Primary Ewing's sarcoma-primitive neuroectodermal tumor of the uterus: a case report and literature review

BACKGROUND: Primary Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) of the uterus is an extremely rare malignancy. CASE: A 30-year-old Korean woman presented with abnormal uterine bleeding with uterine enlargement. A computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen and pelvis showed a huge uterine mass measuring 18 x 20 x 21 cm, metastasis to both pelvic and para-aortic lymph nodes, and omental infiltration. The pathology report of the uterine mass described a uniformly hypercellular tumor, which was arranged in diffuse solid sheets of uniform, small, rounded, and sometimes spindle-shaped cells, with scanty cytoplasm. Immunohistochemically, the mass tested positive for vimentin, CD99, and chromogranin. The patient received several courses of combination chemotherapy and radiotherapy but died from tumor progression 16 months after the initial diagnosis. CONCLUSION(S): This is a rare case of primary uterine ES-PNET in a woman of reproductive age. A review of the literature indicates that primary uterine ES-PNET requires early diagnosis and multimodality treatment including surgery, chemotherapy, and radiotherapy. The behavior of this tumor is potentially aggressive.     

Association Between Antihypertensive Use and Hospitalized Pneumonia in Patients With Stroke: A Korean Nationwide Population-Based Cohort Study

BackgroundWe aimed to examine the association between antihypertensive use and the incidence of hospitalized pneumonia in patients with a history of stroke.MethodsIn this case-crossover study, we obtained data from the Korean National Health Insurance Service–National Sample Cohort database. We included the data of patients with history of stroke who were admitted with a disease code of pneumonia. We analyzed the patients’ exposure to antihypertensives in the 30 (single case period), 90–120, and 150–180 days (2 control periods) before the onset of pneumonia using conditional logistic regression analysis. Additionally, sensitivity analysis and subgroup analysis according to diabetes status, age, and documented disability were performed.ResultsAngiotensin II receptor blocker (ARB) use was associated with a reduced risk of hospitalized pneumonia (adjusted odds ratio [OR] [95% confidence interval; 95% CI]: 0.718 [0.576–0.894]). However, the use of angiotensin converting enzyme inhibitors and other antihypertensives were not associated with a change in hospitalized pneumonia incidence (adjusted OR [95% CI]: 0.902, [0.603–1.350] and 0.788 [0609–1.018], respectively). Subgroup analysis revealed that ARB use was associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke who were older than 65 years, but not in younger (≤ 65 years) group (adjusted OR [95% CI]: 0.687 [0.536–0.880]).ConclusionARB use is associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke, especially in older adults.     

Dynamic Response of Polyindole Coated Zinc Ferrite Particle Suspension under an Electric Field

ZnFe₂O₄ particles initially synthesized through a simple solvothermal method were coated using polyindole (PIn) to prepare an actively controllable core-shell typed hybrid material under both electric and magnetic fields. An advantage of this process is not needing to add the stabilizers or surfactants commonly used for uniform coating when synthesizing core or shell-structured particles. The synthesized ZnFe₂O₄/PIn particles have a lower density than conventional magnetic particles and have suitable properties as electrorheological (ER) particles. The expected spherical shape of the particles was proven using both scanning electron microscopy and transmission electron microscopy. The chemical characterization was performed using Fourier-transform infrared spectroscopy and X-ray diffraction analysis. To analyze the rheological properties, a ZnFe₂O₄/PIn based suspension was prepared, and dynamic rheological measurements were performed for different electric field strengths using a rotary rheometer. Both dynamic and elastic yield stresses of the ER fluid had a slope of 1.5, corresponding to the conductivity model. Excellent ER effect was confirmed through rheological analysis, and the prepared ER fluid had a reversible and immediate response to repeated electric fields.     

Obesity is the only independent factor associated with ultrasound-diagnosed non-alcoholic fatty liver disease: A cross-sectional case-control study

