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The emerging challenges of global health constantly puts forward new requirements for cultivating medical talents. From the perspective of great health, the First Affiliated Hospital of Sun Yat-sen University aims at cultivating top-notch and innovative medical talents for the future. Since 2018, the hospital has been inheriting and innovating the model of training medical elites and has explored and implemented the clinical postdoctoral program. This program relies on the platform of progressive medical training of the relatively mature 'college system' initiated by our hospital. By regrouping the high-quality interdisciplinary faculty team, the platform optimizes the 'outcome-based' advanced training system and builds effective evaluation and the assessment system, to comprehensively strengthen clinical postdoctoral trainees' abilities of clinical and scientific research and teaching. The program provides reference for the cultivation of high-level medical elites.

Background: AIDS is a serious disease worldwide. Prevention has been shown to be more effective than treatment in the effort to control and end the threat of this disease. Purpose: The purpose of this study was to evaluate the effects of an HIV/AIDS prevention education program on adolescents living in a primarily indigenous area of Taiwan. Methods: This study used secondary data prepared by the Health Center of one indigenous township in 2011. Authors analyzed the dataset retrospectively. A 2-week HIV/AIDS prevention education program was arranged for a single group of 50 students from one junior high school and a pretest and posttest were conducted. A total of 45 valid questionnaires were completed. Data were analyzed using descriptive statistics, the McNemar test, and the Wilcoxon signed-rank test. Results: Results indicate that the education program improved the knowledge (p < .001) and attitude (p < .05) of participants significantly between pretest and posttest. The posttest score for knowledge (9.47 ± 3.24) was significantly higher than the pretest score (6.11 ± 3.84). The posttest score for positive attitude (3.72 ± 0.36) was also significantly higher than the pretest score (3.43 ± 0.34). Conclusions / Implications for Practice: This AIDS prevention education program significantly improved the related knowledge and attitudes of participants. Schools and health units may reference the results of this study to design materials for prevention of HIV/AIDS, particularly in the context of indigenous adolescents. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to explore the factors that influenced hospital staff in protecting the privacy of the electronic medical record (EMR) and to conduct a multi-group analysis comparing perceptions about EMR privacy protection by physicians and other hospital staff. Methods: Based on the Theory of Planned Behavior, a cross-sectional survey was conducted to collect data from one military hospital in southern Taiwan. The study subjects were all hospital staff and were recruited via convenience sampling. Results: A total of 129 valid questionnaires was collected. Attitude (AT), subjective norm (SN), and perceived behavioral control (PBC) were positively related to hospital staffs' intention (I) to protect EMR privacy. Moreover, the relationships of AT→I, SN→I, and PBC→I varied significantly between physicians and other hospital staff. Physicians had stronger beliefs about the relationships between SN→I and PBC→I. Conclusions: This study suggested that the subject hospital should offer more training programs pertinent to the protection of EMR privacy. Physicians should also be reminded to engage in these training programs. The hospital could improve staff intention to protect EMR privacy through the influence of the director or their colleagues and also by providing sufficient software and hardware to protect EMR privacy. These measures could decrease patients' concerns about privacy of the EMR and be beneficial to the promotion of the EMR in the future. [ABSTRACT FROM AUTHOR]

Background: Taiwanese midwives began to receive professional training in 1907 during the Japanese Colonial Period. The profession of midwifery flourished until it was gradually sidelined by increasingly available professional obstetrics and medical care and changes in society and culture. Lee Chuan is a former professional midwife. She was born in 1921 in Tainan County and studied at the Midwifery Institute in Taichung, where she graduated in 1943. She worked as a midwife at the Jiangjyun Township Health Center in Tainan County in 1950. She joined the Kaohsiung Municipal Hospital in 1952 and retired from the Kaohsiung Municipal Ta-Tung hospital in 1978. She ended her midwifery career in 1989. Purpose: This study explores the career of midwifery, including initiation, the learning process, and career as a precious historical perspective on the development of maternal-infant care in Taiwan through the mid- and late-20th century, a timeline that covers Japanese and Republic of China administration of Taiwan and addresses social, and culture contexts. Methods: An oral history approach was adopted to explore the midwifery career. Research included literature review, photograph compilation, a review of formal documents, and 14 face-to-face, in-depth interviews with Lee Chuan. Content analysis was performed on collected information and triangulation was used to check rigor. Results: Three themes emerged, including: (1) growth and midwifery enlightenment; (2) midwifery learning experiences; (3) the career of midwifery. Conclusion / Implications for Practice: Results provide Lee Chuan's personal and professional history, under-scoring the meaningful implication and values of traditional midwifery. Results further reveal the merits of the midwife profession. Lee Chuan's profession, humanity, and ways of social communications may also have lessons and insights for maternal and infant care and nursing professionals today. [ABSTRACT FROM AUTHOR]

