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How to Obtain Contact Hours by Reading this Article Instructions 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . To obtain contact hours you must: 1. Read the article, “Music Therapy Training for Undergraduate Nursing Students: A Modality to Foster Interest in Gerontological Nursing” found on pages 25–31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until May 31, 2019. Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Activity Objectives 1. Identify the worldwide shortage of nurses specializing in gerontological nursing. 2. Describe the results of using music therapy to create positive attitudes toward older adults. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. Nursing students generally have a negative attitude toward older adults. Preparing nurses to meet the care needs of an expanding aging population is a challenge for nursing educators. The purpose of the current study was to explore whether incorporating music therapy into a practical geriatric nursing course at a nursing home cultivates positive attitudes toward older adults, raises students' willingness to work with older adults, and increases their interest in specializing in gerontological nursing after graduation. Focus groups were conducted to collect data from three participant groups ( N = 20). Verbatim transcripts of audiorecorded interviews were analyzed using content analysis, which revealed four themes: (a) better appreciation and understanding of music therapy , (b) role modeling instructors' successful experience and positive attitude toward older adults , (c) changing attitudes toward older adults , and (d) improving interaction skills with older adults . Results suggested music can be integrated into a gerontological nursing course to enhance students' motivation to learn, empathize, and approach older adults. [ Journal of Gerontological Nursing, 42 (6), 25–31.]

The aim of this study was to evaluate whether liver fibrosis is predictive of survival in patients who require hepatectomy for small hepatocellular carcinoma.In this retrospective study, we enrolled 174 patients with small HCC who underwent major or minor hepatectomy at the Changhua Christian Hospital during the period January 2001 to June 2007. Patients were classified into two subgroups depending on whether tumor recurrence after surgery. Factors influencing overall survival and recurrence were analyzed and compared between the two subgroups. Univariate and multivariate logistic regression analyses were performed to determine the most significant predictors of tumor recurrence or death. The Kaplan-Meier method and the log-rank test were used to detect differences in cumulative survival between the two subgroups based on histopathologic fibrosis scores.Results of the univariate analysis revealed these variables that tumor margin, type of resection, and degree of fibrosis were independent predictors of tumor recurrence or death. However, the multivariate analysis revealed that fibrosis was the only independent predictor of tumor recurrence. Survival analysis showed that low fibrotic scores were predictive of disease-free survival.The degree of fibrosis is an important predictor of survival among patients who undergo hepatectomy for small HCC.

Piwi-like RNA-mediated gene silencing 4 (PIWIL4) is expressed in somatic tissues and is proposed to silence the transposition of repetitive elements like long interspersed nuclear elements (LINEs) through DNA methylation and maintain the genome stability. Through the knockout of PIWIL4 gene by CRISPR/Cas9 system in mesenchymal stem cells (MSCs), MDA-MB-231 (breast cancer cell line), HT29 (colon cancer cell line) and AGS (gastric cancer cell line), the piRNA biogenesis was decreased and so was the methylation within LINE1 target loci and global methylation. The recruitment of SUV39H1, a histone H3 methyl-transferase, into nucleus was blocked, leading to the reduction of silencing tri-methylation of histone H3 at lysine 9. Concurrently, the active H3K4me3 mark increased after knockout. Also, global CTCF bindings were distorted after the knockout of PIWIL4 especially at the bindings franking the piRNA clusters. This distortion implied the disorganization of genomic conformation which was validated by karyotyping. Through chromosomal G-banding, aneuploidy was observed which indicated the loss of genomic stability. The knockout of PIWIL4 also results in disorganized cytoskeleton, therefore, changed cell stiffness as measured by atomic force microscopy. Neural and hepatic induction of MSCs were also blocked by the knockout of PIWIL4. In correlation, tissue arrays detected abnormal PIWIL4 expression in gastric (n=45), colon (n=30) and breast cancers (n=30). In conclusion, we found that PIWIL4-piRNA interaction helps to maintain somatic DNA methylome, genome stability and stiffness in somatic stem cells. The loss of PIWIL4 expression might then a candidate for cancer biomarker. (Supported by: MOST-105-2314-B-371 -008, MOST-105-2320-B-194 -004, MOST Taiwan) Citation Format: Syuan-Cih Lin, Chia-Chen Chiu, Shou-Tung Chen, Yao-Li Chen, Ping-Yi Lin, Shu-Huei Hsiao, Yu-Wei Leu. Loss of PIWIL4 and piRNAs attenuate somatic methylome and genome stability [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1398. doi:10.1158/1538-7445.AM2017-1398