Objective. There is increasing interest in ultrasound-diagnosed non-alcoholic fatty liver disease (NAFLD) in the ambulatory care setting. The aim of this study was to determine the clinical and metabolic features of ultrasound-diagnosed NAFLD. Material and methods. Fifty ultrasound-diagnosed NAFLD patients who had not consumed alcohol for at least the previous 3 months were matched with 100 controls by age and gender distribution. Clinical, biochemical, and nutritional variables were compared between the ultrasound-diagnosed NAFLD patients and the controls. Conditional logistic regression analyses were used to identify independent factors associated with ultrasound-diagnosed NAFLD. Results. The ultrasound-diagnosed NAFLD patients had higher values on the anthropometric measurements than those of the controls. Aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), uric acid, and γ-glutamyl transpeptidase levels were higher in the ultrasound-diagnosed NAFLD patients than those in the controls (p<0.001). The ASAT/ALAT ratio of the ultrasound-diagnosed NAFLD patients was lower than that of the controls (p<0.001). Total cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, non-HDL-cholesterol, atherogenic index, fasting glucose, systolic blood pressure (BP), diastolic BP, and pulse pressure were higher in the ultrasound-diagnosed NAFLD patients than in the control subjects, while lipoprotein(a) was lower. There were no significant differences in low-density lipoprotein (LDL)-cholesterol levels or nutritional intake between patients and controls. Abnormal ASAT or ALAT, hypertriglyceridemia, lower HDL-cholesterol levels, silent myocardial ischemic pattern on electrocardiogram (ECG), impaired fasting glucose, and obesity were common among the ultrasound-diagnosed NAFLD patients. The only independent factor associated with ultrasound-diagnosed NAFLD was obesity (p<0.001). Conclusions. Our data suggest that NAFLD diagnosed by ultrasound is associated with hypertriglyceridemia, impaired fasting glucose, silent myocardial ischemic pattern of ECG, obesity, and abnormal liver tests in adults. Among these factors, obesity was the only independent factor associated with ultrasound-diagnosed NAFLD.     

Double umbilical cord blood transplantation for children and adolescents

Umbilical cord blood transplantation (UCBT) with two units has been conducted with promising results in adults to overcome the limitation of low cell numbers. In an attempt to improve the outcomes, double UCBT was performed in children and adolescents. Sixty-one patients, including 44 acute leukemia, and 17 other hematologic diseases, received double UCBT. Donor-type engraftment achieved in 82% of patients. Except one patient with persistent mixed chimerism of two units, other 49 patients showed dominancy of one unit and only the CFU-GM was significant factor influencing dominancy. The event-free survival (EFS) of leukemia and other hematologic disease were 59% and 53%, respectively, and the EFS of acute leukemia patients who received transplant in first or second CR (68.6%) was significantly better than in those with advanced disease (22.2%) (P = 0.007). Among the factors influencing outcomes, low cell dose difference between two units (TNC difference/TNC of large unit <15%) were associated with higher TRM, relapse, and lower EFS. Double UCBT was a promising modality of transplant in children and adolescence. However, engraftment and other results were not so satisfactory yet. To improve the outcomes, development of new selection guideline, probably including cell dose difference between two units and technology to enhance engraftment and reduce transplantation-related mortality are warranted.     

Ordering Behavior of Layered Silicate Nanocomposites with a Cylindrical Triblock Copolymer

Summary: The ordering behavior of the nanocomposites of organically modified montmorillonite (OMMT) with a cylindrical triblock copolymer of polystyrene‐block‐poly(ethylene‐co‐butylene)‐block‐polystyrene (SEBS) has been investigated by temperature‐resolved small‐angle X‐ray scattering (SAXS) and rheometry. X‐Ray diffraction (XRD) confirms that the polymer chains are successfully intercalated with the interlayer gallery of the silicates. The data obtained from the SAXS and rheological measurements show that the addition of OMMT leads to a change in the microphase separation behavior of SEBS in the nanocomposites. The molecular interaction between OMMT and the polystyrene (PS) chains of SEBS decreases the structural perfection of the self‐assembling, phase‐separated domain structure of the nanocomposites. Rheological data exhibit that the order‐order (T_OOT) and order‐disorder transitions (T_ODT) of the SEBS/OMMT nanocomposites decrease with the addition of OMMT. The highest elongation at break is obtained at approximately 2% OMMT and its further addition to the mixture leads to decreases in tensile strength and elongation.

The change in the storage modulus (G′) of a) SEBS, b) S98M2, c) S95M5, and d) S90M10, as a function of temperature in the range of 150 ≤ T (°C) ≤ 260.     

Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment

Purpose

The aim of this study was to evaluate the clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection (SISMAD) after conservative treatment.

Methods

Twenty-four patients with SISMAD admitted from September 2006 through March 2013 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and angiographic changes were analyzed retrospectively.

Results

The median follow-up was 18.7 months (range 1.4–67.5 months). Eighteen patients (75 %) were symptomatic, and the median duration of abdominal pain was 2.5 days. All of the patients were treated conservatively. Follow-up computed tomography angiography showed complete remodeling in six patients (25 %), partial remodeling in four patients (17 %), no changes in nine patients (38 %), progression to total occlusion in four patients (17 %) and aneurysmal changes of the false lumen in one patient (4 %). Endovascular intervention was performed in the patient with aneurysmal changes. There was no mortality or morbidity related to the dissection.

Conclusion

SISMAD represented variable angiographic changes, and its clinical course was benign in this study. For patients with SISMAD, if there is no evidence of bowel infarction, bleeding or aneurysmal changes, conservative treatment with close follow-up is sufficient and could reduce unnecessary endovascular interventions.