Rationale:The perivascular epithelioid cell tumor (PEComa) is rare in young man and rarely occurs in the large intestine.Patient concerns:The clinical characteristics, diagnosis, and managements in a 28-year-old boy who presented with sudden onset of cramping and abdominal pain and intermittent melena with a blood pressure of 74/39 mm Hg was retrospectively reviewed. CT scan of the abdomen revealed a 8.9 × 7.2 cm mass in the pelvic floor.Diagnoses:Given the difficulty of obtaining a diagnostic specimen, surgical resection was performed. The pathology report of lower anterior resection was malignant PEComa of the rectum in 2006.Interventions:Treatment consisted of surgical resection only without additional adjuvant therapy. Over the next 49 months (until 2010) after surgery, abdominal CT showed a 0.6-cm hypodense mass over the liver with suspected liver metastasis. He refused any further evaluation and treatment. After 4 years (2014), abdominal CT showed that the original mass had increased from 0.6 to 1.5 cm and the number of tumors had increased from 1 to 3. In August 2014, he underwent a metastatic hepatectomy without additional chemotherapy or radiotherapy.Outcomes:We noted that the metastatic progression was slow in the 4 years after the first operation. At 28 months after metastatic hepatectomy, the patient was doing well. There was also no recurrence of the PEComa of the rectum at the 120-month follow-up in 2016.Lessons:To the best of our knowledge, this is the first report of a PEComa of the rectum with liver metastases treated with only surgical resection. At approximately 8.8 cm, this is the largest PEComa of the rectum reported in the recent literature.

Background/Aim: Sorafenib, an oral multi-kinase inhibitor, has been shown to improve the outcome of patients with osteosarcoma (OS). However, the anti-OS effect and mechanism of sorafenib has not yet been fully understood. The main purpose of this study was to investigate the effect of sorafenib on apoptotic signaling and Nuclear Factor-ĸB (NF-ĸB)-mediated anti-apoptotic and metastatic potential in OS in vitro. Materials and Methods: The effect of sorafenib on apoptotic signaling transduction, anti-apoptotic, and metastatic potential of OS U-2 cells was verified with flow cytometry, trans-well invasion/migration, and western blotting assay. Results: Sorafenib induced the extrinsic and intrinsic apoptotic pathways. In addition, sorafenib reduced the invasion and migration ability of OS cells, induced NF-ĸB activation, and the expression of anti-apoptotic proteins and metastasisassociated proteins encoded by NF-ĸB target genes. Conclusion: Sorafenib led to stimulation of extrinsic/intrinsic apoptotic pathways and NF-ĸB inactivation in U-2 OS cells.Osteosarcoma (OS) is the common form of malignant bone tumor that frequently occurs in children and young adults (1). Conventional treatment strategies for osteosarcoma usually consist of surgery, chemotherapy, and radiotherapy, but the anti-OS efficacy of conventional treatment strategies is limited by chemo-radioresistance and metastasis (2, 3). Nuclear factor-ĸB (NF-ĸB), an oncogenic transcription factor, mediates chemo-radioresistance and metastasis by modulating the expression of anti-apoptotic and invasion-associated proteins encoded by NF-ĸB target oncogenes (4, 5). Suppression of NF-ĸB activation not only increases chemo-radiosensitivity but also reduces the metastatic potential of OS cells (6-9).In addition to improving chemo-radio resistance, how to effectively elicit cell death is also crucial for the treatment of OS. Apoptosis, a form of programmed cell death, is initiated by extrinsic (death receptor) and intrinsic (mitochondrial) signaling pathways, and is carried out by caspases (10). Treatment of OS cells and animal models with anticancer agents leads to 1251 *These Authors contributed equally to this study.

No abstract

Patient: Male, 34-year-old Final Diagnosis: Trauma Symptoms: Coma • fracture Medication: — Clinical Procedure: Crainotomy Specialty: Neurosurgery • Surgery Objective: Unusual clinical course Background: Head trauma, defined as damage to the brain, skull, or scalp when the head is hit by an external force, is a major cause of mortality in military personnel. Therefore, we report a novel case involving a naval helicopter pilot who sustained a helicopter propeller rotor blade injury. Case Report: We describe a case involving a pilot struck on the head by a helicopter rotor blade. He received care from medical staff shortly after the injury and was en route to the nearest trauma center. Cranial computed tomography (CT) scans revealed a comminuted fracture of the right occipital bone, with bone fragment retention in the right cerebral hemispheres. We performed an emergency right occipital craniotomy. The visual field patterns demonstrated right homonymous hemianopia when the patient was discharged. The patient underwent delayed titanium mesh cranioplasty about 3 months after the right occipital craniotomy. From discharge to 5 years, the patient had performed rehabilitation exercise for at least 3 days every week. The patient’s continued recovery was confirmed at the 5-year follow-up in 2019. The bilateral visual acuity was 20/20, and the right homonymous hemianopia problem also disappeared. In the same year, after a physical and psychological assessment by an aviation doctor, he was able to resume flying. Conclusions: This report has shown that despite safety regulations for military and civilian helicopter personnel, which include the wearing of helmets, helicopter rotor blade injuries still occur and can have long-term consequences due to the severity of head injury.

No abstract