Donor safety and preservation of donor health after living liver donation are of paramount importance. In addition, the preoperative mental state of a donor is an important factor in determining the psychological impact of donor hepatectomy. Thus, we aimed to explore the mental health status of living liver donors after hepatectomy. We enrolled 60 donors who were scheduled to undergo living donor hepatectomy during the period January 2014 to March 2015 at a single medical center. Mental health status was measured before and 3 months after surgery using 3 self-report questionnaires, namely the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms, the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to measure quality of life, and the Chinese Health Questionnaire (CHQ) to screen for minor psychiatric disorders. A comparison of the pre- and postdonation CES-D scores revealed a significant reduction in depressive symptoms after surgery (P = .031). There were significant improvements in the physical health domain (P = .031), the psychological health domain (P = .005), the social relationships domain (P = .005), and the environmental health domain (P = .010) of the WHOQOL-BREF. There were no significant changes in CHQ scores after donor hepatectomy (P = .136). All donors reported that they would donate again if required. Approximately one-third (33.3%) of donors experienced more pain than they had anticipated in the immediate postoperative period, and 20.0% of donors had complications after donor hepatectomy. Donor mental health status tended to improve as donors regained physical function during the 1st 3 months of recovery. Long-term monitoring of living donors’ mental health is needed to minimize the adverse psychological outcomes of living liver donation.

The prognostic value for the post-chemoradiation therapy (CRT) pathologic stage is uncertain. The purpose of this study was to compare the pathologic stage in patients undergoing esophagectomy with and without preoperative CRT for esophageal squamous cell carcinoma (ESCC). This study retrospectively reviewed the data from 2151 patients with ESCC who underwent esophagectomy with or without preoperative CRT between 2008 and 2011 in Taiwan. Patients were divided into 2 groups. Group A consisted of patients treated with primary surgery without prior treatments (n=1301), and group B consisted of patients receiving preoperative CRT followed by esophagectomy (n=850). In group A, 679 patients received surgery alone, 92 received postoperative chemotherapy, 416 received postoperative chemoradiation therapy, and 114 received postoperative radiation therapy. In group A, the 3-year survival rates by pathologic stage were 82.2% for stage 0, 67.6% for stage I, 50.7% for stage II, 21.5% for stage III, and 14.8% for stage IV (P

The paper presents infinite speed drives with both maximum torque per amp control and maximum torque per volt control for interior permanent magnet synchronous motor. The presented method controls infinite speed drives MTPA before flux weakening occurs. As the speed goes up further to flux weakening region II, maximum torque per volt control is achieved to give more output torque. Moreover, smooth and automatic transition among constant torque control with MTPA, flux weakening control in region I and flux weakening with MTPV control in region II are achieved by the presented control method. All of these control approaches are under vector control. Experimental results are derived from a DSP-based controlled infinite speed drives. The specifications of the IPMSM include 750 W, 3000 rpm and 4 poles. Experimental results show the presented control method can achieve both MTPA and MTPV control to fully support the theoretical development.

