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Altered brain activities in suicidal subjects have been reported in a number of neuroimaging studies. However, the activity aberrances were inconsistent in previous investigations. Thus, we aimed to address activity abnormalities in suicidal individuals. Databases were searched to perform a meta-analysis of whole-brain functional MRI studies of suicidal individuals through January 14, 2020. Meta-analyses were conducted using Seed-based d Mapping software. Based on a meta-analysis of 17 studies comprising 381 suicidal individuals and 642 controls, we mainly found that increased activity in the bilateral superior temporal gyrus, left middle temporal gyrus, and bilateral middle occipital gyrus, along with decreased activity in the right putamen and left insula, were detected in suicidal individuals compared with nonsuicidal subjects. To reduce methodological heterogeneity between the included studies, subanalyses of behavioral domains were conducted, and the right superior temporal gyrus was found to increase in all subanalyses of domains. In subanalyses of suicidal attempters and ideators, suicide attempters displayed hyperactivation in the bilateral superior temporal gyrus and left middle temporal gyrus and blunted responses in the left insula relative to controls. Suicidal ideators demonstrated elevated activation in the right middle occipital gyrus and reduced activity in the right putamen relative to controls. The bilateral superior temporal gyrus was the most robust finding, replicable in all data sets in the jackknife sensitive analysis. Moreover, increased activity in the right superior temporal gyrus, left middle temporal gyrus, and right middle occipital gyrus was found to be involved with higher suicide ideation scores. This study revealed several brain regions associated with suicidality. These findings may contribute to our understanding of the pathophysiology of suicide and have important implications for suicide prevention and interventions.

Background In the last 5 decades, there has been significant advancement of breast reconstruction and postmastectomy radiotherapy for breast cancer care. There has been concern that breast reconstruction may adversely affect the efficacy of postmastectomy radiotherapy. This, however, has not been proven by clear clinical evidence. Methods By comparing the locoregional recurrence rates and overall survival after postmastectomy radiotherapy between those with and without prosthesis-based breast reconstruction, a retrospective cohort study of the breast cancer patients was done. Multivariable Cox proportional hazards analysis was used to control the confounding factors. Results From January 1, 1998 to December 31, 2011, 1015 patients receiving postmastectomy radiotherapy were identified. Among them, 111 patients had prosthesis-based breast reconstruction, and the other 904 did not have breast reconstruction. Thirty-four of 904 (3.8%) patients in the nonreconstructed group and 4 of 111 (3.6%) patients in the reconstructed group developed locoregional recurrence. Multivariable survival analysis found no significant difference both in locoregional recurrence-free survival (hazard ratio, 0.852; P = 0.771) and in overall survival (hazard ratio = 1.317; P = 0.246) between the nonreconstructed group and reconstructed group. Conclusions Although postmastectomy radiotherapy has been shown to affect the surgical and cosmetic outcomes of breast reconstruction, prosthesis-based breast reconstruction does not seem to have significant adverse impacts on the locoregional recurrence-free survival and overall survival of postmastectomy radiotherapy.

Primary cutaneous and soft tissue angiosarcoma is a rare but highly aggressive malignancy. To date, surgical resection is the mainstay of treatment, but poor prognosis is expected. To investigate whether there are factors associated with poor prognosis after surgical resection and to develop a treatment guideline for current therapy, we retrospectively collected data on 28 patients who underwent surgery as initial treatment and reviewed patient demographics, tumor characteristics, disease courses, and prognoses from September 1996 to May 2013. Of these 28 patients, 17 (60.7%) were men and the mean age at first diagnosis was 66.57 ± 18.57 years. Anatomically, 17 (60.7%) tumors were in the scalp and 11 (39.3%) were in other sites of the body. Of the 28 patients, 23 (82.1%) had achieved negative surgical margins, 24 (85.7%) received adjuvant radiation therapy, and 17 (60.7%) received adjuvant chemotherapy. Twenty-one patients (75%) died during a mean follow-up time of 35.86 ± 28.91 months, and all deaths were caused by angiosarcoma. The 5-year overall survival rate was 17.86%. Sixteen (57.1%) patients had locoregional tumor recurrence, and 20 (71.4%) had distant metastases, with a median of 9.17 (range, 1.9-98.07) months to recurrence or metastasis. Possible predictors of poor prognosis (P < 0.05) in terms of disease-free survival after surgical resection were male sex, cardiovascular disease, smoking, and scalp angiosarcomas, those in terms of overall survival were older than 70 years, male sex, cardiovascular disease, smoking, scalp angiosarcomas, distant metastases, and not receiving adjuvant chemotherapy. In conclusion, although multimodal treatments are used, the overall prognosis after surgical resection is still poor, especially for patients with the above predictive factors. An early diagnosis and complete resection of the primary tumor with or without adjuvant radiotherapy and chemotherapy are suggested for a potential better outcome. For those who have a diffuse lesion pattern with the involvement of vital structures, recurrence, or metastasis, palliative resection could be an alternative treatment choice.

