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Background: The existing literature lacks studies examining the epidemiological link between scrub typhus and deep vein thrombosis (DVT) or pulmonary embolism (PE), and the long-term outcomes. The objective of this study is to explore the potential association between scrub typhus and the subsequent risk of venous thromboembolism, and long-term mortality., Method: This nationwide cohort study identified 10,121 patients who were newly diagnosed with scrub typhus. Patients with a prior DVT or PE diagnosis before the scrub typhus infection were excluded. A comparison cohort of 101,210 patients was established from the general population using a propensity score matching technique. The cumulative survival HRs for the two cohorts were calculated by the Cox proportional hazards model., Result: After adjusting for sex, age, and comorbidities, the scrub typhus group had an adjusted HR (95% CI) of 1.02 (0.80-1.30) for DVT, 1.11 (0.63-1.93) for PE, and 1.16 (1.08-1.25) for mortality compared to the control group. The post hoc subgroup analysis revealed that individuals younger than 55 years with a prior scrub typhus infection had a significantly higher risk of DVT (HR: 1.59; 95% CI: 1.12-2.25) and long-term mortality (HR: 1.75; 95% CI, 1.54-1.99)., Conclusion: The scrub typhus patients showed a 16% higher risk of long-term mortality. For those in scrub typhus cohort below 55 years of age, the risk of developing DVT was 1.59 times higher, and the risk of mortality was 1.75 times higher. Age acted as an effect modifier influencing the relationship between scrub typhus and risk of new-onset DVT and death., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Rapid evolution of artificial intelligence (AI) prompted its wide application in healthcare systems. Stereotactic radiosurgery served as a good candidate for AI model development and achieved encouraging result in recent years. This article aimed at demonstrating current AI application in radiosurgery., Methods: Literatures published in PubMed during 2010-2022, discussing AI application in stereotactic radiosurgery were reviewed., Results: AI algorithms, especially machine learning/deep learning models, have been administered to different aspect of stereotactic radiosurgery. Spontaneous tumor detection and automated lesion delineation or segmentation were two of the promising application, which could be further extended to longitudinal treatment follow-up. Outcome prediction utilized machine learning algorithms with radiomic-based analysis was another well-established application., Conclusions: Stereotactic radiosurgery has taken a lead role in AI development. Current achievement, limitation, and further investigation was summarized in this article., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Nowadays, the physicians usually predict functional outcomes of stroke based on clinical experiences and big data, so we wish to develop a model to accurately identify imaging features for predicting functional outcomes of stroke patients. Using magnetic resonance imaging of ischemic and hemorrhagic stroke patients, we developed and trained a VGG-16 convolutional neural network (CNN) to predict functional outcomes after 28-day hospitalization. A total of 44 individuals (24 men and 20 women) were recruited from Taoyuan General Hospital and China Medical University Hsinchu Hospital to enroll in the study. Based on "modified Rankin Scale (mRS)" and "National Institutes of Health Stroke Scale (NIHSS)" assessments, men, women, and mixed men and women were trained separately to evaluate the differences of the results, and we have shown that VGG-16 demonstrated high accuracy in predicting the functional outcomes of stroke patients. The new deep-learning approach has provided an automated decision support system for personalized recommendations and treatments, assisting the physicians to predict functional outcomes of stroke patients in clinical practice., (© 2022. International Federation for Medical and Biological Engineering.)