Famous anti-pornography feminists, Catharine MacKinnon and Rae Langton believe that pornography harms women in a very special and serious way: by silencing them or violating their civil right to freedom of speech. Langton believes that an analysis of the concept of speech acts shows that pornography silences women's voices. Therefore, pornography destroys political liberty and should not be allowed. Pornography may thus make potential speech acts unspeakable for women, not by preventing them from producing or distributing sounds and scrawls, but by preventing women from doing things with their words. In what follows, I will argue that Langton's view would impose a burdensome range of duties on individuals. This suggests that there are some powerful liberal reasons for thinking that the right to free speech should not include any minimal receptiveness requirement on the part of audiences. [ABSTRACT FROM AUTHOR]

Famous anti-pornography feminists, Catharine MacKinnon and Rae Langton argue that people do not have a right to pornography because pornography subordinates women and silences them by restricting their ability to act in protest against it. Langton emphasizes the act of creating porn. She asserts that pornography not only leads to subordination--it is itself an act of subordination. Therefore, pornography destroys political liberty and equality and should not be allowed. In what follows, I will examine how MacKinnon and Langton attempt to establish that the creation of porn and in so doing denies women equality. I will argue that MacKinnon and Langton fail to show how pornography destroys women's political equality. [ABSTRACT FROM AUTHOR]

Catharine MacKinnon, a famous anti-pornography feminist, believes that pornography harms women in a very special and serious way: by silencing them or violating their civil right to free speech. Pornography may thus prevent women from communicating their ideas to others, not by preventing them from producing or distributing sounds and scrawls, but by preventing those sounds and scrawls from being understood by hearers. In this paper, I will argue that MacKinnon fails to show how pornography violates women's civil right to freedom of speech, and suggest that thus far we remain a long way from showing why pornography harms women. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of ox-LDL/β2GPI/anti-β2GPI antibody complex on apoptosis and inflammatory factors expression in RAW264.7 cells and its mechanism. Methods RAW264.7 cells were treated with medium, ox-LDL, β2GPI/aβ2GPI antibody complex, ox-LDL/β2GPI complex, ox-LDL/aβ2GPI antibody complex, and ox-LDL/β2GPI/aβ2GPI antibody complex separately. The role of signaling pathways was investigated by TLR4 inhibitor TAK-242 and mTOR inhibitor rapamycin. Finally, cells were stimulated with different concentrations of TNF-α. The apoptosis was detected by Annexin V-FITC/PI double labeling. The mRNA expressions of TNF-α and IL-1β were detected by real-time quantitative PCR, and the protein expressions of TNF-α, IL-1β, and apoptosis-related proteins cleaved-caspase-3 (c-caspase-3) and Bcl2 were detected by Western blot. Results Ox-LDL/β2GPI/aβ2GPI antibody complex promoted RAW264.7 cells' apoptosis, with a decrease in protein Bcl2 and an increase in protein cleaved-caspase-3, and enhanced the level of inflammatory factors, while apoptosis and the expression of inflammatory factors were partially reduced when macrophages had been pre-treated with inhibitors. TNF-α up-regulated apoptosis in RAW264.7 cells at 100 ng/mL and 200 ng/mL. Conclusion Ox-LDL/β2GPI/aβ2GPI antibody complex induces apoptosis in RAW264.7 cells by increasing the expression of inflammatory factors. TLR4 and mTOR pathways are involved in the process.

Objective To evaluate the effect of oxidized low-density lipoprotein/β2-glycoprotein I/anti-β2 glycoprotein I antibody (oxLDL/β2GPI/anti-β2GPI) complex on the calcification and inflammatory cytokine expression in A7r5 rat vascular smooth muscle cells, and to find out the role of Toll-like receptor 4 (TLR4) signal in this process. Methods The A7r5 cells were intervened with oxLDL, oxLDL/β2GPI complex, oxLDL/anti-β2GPI complex, β2GPI/anti-β2GPI complex, and oxLDL/β2GPI/anti-β2GPI complex for different time, with or without TLR4 inhibitor (TAK-242). Alizarin red staining was used to observe the calcification. Real-time quantitative PCR was applied to detect the total mRNA levels of actin-associated protein SM22α (trangelin) and Runt-related transcription factor 2 (RUNX2). The protein levels of SM22α and RUNX2 were measured by Western blotting. Tumor necrosis factor α (TNF-α) was detected by ELISA. Different concentrations of TNF-α were adopted to stimulate A7r5 cells, and the above methods were operated to examine the changes of SM22 and RUNX2. Results When A7r5 cells were incubated by oxLDL/β2GPI/anti-β2GPI complex, more calcified nodules were observed, the expression of SM22α was reduced and RUNX2 expression was enhanced at both mRNA and protein levels. And the complex increased the expression of inflammation cytokine TNF-α. TLR4 inhibitor TAK-242 reversed the phenomenon. Different concentrations of TNF-α could reduce mRNA and protein expression of SM22α while raise RUNX2 expression. Conclusion oxLDL/β2GPI/anti-β2GPI complex can increase the expression of cytokine TNF-α, and thus quicken calcification procedure in A7r5 cells, along with the change of the traditional contraction phenotype into the osteogenic phenotype. TLR4 receptor participates in this process.