A 2-year-old boy was admitted to the emergency department after a low impact motor vehicle accident. He was put on a backboard with cervical neck immobilization. On admission, he was pulseless and unresponsive with multiple abrasion wound noted over his face and trunk. After cardiopulmonary resuscitation and intubation, his vital sign was stabilized. The pupils were 4 mm in diameter and reactive; the Glasgow Coma Scale score was 3. Head computed tomography (CT) revealed an intracranial hemorrhage without obvious mass effect. Abdominal CT revealed mild hemoperitoneum and spleen contrast extravastion. Cervical three-dimensional CT reconstruction showed that spondylolisthesis of the axis and C2–C3 bilateral facet dislocation (Fig. 1). Intracranial monitor was performed and was admitted to the Pediatric Intensive Care Unit Service. After general, condition stabilized and no increased intracranial pressure noted. Cervical magnetic resonance imaging was arranged which revealed complete transection of the spinal cord at C2– C3 and T2–T3 levels (Fig. 2). Thoracic CT revealed no further bony fracture (Fig. 3). The boy was quadriplegic

This work presents the effects of feruloylated oligosaccharides (FOs) of rice bran on murine bone marrow-derived dendritic cells (BMDCs) and the potential pathway through which the effects are mediated. We found that FOs induced phenotypic maturation of DCs, as shown by the increased expression of CD40, CD80/CD86 and MHC-I/II molecules. FOs efficiently induced maturation of DCs generated from C3H/HeN or C57BL/6 mice with normal toll-like receptor 4 (TLR-4) or TLR-2 but not DCs from mice with mutated TLR4 or TLR2. The mechanism of action of FOs may be mediated by increased phosphorylation of ERK, p38 and JNK mitogen-activated protein kinase (MAPKs) and increased NF-kB activity, which are important signaling molecules downstream of TLR-4 and TLR-2. These data suggest that FOs induce DCs maturation through TLR-4 and/or TLR-2 and that FOs might have potential efficacy against tumor or virus infection or represent a candidate-adjuvant approach for application in immunotherapy and vaccination.

Background Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature. Methods We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA). Results Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact. Conclusion Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

It has been reported that gold lotion (GL), a formulated product made from the peels of six citrus fruits, has many pharmacological properties, such as anti-tumor, antioxidant, and anti-inflammatory activities. In this study, we investigated the immunomodulatory effect of GL on lipopolysaccharide (LPS) stimulated mouse bone marrow-derived DC maturation and function. Our experimental results have shown that GL significantly impaired the pro-inflammatory cytokine and chemokine secretion, suppressed the expression of major histocompatibility complex class I/II and costimulatory molecules (CD40, CD80 and CD86), increased phagocytic capacity, and reduced propensity to stimulate the autologous CD4(+) and CD8(+) T cell proliferation of LPS-induced DCs. Furthermore, we found that oral administration of GL attenuated the 2,4-Dinitro-1-fluorobenzene induced contact hypersensitivity (CHS) in animal models. Subsequently, our molecular mechanism studies showed that GL interfered with LPS-induced MAPK-JNK, p38 phosphorylation and nuclear translocation of NF-κB p65. In an essence, these findings are the first report to provide new insight in the immunopharmacological role of GL in terms of its effects on DC.

Background Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery. Methods During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage ( n = 7) or hemorrhage due to non-coagulopathic causes ( n = 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes. Results There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 ± 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 ± 29.31 min; P = 0.027). Conclusion Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.

Ursolic acid (UA) is a pentacyclic triterpene acid that is present in a wide variety of medicinal herbs and edible plants. This study investigated the effect of UA on apoptosis and proliferation of hepatocellular carcinoma SK-Hep-1 cells. After treatment of SK-Hep-1 cells with different concentrations of UA, we observed that cell viability was reduced in a dose- and time-dependent manner. Furthermore, there was a dose-dependent increase in the percentage of cells in the sub-G1 and G2/M phases, with cells treated with 60 μM showing the highest percentages of cells in those phases. UA-induced chromatin condensation of nuclei was observed by using DAPI staining. The western blot results revealed that exposure to UA was associated with decreased expression of the anti-apoptotic proteins Mcl-1, Bcl-xL, Bcl-2, and TCTP and increased expression of apoptosis-related proteins TNF-α, Fas, FADD, Bax, cleaved caspase-3, caspase-8, caspase-9, and PARP. Immunocytochemistry staining showed that treatment with UA resulted in increased expression of caspase-3. Moreover, exposure to UA resulted in the inhibition of the PI3K/Akt and p38 MAPK signaling pathways. These findings suggest that UA inhibits the proliferation of SK-Hep-1 cells and induces apoptosis.