The long noncoding RNA (lncRNA) THOR is highly conserved and expressed in various human cancer tissues, although its potential role and underlying mechanism in endometrial cancer (EC) remain unknown. This study aims to explore THOR's biological function and molecular mechanism in EC progression. THOR expression in EC tissues and cell lines was detected by quantitative reverse transcription PCR (qRT-PCR) and in situ hybridization (ISH). THOR expression based on The Cancer Genome Atlas (TCGA) and clinical sample analyses was significantly higher in EC tissues than normal tissues, and higher THOR levels were closely associated with poor overall survival in EC. Additionally, a positive correlation between ISH-detected THOR expression and pathological grade was observed. CCK-8, colony formation, and transwell migration and invasion assays revealed that THOR significantly enhances the proliferation, migration, and invasion abilities of EC cells. Moreover, IGF2BP1 protein expression and ERK and AKT protein phosphorylation levels in EC cells increased significantly with THOR overexpression in EC cells. In conclusion, our findings suggest that THOR promotes EC cell growth and invasion, and IGF2BP1-mediated AKT and ERK signaling pathways activation might be involved. Clinically, THOR is significantly expressed in EC, and high THOR expression correlates with poor prognosis, making it a potential prognostic marker for EC., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Acute cholecystitis (AC) is a common surgical emergency. The Tokyo Guidelines 2018 (TG18) provides a reliable algorithm for the treatment of AC patients to achieve optimal outcomes. However, the economic benefits have not been validated. We hypothesize that good outcomes and cost savings can both be achieved if patients are treated according to the TG18., Method: This retrospective study included 275 patients who underwent cholecystectomy in a 15-month span. Patients were divided into three groups (group 1: mild AC; group 2: moderate AC with American Society of Anesthesiologists (ASA) physical status class ≤ 2 and Charlson Comorbidity Index (CCI) score ≤ 5; and group 3: moderate AC with ASA class ≥ 3, CCI score ≥ 6, or severe AC). Each group was further divided into two subgroups according to management (followed or deviated from the TG18). Patient demographics, clinical outcomes, and hospital costs were compared., Results: For group 1 patients, 77 (81%) were treated according to the TG18 and had a significantly higher successful laparoscopic cholecystectomy (LC) rate (100%), lower hospital cost ($1896 vs $2388), and shorter hospital stay (2.9 vs 8 days) than those whose treatment deviated from the TG18. For group 2 patients, 50 (67%) were treated according to the TG18 and had a significantly lower hospital cost ($1926 vs $2856), shorter hospital stay (3.9 vs 9.9 days), and lower complication rate (0% vs 12.5%). For group 3 patients, 62 (58%) were treated according to the TG18 and had a significantly lower intensive care unit (ICU) admission rate (9.7% vs 25%), but a longer hospital stay (12.6 vs 7.8 days). However, their hospital costs were similar. Early LC in group 3 patients did not have economic benefits over gallbladder drainage and delayed LC., Conclusion: The TG18 are the state-of-the-art guidelines for the treatment of AC, achieving both satisfactory outcomes and cost-effectiveness., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Frailty has been shown to be an independent negative predictor of surgical outcomes in geriatric patients. Traditional measurements of muscle strength and mass are impractical in emergency settings, and computed tomography (CT)-measured skeletal muscle mass has been proposed as an alternative. However, the cutoff values for low muscle mass are still unknown, and their impact on abdominal emergencies in the elderly population is unclear., Methods: A total of 462 young trauma patients aged 18-40 years were analyzed to establish sex-specific reference cutoff values for the CT-measured muscle index (MI) and muscle gauge (MG) values. The impacts of low MI and MG values were investigated in 1192 elderly patients (aged ≥ 65 years) undergoing abdominal surgery., Results: The sex-specific cutoff values for MI and MG were determined by adopting European Working Group on Sarcopenia in Older People 2 guidelines. The correlation between MG and aging was significantly stronger than that between MI and ageing. With regard to the MG, the L4 psoas muscle gauge (L4 PMG) was further investigated in an elderly cohort owing to its high predictive value and ease of use in the clinical setting. A low L4 PMG value was an independent risk factor for overall complications and mortality in elderly patients with abdominal emergencies., Conclusion: The current study was the largest study investigating the correlations between MG values and aging in the Asian population. A low L4 PMG value may help surgeons during preoperative decision making regarding geriatric patients with abdominal emergencies., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: With recent transformations in medical education, the integration of technology to improve medical students' abilities has become feasible. Artificial intelligence (AI) has impacted several aspects of healthcare. However, few studies have focused on medical education. We performed an AI-assisted education study and confirmed that AI can accelerate trainees' medical image learning., Materials: We developed an AI-based medical image learning system to highlight hip fracture on a plain pelvic film. Thirty medical students were divided into a conventional (CL) group and an AI-assisted learning (AIL) group. In the CL group, the participants received a prelearning test and a postlearning test. In the AIL group, the participants received another test with AI-assisted education before the postlearning test. Then, we analyzed changes in diagnostic accuracy., Results: The prelearning performance was comparable in both groups. In the CL group, postlearning accuracy (78.66 ± 14.53) was higher than prelearning accuracy (75.86 ± 11.36) with no significant difference (p = .264). The AIL group showed remarkable improvement. The WithAI score (88.87 ± 5.51) was significantly higher than the prelearning score (75.73 ± 10.58, p < 0.01). Moreover, the postlearning score (84.93 ± 14.53) was better than the prelearning score (p < 0.01). The increase in accuracy was significantly higher in the AIL group than in the CL group., Conclusion: The study demonstrated the viability of AI for augmenting medical education. Integrating AI into medical education requires dynamic collaboration from research, clinical, and educational perspectives.