Objective To investigate the effect of oxidative low-density lipoprotein/β2 glycoprotein I/anti-β2 glycoprotein I antibody (oxLDL/β2GPI/anti-β2GPI antibody) complex on autophagy in mouse macrophages (RAW264.7 cells) and its mechanism. Methods RAW264.7 cells were stimulated with medium, oxLDL, oxLDL/β2GPI complex, oxLDL/β2GPI/anti-β2GPI antibody complex, oxLDL/anti-β2GPI antibody complex and β2GPI/anti-β2GPI antibody complex separately. The protein levels of autophagy-associated proteins including LC3 and P62 were detected by Western blot analysis. The tandem mRFP-GFP-LC3 adernovirus was used to detect the patency of autophagosomes and autophagy flow. The AKT pathway inhibitor LY294002 (50 μmol/L) was used for investigating the role of AKT pathway in the autophagy in RAW264.7 cells treated by oxLDL/β2GPI/anti-β2GPI antibody complex. Results oxLDL/β2GPI/anti-β2GPI antibody complex reduced the level of LC3-II protein and the number of autophagosomes, increased the level of P62 protein and blocked the autophagy flow. In addition, the autophagy in RAW264.7 cells was partially restored by the pre-treatment of LY294002. Conclusion The oxLDL/β2GPI/anti-β2GPI antibody complex can inhibit the autophagy in RAW264.7 cells through activating the AKT pathway.

Objective To investigate the effects of β2 glycoprotein I/anti-β2 glycoprotein I antibody complex (β2GPI/aβ2GPI) on lipid phagocytosis and class B scavenger receptor CD36 expression of macrophages, and the role of Toll-like receptor 4 (TLR4) during the process. Methods THP-1 macrophages were induced from THP-1 cells treated by 100 ng/mL phorbol ester (PMA), and then identified by morphological observation and DiI-oxLDL uptake assay. THP-1 macrophages were treated with RPMI1640 medium, β2GPI, aβ2GPI or β2GPI/aβ2GPI. The protein and mRNA expression of TLR4 were detected by Western blot analysis and real-time fluorescent quantitative PCR (qRT-PCR), respectively. After that, THP-1 macrophages were treated with RPMI1640 medium, oxidized low-density lipoprotein (oxLDL), oxLDL combined with β2GPI/aβ2GPI or oxLDL combined with LPS. Intracellular lipid deposition was observed by oil red O staining; the mRNA and protein expression of CD36 were detected by qRT-PCR, immunofluorescence and Western blot analysis. To unveil the role of TLR4 in this process, THP-1 macrophages were pre-treated with or without TLR4 inhibitor TAK-242 (1 μg/mL). Results After PMA treatment, THP-1 cells showed macrophage-like morphology and were able to engulf DiI-oxLDL. Compared with RPMI1640 medium, β2GPI/aβ2GPI treatment significantly increased TLR4 expression in THP-1 macrophages. Compared with oxLDL alone, oxLDL combined with β2GPI/aβ2GPI inhibited lipid deposition and CD36 expression in THP-1 macrophages, which could be partly reversed by TLR4 blockage. Conclusion The β2GPI/aβ2GPI can inhibit the phagocytosis of oxLDL and CD36 expression in macrophages, which is linked to the function of TLR4.

