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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: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. Methods: Between 2013–2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). Results: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. Conclusions: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

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.

Proinflammatory cytokine interleukin-1β (IL-1β) stimulates several mediators of cartilage degradation and plays an important role in the pathogenesis of osteoarthritis (OA). Honokiol, a low molecular weight natural product isolated from the Magnolia officinalis, has been shown to possess anti-inflammatory effect. Here, we used an in vitro model of cartilage inflammation to investigate the therapeutic potential of honokiol in OA. Human OA chondrocytes were cultured and pretreated with honokiol (2.5–10 µM) with or without IL-1β (10 ng/ml). Nitric oxide (NO) production was quantified by Griess reagent. Prostaglandin (PG)E2, metalloproteinase-13 (MMP-13), and interleukin-6 (IL-6) productions were quantified by enzyme-linked immunosorbent assay. The expressions of collagen II, cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and nuclear factor κB (NF-κB)-related signaling molecules were determined by Western blotting. Our data showed that IL-1β markedly stimulated the expressions of iNOS and COX-2 and the productions of NO, PGE2, and IL-6, which could be significantly reversed by honokiol. Honokiol could also suppress the IL-1β-triggered activation of IKK/IκBα/NF-κB signaling pathway. Moreover, honokiol significantly inhibited the IL-1β-induced MMP-13 production and collagen II reduction. Taken together, the present study suggests that honokiol may have a chondroprotective effect and may be a potential therapeutic choice in the treatment of OA patients. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:573–580, 2014.

Alternating current field Measurement is one of the important progresses about electromagnetic nondestructive testing in recent years. Alternating magnetic fields excitation testing model is established by using electromagnetic simulation software ANSOFT, a flat plate crack defects are simulated. By analyzing its principle, crack depth and the width change influence on test results, finally the simulation results are verified by the method of experiment. The experimental results are consistent with the simulation results. The results show that this differential probe has good effect on crack defects test.

Osteoarthritis (OA) is a degenerative joint disease involving a combination of cartilage degradation and inflammation. EGb761, a standardized extract of Ginkgo biloba leaves, holds an anti-inflammatory potency. Here, we determined whether EGb761 could inhibit lipopolysaccharide (LPS)- and IL-1β-induced inflammatory responses in human articular chondrocytes and apply the chondroprotection in OA rats. We found that LPS markedly induced the productions of PGE2 and NO and the protein expressions of COX-2 and iNOS in human chondrocytes. LPS was also seen to up-regulate the expressions of toll-like receptor-4 (TLR4), its downstream signal TNF receptor-associated factor 6 (TRAF6), and nuclear factor (NF)-κB signaling. These LPS-induced inflammatory responses were efficaciously reversed by EGb761 and its active components quercetin and kampferol. The similar results could be observed by using IL-1β as an in vitro model to mimic an inflammatory response. In an OA rat model, PGE2 and NO levels in blood, the histological alterations, and COX-2 and nitrotyrosine expressions in cartilages were markedly increased, which were effectively reversed by EGb761. Our results suggested that EGb761 exerts the anti-inflammatory effects on human articular chondrocytes and OA rats.

Metal Magnetic Memory (MMM) testing method has its own effective and unique advantages on the research of extension of metal crack. The array magnetic memory testing sensor designed and assembled in accordance with specific conditions, could evidently enhance testing-efficiency, such as for components with complex shape or large surface area, and may simplify the test equipment correspondingly. A kind of array magnetic memory sensor with Hall elements as core components was designed and an experiment on metal magnetic memory testing on extension of metal crack was executed. The experiment results indicate that the magnetic memory testing technique could effectively monitor and qualitatively evaluate the progress of metal crack extension.

Crack propagation is the main reason which leads to the invalidity of the metal components. A set of detecting equipment based on the acoustic emission method was designed, and it was mainly composed of acoustic emission sensor, signal operating circuits and signal acquisition system. Specimens of 16MnR material were manufactured and the static axial tension test of them was carried on. Acoustic emission signals from the specimen were detected by acoustic emission equipment by using piezoelectric ceramic sensor. Signal datum were acquired and operated by the acquisition system, as well as the acquisition program written for it. The final results has demonstrated that acoustic emission equipment designed for the test performed well in acquiring the signals induced by the metal crack propagation.

The relations between stresses and leakage magnetic signal of concentration area of the airplane’s landing gear under varying load were studied. The finite element method was used to calculate the stress of axle under different conditions; An experiment was designed to simulate the stress status under the bending moment, the slight magnetic signals on specimen were measured, and the relation of the signals and stress was studied. The new testing method was explained with the theory of ferromagnetic and the significance of this technique for detecting defects of the airplane structural part was discussed. The safety of airplane’s main bearing parts plays an important role during its operation and it often comes to bad situation of fatigue damage for stress concentration [1, 2]. To prevent the breaking down of structural parts and get rid of big accidents, it becomes important and necessary to find out the early concentration and damage zone, and to make some certain examination of damage and stress status [3]. The method of magnetic memory testing would be effective for the confirming of stress concentration zone in the equipment or structural parts, and could lead the way ahead the matters of fatigue analysis, evaluation of equipment life and technological design. The method can detect the endurance failure of the airplane’s undercarriage shaft, which is composed of ferromagnetic materials, and that provides the experimental basis for the prevention of parts’ fatigue defects.