There is increasing evidence showing that hepatic resection is probably the best definitive treatment for unilateral hepatolithiasis. However, the role of hepatic resection for bilateral hepatolithiasis is rarely mentioned in the literature.We retrospectively reviewed 197 patients who underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital from December 1987 to December 2007. A total of 156 patients with unilateral hepatolithiasis were defined as the UNI group (control group), and 41 patients with bilateral hepatolithiasis were defined as the BI group (study group). The short- and long-term outcomes were measured.The BI group had longer operating time (200 min versus 173 min, P = 0.006), lower immediate stone clearance rate (56.1% versus 91.7%, P0.001), lower final stone clearance rate (75.6% versus 94.9%, P = 0.001), higher rate of stone recurrence (22.6% versus 6.1%, P = 0.009) and higher disease-related mortality (19.5% versus 5.1%, P = 0.006). Thirty patients with bilateral peripheral stones were indicated for bilateral hepatectomy, but only 20 (66.7%) of them actually underwent the proposed procedure. Of the patients who did not achieve immediate stone clearance, bilateral peripheral stones represented 88.9% (P = 0.044). Of the patients who had stone recurrence, patients less than 35 years old represented 42.9% (P = 0.007).Bilateral hepatolithiasis has worse outcomes than unilateral hepatolithiasis after being treated with hepatic resection. Regarding bilateral peripheral stones, there is often a discrepancy between the extent of stone-affected parenchyma and that of final liver resection, resulting in a lower immediate stone clearance rate. A higher stone recurrence rate was observed among younger population.

Polycomb-group proteins mark specific chromatin conformations in embryonic and somatic stem cells that are critical for maintenance of their "stemness". These proteins also mark altered chromatin modifications identified in various cancers. In normal differentiated cells or advanced cancerous cells, these polycomb-associated loci are frequently associated with increased DNA methylation. It has thus been hypothesized that changes in DNA methylation status within polycomb-associated loci may dictate cell fate and that abnormal methylation within these loci may be associated with tumor development. To assess this, we examined the methylation states of four polycomb target loci -Trip10, Casp8AP2, ENSA, and ZNF484 - in liver cancer. These four targets were selected because their methylation levels are increased during mesenchymal stem cell-to-liver differentiation. We found that these four loci were hypomethylated in most early-stage liver cancer specimens. For comparison, two non-polycomb tumor suppressor genes, HIC1 and RassF1A, were also examined. Whereas the methylation level of HIC1 did not differ significantly between normal and tumor samples, RassF1A was significantly hypermethylated in liver tumor samples. Unsupervised clustering analysis classified the methylation changes within polycomb and non-polycomb targets to be independent, indicating independent epigenetic evolution. Thus, pre-deposited polycomb marks within somatic stem cells may contribute to the determination of methylation changes during hepatic tumorigenesis.

This paper proposes a new voltage control technique for IPMSM drives to extend DC-link voltage utilization for flux weakening operation. The presented method does not require look-up-table and motor parameter for flux weakening operation. The difference between the switching period and summation of active switching times for PWM control of inverter is used to modify the d-axis current reference under flux weakening region such that the voltage trajectory of inverter output can move to the hexagon of the space vector to extend the utilization of DC-link voltage. As the summation of active switching times is less than its switching period, constant torque with maximum torque per ampere (MPTA) control is retained. In contrast, flux weakening control is considered. Smooth and automatic transition between constant torque and flux weakening regions can be achieved. Experimental and simulation results will be presented to fully support the claims.