Objective: To evaluate the association between SLC22A1 expression and the outcomes of hepatocellular carcinoma (HCC) patients., Methods: A tissue microarray of 303 HCC and matched adjacent noncancerous liver tissues (ANLTs) were constructed. The expression of SLC22A1 was tested by immunohistochemistry (IHC) and scored by two pathologists according to a 12-score scale (a score>6 was defined as high expression, and a score≤6 as low expression). The correlation of SLC22A1 expression with the clinicopathological features and the patients' outcome was analyzed., Results: All the ANLTs had a IHC score of 12, as compared to only 29 (9.6%) of the HCC tissues. The patients were divided into 2 groups based on the IHC scores: 59% (180/303) in low expression group and 41% (123/303) in high expression group. The disease-free survival (DFS) rates and overall survival (OS) rates were significantly lower in low SLC22A1 expression group than in the high expression group. The 1-, 3-, and 5-year DFS rates were 43%, 31% and 27% in the low expression group, and were 58%, 47% and 43% in the high expression group, respectively. The 1-, 3-, and 5-year OS rates were 66%, 38% and 32% in low expression group, and were 80%, 57% and 50% in the high expression group, respectively. A low expression of SLC22A1 was positively correlated with the tumor diameter, BCLC stage, tumor differentiation, and AFP levels (P<0.05), and was an independent predictor of poor overall survival (HR=1.454; 95% CI, 1.050-2.013)., Conclusions: Down-regulation of SLC22A1 is a malignant feature and a potential prognostic marker of HCC.

Objective: To investigate the safety and efficacy of radiofrequency-assisted anterior approach right hepatectomy for hepatocellular carcinoma (HCC)., Methods: The clinic data of 12 HCC patients who underwent radiofrequency-assisted anterior approach right hepatectomy from January 2010 to July 2011 was analyzed retrospectively. Surgical techniques and treatment response were retrospectively reviewed. All the 12 patients were male, aging from 38 to 57 years with a mean of (48 ± 6) years. Ten of the 12 patients were infected with hepatitis B virus. A retrohepatic tunnel anterior to the surface of the inferior vena cava (IVC) was developed. The liver was hanged away from the IVC and radiofrequency was carried out along the Cantline's line. Scalpel was used to cut off the liver parenchyma along the middle of the ablated area until the parenchyma was fully resected. After short hepatic veins and the right hepatic vein were ligated, ligaments of right liver were fully isolated and right liver was resected. The t test was performed between 2 groups., Results: The surgical time was 165 to 295 minutes, with a mean of (230 ± 55) minutes. The bleeding was 150 to 1500 ml, with a mean of (516 ± 378) ml, which was better than those of anterior approach right hepatectomy ((1291 ± 1159) ml) and classical right hepatectomy ((2129 ± 2012) ml; t = 1.236, 3.265; P < 0.05). The postoperative hospital stay was 8 - 19 days, with a mean of (12 ± 4) days. There were no medical complications and no postoperative death. All patients were cured and discharged., Conclusions: Radiofrequency-assisted anterior approach right hepatectomy for HCC is safe and effective and could effectively decrease intra-operative bleeding and shorten surgical time.

Objective: To explore the technical success rate, efficacy, overall survival, recurrence-free survival and prognostic factors of transcatheter arterial chemoembolization (TACE) plus thermal ablations of radiofrequency ablation (RFA) and microwave ablation (MWA) in the patients with large hepatocellular carcinoma (HCC)., Methods: Forty-five cases with Child-pugh class A, B cirrhosis and large HCC with a maximum tumor between 5.0 cm to 10.0 cm underwent TACE and thermal ablation. Twenty-five patients received TACE plus RFA while the other 20 patients underwent TACE plus MWA. Their efficacy, long-term survival and prognostic factors were statistically analyzed., Results: TACE plus thermal ablation were performed in 84 tumors with a successful rate of 100% (86/86) and a complete ablation rate of 94.0% (79/84). The major complication rate was 6.7% (3/45). Local and distant recurrence rates were 66.7% (30/45) and 71.1% (32/45) respectively. The 1 and 2-year recurrence-free survival rates were 26.7% (12/45) and 13.3% (6/45). And the 1, 2 and 3-year survival rates were 80.0% (36/45), 33.3% (15/45) and 6.7% (3/45) respectively. Univariate and Cox regression analyses indicated that tumor size > 7.0 cm, multi-nodularity, incomplete necrosis and pretherapy α-fetoprotein (AFP) ≥ 200 µg/L were 4 unfavorable prognostic factors for the long-term survival., Conclusion: The combined procedures of TACE and percutaneous thermal ablation are both safe and effective for the unresectable large HCC (> 5.0 cm). It represents an alleviate treatment for those patients with tumor size > 7.0 cm. Tumor size, tumor number, completeness of necrosis and AFP level are all significant prognostic factors.