This paper examines the use of closed-circuit television (CCTV) system notices in banks. This study was designed to measure the effect of the wording of CCTV notices on customer service quality expectations and purchase intent, while also considering the customer involvement as the moderating effects. Results show that customers, in expectation of better service quality, may be more likely to purchase the service when moderately worded CCTV notices (i.e. ‘please smile, the CCTV is running!’) had been employed in the bank rather than when the negatively worded CCTV notices (i.e. ‘Taping now! All your behaviour here is monitored by the CCTV system!’) are deployed. These effects were stronger in low-involvement situations. Implications of the findings and the future research directions are also discussed.

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

Osteoarthritis (OA) is a degenerative joint disease involving a combination of cartilage degradation and inflammation. EGb761, a standardized extract of Ginkgo biloba leaves, holds an anti-inflammatory potency. Here, we determined whether EGb761 could inhibit lipopolysaccharide (LPS)- and IL-1β-induced inflammatory responses in human articular chondrocytes and apply the chondroprotection in OA rats. We found that LPS markedly induced the productions of PGE2 and NO and the protein expressions of COX-2 and iNOS in human chondrocytes. LPS was also seen to up-regulate the expressions of toll-like receptor-4 (TLR4), its downstream signal TNF receptor-associated factor 6 (TRAF6), and nuclear factor (NF)-κB signaling. These LPS-induced inflammatory responses were efficaciously reversed by EGb761 and its active components quercetin and kampferol. The similar results could be observed by using IL-1β as an in vitro model to mimic an inflammatory response. In an OA rat model, PGE2 and NO levels in blood, the histological alterations, and COX-2 and nitrotyrosine expressions in cartilages were markedly increased, which were effectively reversed by EGb761. Our results suggested that EGb761 exerts the anti-inflammatory effects on human articular chondrocytes and OA rats.

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.

The Ministry of Education launched the first batch of “education and training programs of excellence Engineers” project in June 2010, and Tsinghua University and other 60 universities approved to become the first project implementation units [1]. This measure is of great importance to carry out our long-term development of higher engineering education reform plan and promote our engineering education to a higher grade. The core objective of this project is to train a large number “qualified engineers” to meet the needs of modern manufacturing and production, guarantee the support of intelligence for building an innovative country and developing modern industry, and finally enhance our science and technology competiveness and overall national strength in the next few years. This request that we should overcome the drawbacks of the original teaching system, focus on developing the innovating ability of students, and establish the open innovative teaching programs and models emphasizing school-enterprise collaboration and stressing practice in the professional planning and construction[2]. To this end, we conduct a useful thought and discussion in the process of developing training programs.

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.

Islet-like cell clusters (ICCs) have been suggested to be a source of insulin-producing tissue for xenotransplantation in type 1 diabetes. We designed an approach to maintain the cultured rat pancreatic ICC survival and function, when cocultured with human umbilical cord mesenchymal stem cells (HUMSCs). HUMSCs in coculture have the ability to maintain ICC survival and function, for which number and insulin secretion of ICCs are increasing and lasting for 3 months, while ICCs gradually crash, which results in cell death after a period of 12 days of culture without HUMSCs. Cytokine protein array showed it has more than a twofold increase in levels of several cytokines (interleukin-6, tissue inhibitor of metalloproteinases-1, tissue inhibitor of metalloproteinases-2, monocyte chemoattractant protein-1, growth related oncogene, hepatocyte growth factor, insulin-like growth factor binding proteins 4, and interleukin-8) on coculture medium, implying an important role of these cytokines in this coculture system. These findings suggest that coculture with HUMSCs may have a significant potential to protect ICCs from damage during culture, and may be employed in a novel culture approach to maintain islet cell survival and function before transplantation.

Background/Purpose Traditionally, clinical clerkship training in Taiwan does not provide medical students with sufficient patient care responsibilities and often results in inadequate clinical skills. Methods We implemented a pilot clerkship program at a comprehensive cancer center that emphasizes core clinical competency through direct patient care and dedicated faculty and mentors. Students were an integral part of the patient care team held accountable for providing coordinated and holistic care. Students' self-assessment of clinical competencies, faculty evaluation, and objective structured clinical examination were compared against their peers trained by traditional clerkship at a main teaching hospital. Results Fifty medical students completed the clerkship program in the first 3 years. At the end of the clerkship, participants rated themselves significantly higher than their peers in almost all patient care and clinical skill domains. The most significant areas included physical examination, clinical reasoning, developing management plan, holistic approach, handling ethical issues, and time management skills. The students rated their clerkship teachers significantly higher in time spent with students, skills and enthusiasm in teaching, as well as giving students appropriate patient care responsibilities. There was no significant difference in the end-of-clerkship objective structured clinical examination performance, but participants of the program achieved better grades in their subsequent internship. Conclusion This pilot collaborative program presented a successful model for clinical education in the teaching of core clinical competencies through direct patient care responsibilities at the clerkship stage. It is hoped that the project will become a catalyst for medical education reform in Taiwan and regions with similar traditions.