Advance reservation of resources imporves quality-of-service by assuring the availability of resources at a future time However, it tends to fragment the available resources time and may lead to poor system utilization This paper proposes new job scheduling techniques to address this temporal fragmentation problem The goal is to schedule jobs with dependency to processors whose available times are fragmented into non-continuous time slots We propose a greedy algorithm to find the optimal schedule for jobs with single chain dependency We also propose a dynamic programming algorithm to find the optimal schedule for jobs with multiple-chain dependency In order to reduce scheduling time, we also propose three efficient heuristic algorithms Experimental results indicate that these heuristics are scalable and can find near optimal solutions.

This paper proposes a new voltage trajectory control for field weakening operation of induction motor drives. The presented method doesn't require look-up-table and reduces the parameter sensitivity. Moreover, the DC-link voltage can be fully utilized such that the voltage moves along the hexagon trajectory of space vector of voltage. The difference between the switching period and summation of active switching times for inverter PWM control is used for field weakening control. As the summation of active switching times less than its switching period, constant torque is retained. In contrast, field weakening control is considered. Smooth and automatic transition between two field weakening regions can be achieved by the calculated q-axis current subjected to the voltage, current and maximum pull-out torque constraints. Experimental and simulation results will be presented to fully support the claims.

DNA methylation is a dominant silencing epigenetic modification that is inheritable in somatic cells. The recruitment of DNA methylation was proven to be able to reshape the cell physiology and cause tumorigenesis. The reversible nature of the methylation modification also makes the DNA methylation a therapeutic target and the monitoring of the methylation/demethylation dynamics in vivo is thus important for the development of demethylation agents. A targeted DNA methylation method and a two-component reporter system were combined to monitor the increase and demolishment of DNA methylation in vivo. The two constructs of the reporter systems are: target gene promoter (like HIC1 and ENSA) linked with the Tet repressor gene; the other is the Tet operator linked with the reporter like EGFP (in cell), IFP and iRFP. Both constructs were co-transfected into cells like mesenchymal stem cells, MDA-MB-231 and HCT116, and stable clones with both constructs were isolated and validated. Targeted DNA methylation method was used to transfect the isolated cell and, as the increase of DNA methylation, the reporters expressed. The increased methylation was then quenched after the adding of demethylation agents. To test this system in vivo, cells with both constructs were injected into the immune-deficient mice and the tumors grew afterward. Targeted DNA methylation was performed in vivo and the increase of methylation/expression of reporter genes were observed by fluorescence-based tomography. This combined system is also effective to monitor the demethylation effects of the demethylation agents. (Supported by: NSC- 102-2320-B-194-003-MY3 and NSC-102-2314-B-371- 003-MY3, MOST Taiwan) Citation Format: Yao-Li Chen, Shou-Tung Chen, Chun-Chun Chung, Chia-Chen Hsu, Ping-Yi Lin, Wan-Ling Chuang, Yi-Ju Chu, Yu-Wei Leu, Shu-Huei Hsiao. In vivo visualization of the targeted DNA methylation. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-153. doi:10.1158/1538-7445.AM2015-LB-153

Periodic broadcast techniques have been demonstrated to effectively deliver the popular media contents with short startup delay. Due to the broadcast nature, this approach optimizes the server streams sharing by default. With essentially no overhead in scheduling user requests, these server-push schemes easily accomplish better service scalability than other elaborate client-pull designs. Unfortunately, there has been no support for interactive VCR-like services. Users are only allowed to playback the media title in a regular fashion. In this paper, we propose a novel streaming protocol to compensate for such shortage. The idea is to recursively split the successive video frames into several disjoint groups. Yet, different groups are served by the corresponding clusters of server channels at the reduced delivery capacity. With such design, each client is allowed to individually fulfill the specific interactivity requirement by tuning to the proper channels in the clusters with no server intervention. Consequently, the scalability of interactive services is maximized with no sacrifice on the support of the regular service demands. The performance study demonstrates significant server bandwidth saving can be realized using the proposed technique.

