Pelvic skeletal metastasis of hepatocellular carcinoma with sarcomatous change: a case report

Sarcomatoid hepatocellular carcinoma (HCC) is a very rare histologic variant of HCC. The characteristic of skeletal metastatic sarcomatoid hepatocellular carcinoma has never been reported. We reported a patient with sarcomatoid hepatocellular carcinoma pelvic metastasis who presented with huge pelvic metastasis that had relatively small osteolytic lesion centrally located accompanied by huge bipeduncular invasive expansile lesions into surrounding soft tissue. The lesion showed almost non-isotope uptake in 99mTc-methylene diphosphonate bone scintigraphy study. He underwent radiotherapy and tumor excision but the tumor rapidly recurred. In addition, serum α-fetoprotein level was never elevated beyond normal limit (< 20 ng/mL) through the whole course of treatment. We considered sarcomatoid hepatocellular carcinoma bone metastasis a highly aggressive lesion with unusual metastatic pattern. Surgical treatment with adequate safe margin in such a huge tumor with hypervascularity and extensive invasion in the pelvis was difficult; and radiotherapy maybe refractory regarding the sarcomatous nature. Therefore, debulking operation with local symptoms control may provide a better quality of life. And the clinical course suggests sarcomatoid hepatocellular carcinoma is derived from the transition of an ordinary hepatocellular carcinoma

Spatiotemporal impact of COVID-19 on Taiwan air quality in the absence of a lockdown: Influence of urban public transportation use and meteorological conditions

The unprecedented outbreak of COVID-19 significantly improved the atmospheric environment for lockdown-imposed regions; however, scant evidence exists on its impacts on regions without lockdown. A novel research framework is proposed to evaluate the long-term monthly spatiotemporal impact of COVID-19 on Taiwan air quality through different statistical analyses, including geostatistical analysis, change detection analysis and identification of nonattainment pollutant occurrence between the average mean air pollutant concentrations from 2018–2019 and 2020, considering both meteorological and public transportation impacts. Contrary to lockdown-imposed regions, insignificant or worsened air quality conditions were observed at the beginning of COVID-19, but a delayed improvement occurred after April in Taiwan. The annual mean concentrations of PM10, PM2.5, SO2, NO2, CO and O3 in 2020 were reduced by 24%, 18%, 15%, 9.6%, 7.4% and 1.3%, respectively (relative to 2018–2019), and the overall occurrence frequency of nonattainment air pollutants declined by over 30%. Backward stepwise regression models for each air pollutant were successfully constructed utilizing 12 meteorological parameters (R2 > 0.8 except for SO2) to simulate the meteorological normalized business-as-usual concentration. The hybrid single-particle Lagrangian integrated trajectory (HYSPLIT) model simulated the fate of air pollutants (e.g., local emissions or transboundary pollution) for anomalous months. The changes in different public transportation usage volumes (e.g., roadway, railway, air, and waterway) moderately reduced air pollution, particularly CO and NO2. Reduced public transportation use had a more significant impact than meteorology on air quality improvement in Taiwan, highlighting the importance of proper public transportation management for air pollution control and paving a new path for sustainable air quality management even in the absence of a lockdown