production of the CO2- radical ion could be accounted for based on the concept of hydrogen bond between the oxygen atom of CO2(3)- and the hydrogen atom of NH4+.

Time-dependent temperature profiles in dental casting molds were analyzed by an unsteady heat conduction model. The thermal conductivity and initial temperature of the mold greatly affected the heat transfer in the mold. The thermal conductivities of gypsum- and phosphate-bonded investments at high temperatures were accurately measured by means of the hot wire method. From the data obtained, the solidification times of Ag, Ag alloy, and Co-Cr alloy were calculated and compared with the experimental results.

The present ESR investigation shows clearly that chromium is potentially present in the calcified tissues. With the use of the hydrazine-deproteinated procedure, it is suggested that chromium is associated with the organic constituent of the calcified tissues. The fact that the unheated tissues disclosed no chromium signal indicates either that the potentially present chromium is not paramagnetic, or that it is still paramagnetic, but the chromium signal cannot be detected because of a short relaxation time due to strong interaction with the organic materials.

The dissolution rate of synthetic fluoridated apatite pellets with various fluoride content was measured in acetate buffer solution at pH 4.0. The dissolution rate decreased with degree of fluoridation. The rate decreased greatly at low fluoride levels. The experimental data were analyzed by means of a diffusion-controlled model and compared with the solubility data. This model showed that the initial dissolution rate is greatly affected by both the solubility and the overall mass transfer resistance. Overall mass transfer resistance is affected by fluoride content.

With the use of CO3-3 radical ions as probes, it is concluded that the carbonate ions substitute in the apatite lattice of human tooth enamel in two different ways. Most of the carbonate ions in the apatite lattice are aligned with their symmetry axis parallel to the c axis, whereas the remaining carbonate ions are aligned with their symmetry axis perpendicular to the c axis.

Fluoridated hydroxyapatites were synthesized at 80 degrees C (pH 7.4) to study their crystallinity and solubility in relation to fluoride content. The crystallinity of fluoridated hydroxyapatities increased initially, then decreased, and finally increased again with the degree of fluoridation, whereas the decrease in relative solubility of fluoridated hydroxyapatites at 25 degrees C (pH 4.0) was proportional to the logarithm of the fluoride content.

Twenty experimental phosphate-bonded investments were prepared by the mixing of two types of fillers (spherical glass beads and irregularly shaped silica particles) with five types of filler aggregates of different porosities, and two different ratios of MgO to NH4H2PO4. These investments were mixed with three different liquids, and their setting expansion, time until setting expansion began (induction time), and fluidity were measured under constant experimental conditions. The following results were obtained: (1) The setting expansion was significantly related to bulk porosity of filler aggregates, not to packed porosity, despite variations in type of filler, ratio of MgO to NH4H2PO4 or type of liquid; and (2) the fluidity and the time until setting expansion began were also related to the bulk porosity of the filler aggregates.

The present high-voltage electron microscopic study showed two types of radiation damages in OCP. The first type commenced with the formation of voids, which later grew and coalesced along the c-axis. The second type was characterized by the appearance of paired and concentric strain fields and the subsequent formation of dislocations. The origin of the strain fields is attributed tentatively to a precipitation of a second phase in the crystal.