Purpose: Upper urinary tract urothelial carcinoma (UTUC) is a relatively uncommon malignancy in Western countries, affecting more men than women. By contrast, UTUC is relatively common in Taiwan and diagnosed more often in women than in men. Previous studies regarding the gender effect on cancer behaviour with UTUC have been controversial. Investigation of female predominance of UTUC in Taiwan may help improve UTUC management in Taiwan as well as understand the gender effect on urothelial carcinoma., Methods: Between January 2005 and December 2015, 828 patients with localized UTUC treated with radical nephroureterectomy were enrolled. Cox regression analysis was performed to assess the independent roles of perioperative factors on local recurrence and systemic recurrence., Results: Multivariate analysis revealed the male gender had a trend associated with higher systemic recurrence (P = 0.096) and independently associated with higher bladder recurrence (P = 0.011) and cancer-specific mortality (P = 0.014), even after taking smoking and other established prognostic factors into consideration. Bladder cancer history and multifocal disease are strongly associated with bladder recurrence., Conclusion: Compared with female UTUC patients, male UTUC patients in Taiwan were associated with more bladder recurrences and higher cancer-specific mortality and had a trend associated with more systemic recurrences.

Although neuralgic amyotrophy (NA) has occasionally been reported to be associated with reactivated herpes zoster, their associated risk remains unknown. The aim of this study was to assess the risk of developing NA following preceding herpes zoster. The authors used the National Health Insurance Research Database of Taiwan to select 41,548 patients with newly diagnosed herpes zoster during the period 2000 to 2010 and randomly extracted 166,192 matched control subjects. All participants in the study and control groups were followed for 3 months after the diagnosis to identify those who developed NA. Cox proportional hazards regression analyses were performed to evaluate the subsequent risk of NA. Twenty-one subjects from the group with herpes zoster (0.05%) developed NA over the 3-month period and 46 from the group without herpes zoster (0.03%). The patients with herpes zoster had a higher risk of developing NA (adjusted hazard ratio = 1.408, 95% confidence interval = 1.013-2.319, P = 0.030). In the patients with herpes zoster, female sex, age ≥ 65, hepatitis E virus (HEV), and having had a recent infectious event including pneumonia and influenza were risk factors for developing NA (adjusted HR 2.746, 1.998, 2.735, 2.016, and 1.718, respectively, all P < 0.05). Patients with herpes zoster attack have a higher risk of developing NA over a 3-month period after diagnosis, especially those who are female, age ≥ 65, HEV, or have experienced a recent infectious event or pneumonia and influenza.

It has been assumed that cognitive disorder and visual-spatial disturbance in multiple system atrophy of the predominantly cerebellar type (MSA-C) are attributable to degradation of cerebellar function. The purpose of this study was to use diffusion tensor imaging (DTI) tractography to determine if patients with MSA-C characterized in part by visual-spatial disorders and cognitive disorders have changes of the structural connectivity network of nerve fibers, and to further describe the structural connectivity network. The study included 20 patients with MSA-C and 30 age- and sex-matched healthy controls. A 1.5T magnetic resonance imaging (MRI) scanner was used to obtain images for DTI tractography. Image preprocessing was done by large deformation diffeomorphic metric mapping. Whole-brain connectivity analysis was carried out. The patients had decreased numbers of long association fibers connecting the right parietal lobe to the frontal lobe. The commissural fibers and short association fibers connecting the bilateral frontal and occipital lobes and the number of short association fibers at the bilateral frontal and occipital region were also decreased significantly. The patients had a significant decrease in fiber density in the cerebellum compared to the healthy subjects. Our results provide DTI evidence suggesting that frontal and occipital white matter is involved in patients with MSA-C. This finding may correlate with their clinical symptoms such as cognitive disturbance as well as visual-spatial impairment. Therefore, cognitive disturbance and visual-spatial deficits in MSA-C might not be due to cerebellar lesions only as is widely believed but also involve cerebral lesions.

