Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma

Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.     

Viral response at 6 months is associated with treatment outcome of adefovir add-on therapy for lamivudine-resistance

Background and Aim: Adefovir add‐on therapy is recommended for patients infected with lamivudine‐resistant hepatitis B virus (HBV). We aimed to describe the long‐term treatment outcome and predictors for good response of adefovir add‐on therapy. Methods: A total of 559 chronic hepatitis B (CHB) patients who had been treated for at least 12 months with adefovir add‐on therapy due to resistance to lamivudine were retrospectively included. Complete virologic response (CVR) was defined as serum HBV DNA < 9 IU/mL. Viral responses at 6 months were classified as PCR negativity, partial virologic response (PVR, HBV DNA < 2000 IU/mL), or inadequate virologic response (IVR, HBV DNA ≥ 2000 IU/mL). Results: The median duration of follow‐up was 31.5 months (range, 12–56). The cumulative probabilities of CVR during adefovir add‐on therapy were 58%, 70%, 78%, and 80% at 12, 24, 36, and 43 months, respectively. The cumulative rates of resistance to adefovir were 0.4%, 0.8%, and 3.1% at 12, 24, and 36 months, respectively. The only baseline factor associated with CVR (hazard ratio 0.83, 95% confidence interval 0.62–0.91, P ≤ 0.001) and resistance to adefovir (hazard ratio 1.925, 95% confidence interval 1.13–3.30, P = 0.017) was serum HBV DNA level. Comparison of the cumulative rates of CVR and resistance to adefovir according to viral response at 6 months showed significant differences among the three groups (P < 0.0001 and P = 0.0005, respectively). Conclusions: Pre‐treatment HBV DNA level and viral response at 6 months is associated with treatment outcome for adefovir‐add on therapy in lamivudine resistance.     

Frequency and risk factors of renal impairment during long-term adefovir dipivoxil treatment in chronic hepatitis B patients

Background and Aim: There are insufficient data on renal safety during long‐term adefovir dipivoxil (ADV) treatment. We aimed to elucidate the incidence and risk factors of renal impairment in chronic hepatitis B (CHB) patients treated with ADV. Methods: We retrospectively enrolled 687 CHB patients (51.4% with compensated cirrhosis) treated with ADV alone (18.2%) or in combination with lamivudine (81.8%) for more than 12 months. Renal function was measured using the estimated glomerular filtration rate (eGFR), and renal dysfunction was defined as mild (20–30% decrease), moderate (30–50%), or severe (more than 50%). Results: During the median treatment duration of 27 months, 72 patients (10.5%) developed renal impairment, which was mild in 77.8% of cases, moderate in 20.8% of cases, and severe in one patient. The cumulative incidence of renal impairment at 1, 3, and 5 years was 2.6%, 14.8%, and 34.7%, respectively. Modification of the dosing interval or discontinuation of ADV was required in seven and three patients, respectively, and none of them showed a further decline in the eGFR. Although a univariate analysis revealed age, the number of exposure to radio‐contrast dye, liver cirrhosis, and hepatocellular carcinoma as risk factors of renal impairment, age was the only significant risk factor identified in the multivariate analysis (odds ratio = 1.048, 95% confidence interval = 1.019–1.076, P = 0.001). Conclusions: Renal impairment in long‐term ADV users was relatively frequent, but serious renal toxicity was rare, and all cases were safely managed. Careful monitoring of renal function is required, especially in older patients.     

A Pilot Clinical Study of Ocular Prosthesis Fabricated by Three-dimensional Printing and Sublimation Technique