Objective: To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellular carcinoma (HCC)., Methods: A total of 188 consecutive patients with large HCC ( > or =5 cm) undergoing right hepatectomy were reviewed retrospectively. Among them, 92 patients received anterior approach right hepatectomy (anterior group) while the other conventional right hepatectomy (conventional group). Their clinicopathologic data and survivals were compared., Results: There were five surgical deaths (2.7%), two in the anterior group and three in the conventional group. The biochemical and tumor pathological data (except for tumor size) of these two groups were comparable. The mean intraoperative blood loss, the number of patients with massive hemorrhage ( >3000 ml) and the volume of blood transfusion of the anterior group were markedly less than those of conventional group. The 1-, 3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group (56.2%, 30.9% vs. 39.1%, 13.0%, P = 0.043). The 1- & 3-year cumulative survival rates of the anterior group were also markedly higher than those of conventional group. The Cox regression model indicated that tumor size [P = 0.014, odd ratio (OD) = 1.074] and surgical procedure (P = 0.009, OD = 0. 468) were independent risk factors correlated with disease-free survival. And the surgical procedure (P = 0.003, OD = 0.369) was the only independent risk factor for postoperative cumulative survival., Conclusion: Anterior approach right hepatectomy can significantly decrease intraoperative blood loss. The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.

Objective: To investigate the safety and efficacy of hepatic resection combined with intraoperative ablation to treat multifocal hepatocellular carcinoma., Methods: Clinical data of patients diagnosed with multifocal hepatocellular carcinoma and treated with hepatic resection combined with intraoperative ablation from March 1998 to September 2007 were retrospectively reviewed. Treatment response, postoperative complications and survival data were analyzed., Results: Combined treatment modalities were well tolerated except one patient dying of postoperative hepatic functional failure. The postoperative complication rate was 23.5% with a mortality rate of 6.7%. Postoperative complication included wound infection (1 case), bile leakage (1 case), subphrenic and pleural effusion (1 case), ablation-associated liver abscess (1 case), all of which were treated with non-surgical methods. The median survival time was 25.9 months. The 1, 3, 5 year survival rates were 70.6% (12/17), 23.5% (4/17), 17.6% (3/17), respectively. Three patients survived more than 5 years after surgery. Up to April 2008, 4 patients were still alive., Conclusion: Hepatectomy combined with intraoperative thermal ablation provides a treatment modality for patients with multifocal hepatocellular carcinoma and may improve the prognosis.

Objective: To compare the clinical results of surgical resection (SR) and percutaneous thermal ablation (PTA) for early-stage hepatocellular carcinoma (HCC) (single tumor nodule

Objective: To ascertain the changes of haemolymph protein concentration in adult Anopheles stephensi mosquitoes under different feeding conditions., Methods: Haemolymph samples from four groups of adult An. stephensi, fed with sucrose solution, normal blood, plasmodium-infected blood and nitroquine, respectively, were collected by expulsion method. The concentration of haemolymph protein was examined by Bradford method. The results were analyzed automatically by Excel program., Results: The level of protein concentration in the infected blood-fed group was higher than the sucrose solution group and normal blood group at day 8 after Plasmodium yoelii infection, the average concentration was 4.436, 3.080 and 3.092 micrograms/microliter, respectively. The haemolymph protein concentration (2.264 micrograms/microliter) in the nitroquine-administered mosquitoes was lower than the infected blood-fed mosquitoes., Conclusion: The haemolymph protein concentration of the adult An. stephensi decreases after the nitroquine administration, indicating that the haemolymph proteins may be involved in the melantotic encapsulation reaction of plasmodial oocysts.

Objective: To study the change of intracellular free Ca2+ in the oocyst when it melanized and to find out the relationship between the melanized oocyst and its intracellular level of free Ca2+ in a Plasmodium-refractory strain of Anopheles dirus., Methods: The distribution and experimental condition of the intracellular free Ca2+ in oocyst of Plasmodium yoelii was measured with Ca2+ sensitive dye Fluo-3/AM and Pluronic F-127 under confocal laser scanning microscope (CLSM) at different time., Results: The best load condition was that the oocysts were incubated in 3 mumol/ml Fluo-3/AM adding 1 microliter/ml 25% Pluronic F-127 for 60 min at 37 degrees C. Fluorescent imaging of oocysts was affected by an increase or decrease of the concentration of Fluo-3/Am and incubation time. The distribution of intracellular free Ca2+ was heterogeneous in the oocysts. The mean value of Ca2+ in the mature oocysts was (137.15 +/- 7.02) nmol/L (X +/- S) but was (18.44 +/- 1.75) nmol/L in melanized oocysts with Ca2+ sedimentation in the wall of oocyst., Conclusion: The results suggest that the level of the intracellular free Ca2+ in oocyst decreased and excreted during its melanization in a Plasmodium-refractory anopheline mosquito species.