In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to rem

Objective: For diagnosing osteosarcoma correctly, a combination of clinical, radiological and histological examinations is required. Erroneous treatment may cause local contamination and systemic seeding in patients. The purpose of this study was to compare outcomes of planned and unplanned treatment for osteosarcoma. Methods: A retrospective review of patients with high-grade osteosarcoma who received appropriate surgical treatment and chemotherapy (n ¼ 134) and those who were misdiagnosed and received unplanned surgery (n ¼ 16) between July 1995 and February 2005. Results: Patients who received unplanned treatment were older (mean age: 29.7 vs. 19.7 years; P ¼ 0.003) and had a smaller mean tumor volume (119 vs. 280 ml; P ¼ 0.015). The 5-year survival rate was not statistically different between the groups. Patients who had unplanned treatment had a higher local recurrence rate (43.8 vs. 17.9%; P ¼ 0.024) and a shorter mean time for recurrence (11.9 vs. 20.8 months; P ¼ 0.036). Furthermore, in patients who underwent unplanned treatment, lung metastases occurred earlier (6.1 vs. 16.2 months P ¼ 0.021) and the final limb salvage rate was less (68.7 vs. 87.3%; P , 0.001). Conclusions: Unplanned treatment for high-grade osteosarcoma can result in failure of local control and earlier systemic metastases.

Sex reassignment surgery has proved to be the best resolution for primary transsexuals. In 1980, Dr. Rubin stated that preservation of the glans to reconstruct the clitoris in male-to-female sex reassignment surgery gave good cosmetic and functional results. In his series, Rubin used the corpus spongiosum as the vascular pedicle of the neoclitoris, but urine leakage is a complication. From 1988 to the present, the dorsal portion of the glans penis with the dorsal neurovascular pedicle has been used here for clitoroplasty in nine male-to-female primary transsexuals. All neoclitorides survived well, with good preservation of light touch and sexual sensation. No urine leakage has occurred. Six patients who were followed reported sexual satisfaction.

A tissue system in which fibroblasts and myocytes from chick embryonic hearts were separately maintained was used to study the toxicity of ethanol. To reproduce the teratogenic effects of acute, high concentrations of ethanol typical of "binge" drinking, an open tissue culture system was employed. With open cultures, the cells were initially exposed to peak alcohol levels for approximately 6 hr and were exposed to decreasing concentrations of ethanol for the remainder of each 24 hr period. After the first day of ethanol exposure, there was substantial cell loss in both fibroblast and myocyte cultures. Alcohol-induced cell loss was dose-dependent. Despite decreased cell density after the first day of ethanol exposure, the surviving cells differentiated into monolayers of fibroblasts or beating cardiac muscle fibers. However, both ethanol-exposed fibroblasts and myocytes appeared atrophic, that is, smaller and shrunken. Electrophoretic analysis or these ethanol-exposed fibroblast and myocyte cultures revealed specific reduction in the cellular contents of alpha-actinin, myosin, and actin. These decreases in cytoskeletal proteins may be responsible for the morphological abnormalities noted in these cells.