PurposeWe sought to evaluate the safety and effectiveness of patient-specific ocular prostheses produced by three-dimensional (3D) printing and the sublimation technique. A comparison with prostheses produced using manual manufacturing methods was then performed.MethodsTo confirm the biological and physiochemical safety, cytotoxicity, systemic acute toxicity, intradermal reaction, and skin sensitization tests were conducted according to the International Organization for Standardization guidelines. The compressive strength of the prostheses was also tested. Further, a case series of three patients who wore the 3D printed prostheses for more than eight hours daily for 4 weeks was executed. Self-assessments by these individuals using a questionnaire and safety evaluations focusing on the occurrence of conjunctival inflammation or allergic reactions according to the Cornea and Contact Lens Research Unit criteria by slit-lamp examination and similarity assessment were completed.ResultsThe 3D printed ocular prostheses met the necessary qualifications per the biological and physiochemical safety tests, showing the absence of cytotoxicity, acute systemic toxicity, intradermal reactivity, and skin-sensitizing potency. Also, there was no difference in strength test results between previous ocular prostheses and the 3D printed ones. Self-assessment by the patients yielded satisfactory results, with no significant difference in the level of satisfaction reported for the 3D printed and previous handmade ocular prostheses. The 3D printed prosthesis did not trigger any side effects in the conjunctival sac and showed similar objective findings with respect to the color of the iris, sclera, and vessel patterns.ConclusionsOur study confirms the biologic and physiochemical safety of 3D-printed ocular prostheses created using computer-aided design technology and a sublimation technique. The patients’ questionnaires and the judgment of the ophthalmologists/ocularists showed that the 3D printed ocular prosthesis was acceptable in function and appearance through a case series report.     

Work function modification of PEDOT:PSS by mixing with barium acetylacetonate

Poly(3,4-ethylenedioxythiophene)polystyrene sulfonate (PEDOT:PSS) is often used as a hole injection and extractor for various organic electronic devices. This study investigated whether it is possible to n-dope PEDOT:PSS with barium acetylacetonate (Ba(acac)₂) to change its work function so that to be more suitable for electron injection and extraction. Molecular dynamics simulations suggested that barium cations can interact with the aromatic rings of PEDOT and the negatively charged sulfonate in PSS. At high doping concentration, we found that PEDOT became dedoped and precipitated resulting in a clear solution after filtration. The absence of the absorption peak of PEDOT at 263 nm indicates the removal of PEDOT after filtration. The shift in O 1s to a lower binding energy as seen in X-ray photoelectron spectroscopy suggested that the polystyrene sulfonic acids are being ionized to form barium polystyrene sulfonate (Ba–PSS). By spin-coating the solution on top of indium tin oxide, the work function can be adjusted to as low as 3.6 eV. The ability of such a mixture to inject and extract electrons is demonstrated using 2,7-bis(diphenylphosphoryl)-9,9′-spirobifluorene as an electron transporting layer. We attributed the lowering of the work function as the result of the formation of an interfacial dipole as large as 1.37 eV at the ITO/Ba–PSS interface.

Modification of poly(3,4-ethylenedioxythiophene)polystyrene sulfonate as electron injection layer.     

Aliovalent-doped sodium chromium oxide (Na0.9Cr0.9Sn0.1O2 and Na0.8Cr0.9Sb0.1O2) for sodium-ion battery cathodes with high-voltage characteristics

NaCrO₂ with high rate-capability is an attractive cathode material for sodium-ion batteries (NIBs). However, the amount of reversibly extractable Na⁺ ions is restricted by half, which results in relatively low energy density for practical NIB cathodes. Herein, we describe aliovalent-doped O3–Na_0.9[Cr_0.9Sn_0.1]O₂ (NCSnO) and O3–Na_0.8[Cr_0.9Sb_0.1]O₂ (NCSbO), both of which show high-voltage characteristics that translate to an increase in energy density. In contrast to NaCrO₂, NCSnO and NCSbO can be reversibly charged to 3.80 and 3.95 V, respectively, delivering 0.5 Na⁺ along with Cr^3+/4+ redox alone. The reversible chargeability to Na_0.4[Cr_0.9Sn_0.1]O₂ and Na_0.3[Cr_0.9Sb_0.1]O₂ is not associated with the suppression of Cr⁶⁺ formation. Both compounds show concentrations of Cr⁶⁺ that are higher than that of Na_0.3CrO₂, with an absence of O3′ phases. This implies that aliovalent-doping contributes to a suppression of the Cr⁶⁺ migration into tetrahedral sites in the interslab space, which reduces the possibility of irreversible comproportionation. NCSnO and NCSbO deliver capacities comparable to that of NaCrO₂, but show a higher average discharge voltage (2.94 V for NaCrO₂; 3.14 V for NCSnO; 3.21 V for NCSbO), which leads to a noticeable increase in energy densities. The high-voltage characteristics of NCSnO and NCSbO are also validated via density-functional-theory calculations.

In contrast to O3–NaCrO₂, O3–Na_0.8[Cr_0.9Sb_0.1]O₂ shows reversibility when charged to 3.95 V and high-voltage charge/discharge features, which results in improvement of energy density.