Background: Osteoporosis is predominantly a condition of the elderly. In this study, we evaluated the effects of teriparatide on lung function and pain relief in elderly women with multiple osteoporotic vertebral compression fractures. Methods: A total of 37 patients who received teriparatide treatment during the period January 2010 to December 2011 were enrolled. Dual-energy X-ray absorptiometry scans were used to measure bone mineral density (BMD) and lung function was measured using a MasterScreen Body Jaeger spirometer. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values were recorded. The Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for pain were used to evaluate physical health and pain intensity, respectively, at baseline and after 6 months of teriparatide treatment. Results: Mean BMD at the lumbar spine increased from 0.716 g/cm2 at baseline to 0.829 g/cm2 after 6 months of treatment. In addition, both mean FVC and FEV1 values after 6 months of treatment were significantly higher than baseline values (99.01% and 100.06% vs. 87.62% and 90.62%, respectively). Teriparatide treatment also resulted in a significant reduction in self-reported pain intensity and a significant improvement in physical health as measured by VAS and ODI scores, respectively. Conclusions: In addition to increasing BMD, teriparatide treatment improves the lung function and results in diminished pain intensity in women with multiple osteoporotic vertebral compression fractures.

Background: High-grade primary glioma have poor prognosis and predictive biomarkers is very important. Midkine (MDK), a heparin-binding growth factor, is important in regulating carcinogenesis, cell proliferation, mitogenesis, and angiogenesis. This study aimed to identify over-expression of MDK in gliomas and correlate this with clinical outcomes. The authors put forward their hypothesis correlating proliferation and poor survival with over-expression of this novel protein. Methods: Two datasets from Gene Expression Omnibus (GEO) included human data of 100 and 180 patients, respectively. The MDK expression, World Health Organization (WHO) pathological grade, sex, age, and survival time were identified for statistical analysis. Results: A search of the GEO profile revealed that MDK expression level was statistically greater in the WHO grade IV compared with grade II (P = 0.002), in grades III and IV compared with nontumor control (P = 0.044 and P < 0.001, respectively) after adjustments using the Bonferroni method. By the Kaplan-Meier survival curve, the high MDK expression group had poorer survival outcome (2.38-fold hazard, 95% confidence interval: 1.22-4.63) than the low MDK expression group after adjustments for WHO grade and age. Conclusions: Taken together, there is a positive correlation between MDK expression and WHO grading of human gliomas. Moreover, MDK over-expression is significant correlated to poor survival outcome in high-grade, suggesting that MDK may be an important therapeutic target.

Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

Purpose. The aim of this study is to investigate the relationship between SHP-1 phosphatase activity and clinicopathological characteristics in hepatocellular carcinoma (HCC). Methods. Patients. Between July 2011 and August 2012, 86 patients who underwent surgical hepatectomy resection at Changhua Christian Hospital were enrolled retrospectively. This study was approved by the Institutional of Review Board. For each patient, the diagnosis of hepatocellular carcinoma was confirmed by pathology reports. The clinical data of all patients were obtained through chart review. The data included hepatitis B or C status and the levels of alpha-fetoprotein (AFP). Histological differentiation and pathological staging were studied regarding the 7th American Joint Committee on Cancer (AJCC) cancer staging manual. Further analysis with standard immunohistochemistry and tissue microarray, which used 86 paraffin-embedded paired specimens of HCC. Immunopositivity was assessed by two pathologists who were blinded to the clinical information. SHP-1 immunoreactivity was scored as negative (0), weak (1), moderate (2), and strong expression (3), respectively. A final immunohistochemical score was calculated by the percentages of stained cells and the intensities of the staining. Statistical Analysis. The patients were classified into two subgroups based on the expression of SHP-1. Categorical variables were compared using the χ2 test or Fisher exact test when appropriate. For continuous variables, Mann-Whitney U tests were used to examine the differences between two subgroups in terms of the clinicopathological characteristics of patients with HCC. P values less than 0.05 were considered to be statistically significant. All statistical analysis was performed with SPSS for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA). Preliminary Results. A total of 86 patients were enrolled in this study. The mean age among patients was 63 years (SD, 11 years) and most of them were male (69.8%). Regarding the clinicopathological characteristics of the two subgroups based on their SHP-1 gene expression status. There were no statistical differences between the two subgroups regarding age, gender, tumor size, HbsAg, HCV and TNM stage. However, the variables of AFP levels and histological grade were found to be statistically significant. Conclusions. In the present study, we performed immunohistochemical staining of SHP-1 in a tissue array of 86 paired specimens from HCC patients. SHP-1 was found overexpressed in the tissues. Addtionally, there were no statistical differences in clinicopathological data except AFP levels and histological grade. However, the role of SHP-1 in tumorigenesis is still unknown. With this preliminary finding, we suggest that it is essential to conduct a further study to clarify the tumorigenesis pathways of SHP-1 and to follow up the prognostic outcomes among these HCC patients. Citation Format: Ping-Yi Lin, Yao-Li Chen, Pei-Yi Chu, Kuen-Feng Chen. Src homology region 2 domain-containing phosphatase-1 (SHP-1) is overexpressed in hepatocellular carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1799. doi:10.1158/1538-7445.AM2013-1799

