Adenosquamous carcinoma in the duodenum is extremely rare disease entity and only 6 cases were reported all over the world so far. Recently we encountered a 62 year-old female patient with duodenal adenosquamous carcinoma. The patient subsequently underwent Whipple's operation. Histopathologic examination revealed two pathologic components composed of adenocarcinoma and squamous cell carcinoma. The metastatic foci of lymph nodes were composed of pure squamous cell carcinoma. For differential diagnosis, we performed several special stains including high molecular weight cytokeratin(HMWCK), low molecular weight cytokeratin(LMWCK), carcinoembryogenic antigen( CEA), mucicarmine, periodic acid-Schiff(PAS). Immunohistochemical stains demonstrated LMWCK, CEA, mucicarmine positivity for glandular component and HMWCK for squamous component. Weak positivity for squamous component was observed with PAS stain. The pathogenesis of adenosquamous carcinoma is controversial issue and not resolved yet, so we discussed the histogenesis of adenosquamous carcinoma.
Adenocarcinoma ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Coloring Agents ; Diagnosis, Differential ; Duodenum ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Molecular Weight ; Rare Diseases

Objective: We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people’s attitudes toward digital therapeutics during the pandemic. Methods: Data was collected online from participants, aged between 20–50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures. Results: Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics. Conclusion We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.

Objective: This study evaluated the clinical effectiveness of Minds.NAVI, a depression screening kit combining psychometric measures and stress hormone biomarkers, in a prospective clinical trial. The objective was to assess its potential as a depression screening tool and investigate the associations between psychological assessments, salivary hormone staging, and depression severity. Methods: Thirty-five participants with major depressive disorder and 12 healthy controls (HCs) were included. The Minds.NAVI software, utilizing the PROtective and Vulnerable factors battEry Test (PROVE) and salivary cortisol/dehydroepiandrosterone (DHEA) analysis, was employed. The PROVE test is a comprehensive self-report questionnaire that assesses depressive symptoms, suicide risk, attachment style, adverse childhood experiences, mentalization capacity, and resilience. In addition, salivary cortisol and DHEA levels were measured to evaluate the functional stage of the hypothalamic–pituitary–adrenal (HPA) axis. Results: Minds.NAVI exhibited 100% sensitivity, 91.7% specificity, and 97.9% accuracy in distinguishing depression from HCs within an exploratory small group. Salivary stress hormone phases showed changes with depression stage (p=0.030), and the proportion of patients with “adrenal exhaustion stage” was higher in the moderate/severe depression group (p=0.038). Protective/vulnerable factors differed significantly between controls and depressed groups (p<0.001). Cortisol awakening response inversely correlated with depressive symptom severity (r=-0.31, p=0.034). Conclusion This study suggested possible clinical effectiveness of Minds.NAVI, a depression screening tool that integrates psychometric measures and stress hormone biomarkers. The findings support the potential association between depression, chronic stress, and HPA axis hyporesponsiveness.