AIM: To compare the outcomes of concomitant cholangiocarcinoma (C-CCA) and subsequent cholangiocarcinoma (S-CCA) associated with hepatolithiasis. METHODS: From December 1987 to December 2007, 276 patients underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital. Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base. Ten patients were diagnosed with C-CCA based on the preoperative biopsy or postoperative pathology. During the follow-up period, 12 patients developed S-CCA. The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out. Patient charts were reviewed to collect clinical information. Parameters such as CCA incidence, interval from operation to CCA diagnosis, interval from CCA diagnosis to disease-related death, follow-up time, and mortality rate were calculated for both the C-CCA and S-CCA groups. The outcomes of the C-CCA and S-CCA groups were mathematically compared and analysed. RESULTS: Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis, the incidence rates of C-CCA and S-CCA were fairly similar (4.8% vs 4.5%, respectively, P = 0.906). However, for the patients with bilateral hepatolithiasis, the incidence rate of S-CCA (12.2%) was higher than that of C-CCA (4.7%), although the sample size was limited and the difference between two groups was not statistically significant (P = 0.211). The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group. Regard to the average time intervals from operation to CCA diagnosis, S-CCA was diagnosed after 67 mo from the initial hepatectomy. The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group, this difference approached statistical significance (P = 0.075). Regarding the rates of overall and disease-related mortality, the C-CCA group had significantly lower overall mortality (70% vs 100%, P = 0.041) and disease-related mortality (60% vs 100%, P = 0.015) than the S-CCA group. For the survival outcomes of two groups, the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group (log rank P = 0.005). In the C-CCA group, three patients were still alive at the time of data analysis, all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy. In the S-CCA group, only one patient had chance to undergo a second hepatectomy, and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION: C-CCA has better outcomes than S-CCA. The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.

The secret-sharing mechanism has been widely applied to the e-commerce, communications and multimedia fields. With sufficient shares, the involved participants can cooperate to reveal secret data. Fraudulent participants, however, may provide a fake shadow in order to fool others. Consequently, cheating prevention has become a critical essential for secret sharing systems. In this article, the authors propose an efficient image secret sharing scheme that can resist cheating attacks. The simulator shows that the novel scheme is sensitive to cheating detection and cheater identification. In particular, the new method allows an authorised participant to reveal a lossless secret image and to further restore the valued host image without distortion. The reversibility of the secret sharing system provides practicability and widespread potential for preserving medical images, military images and artistic images.

OBJECTIVE To determine the effect of cardiac valve replacement on pregnancy outcome. METHODS We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, chi 2, and Fisher exact tests were used for analysis. RESULTS There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively; P < .05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%). CONCLUSION Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.

Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.