Purpose: Traumatic diaphragm rupture is a rare trauma that is easily overlooked. A missed diagnosis would result in chronic traumatic diaphragmatic herniation (CTDH). Surgical repair is the standard treatment that is conventionally performed by laparotomy or thoracotomy. Laparoscopic repair has been reported, but its efficacy remains controversial. In this study, we present our novel technique and experience of laparoscopic repair of CTDH and analyze the feasibility and effectiveness of this procedure., Methods: We conducted a prospective collection with retrospective review of patients with CTDH treated at Chang Gung Memorial Hospital, Taiwan, from 2000 to 2013. The demographic characteristics, surgical procedure, perioperative results, length of hospital stay (HLOS) and follow-up were record and analyzed., Results: There were 114 patients with traumatic diaphragm hernia, and 24 of them had CTDH with a mean age of 54.9 ± 13.3 years. The HLOS was 15.08 ± 8.17 days. Regarding the surgical method used, 19 patients had open surgery, and 5 patients underwent laparoscopic surgery. The demographic distribution, trauma mechanism, location and size of CTDH were comparable. In the laparoscopic group, the patients had a shorter median HLOS (6 days) than in the open surgery group (16 days; p = 0.002). There was no mortality or recurrence in both groups., Conclusions: In this study and literature review, patients had laparoscopic repair with a smooth recovery. Laparoscopy provides good surgical exposure, allowing easy repositioning of the herniated content and a smooth repair of the defect without the morbidity of laparotomy. For CTDH, with caution, we can apply this technique with an acceptable result.

This study surveyed the characteristics of the indicator for the synchrony of brain activities, regional homogeneity (ReHo), in patients who were diagnosed with major depressive disorder (MDD) without co-morbidities. Forty-four patients with MDD and twenty-seven normal controls were enrolled in our study. The ReHo outputs of patients and controls were compared by a nonparametric permutation-based method with global brain volume, age, and gender as covariates. In addition, the correlations between the clinical variables (such as depression severity, anxiety severity, illness duration) and ReHo values were also estimated in each group and across both groups. The patients with MDD had lower ReHo values than the controls for the cognitive division of right anterior cingulate cortex and the left inferior parietal lobule. In contrast, the patients had higher values of ReHo than controls for the right inferior temporal lobe and the right cerebellum. Additionally, the ReHo values were negatively correlated with the depression severity and with illness duration in the right anterior cingulate cortex. MDD patients had significant alterations in the ReHo of the parieto-cingulate and temporo-cerebellum regions with opposite trends.

Purpose: To study the differences in protein expression profiles of follicular fluid (FF) between controlled ovarian hyperstimulation (COH) and natural ovulatory cycles., Methods: Twelve infertile women undergoing in vitro fertilization and embryo transfer (IVF-ET), with matched clinical information, were retrospectively recruited in the IVF center of our university hospital, including six undergoing COH and another six with natural cycles. FF was sampled from dominant follicles with mature oocytes. Protein expression profiles in each FF sample were analyzed respectively using two-dimensional gel electrophoresis. Differentially expressed proteins were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and validated by western blotting. Differentially expressed proteins were further analyzed using Ingenuity Pathway Analysis (IPA) software., Results: Two proteins were downregulated and 11 proteins were upregulated (change ≥1.5-fold, P < 0.05) in the COH group. We identified one down-egulated and seven upregulated proteins using MALDI-TOF MS. Four differentially expressed proteins, including transferrin, complement component C3 (C3), haptoglobin and alpha-1-antitrypsin (AAT), were further validated by rate nephelometry and western blotting analyses. The IPA analysis revealed a significant network involved in the humoral immune and inflammatory responses., Conclusions: The eight differentially expressed proteins were related to immune and inflammatory responses in the ovary. Our results provide new insights into the influence of COH on follicular (spp) development and IVF outcomes.

Many animals modify behavioural decisions based on information they have previously acquired. Contest behaviour is often affected by previous contest experiences: individuals behave more and less aggressively after a victory and defeat, respectively (winner/loser effect). Individuals in the field sometimes encounter multiple competitors in quick succession, but whether these experiences interact to influence each other's importance is unclear. We tested five hypotheses for experience interaction (no interaction, retroactive interference, proactive interaction, reinforcement and diminishing returns) using Kryptolebias marmoratus. Focal individuals were paired up with opponents having the same 1-month contest outcome (1 month before the experiment), as this difference in actual or perceived fighting ability has been shown to affect the fish's response to new experiences. We gave the focal individual of a pair a winning or losing experience on day 1. Then both fish of the pair received the same winning, losing or no-contest experience on day 2. Then we organised fights between the two. The effect of a day-1 losing experience did depend on the fish's actual or perceived fighting ability: one-month losers readily showed loser effects from the day-1 losing experience, irrespective of the day-2 experience (i.e. no interaction between day-1 and day-2 experiences). One-month winners, however, only showed loser effects from a day-1 losing experience when the day-2 experience was also a loss (i.e. reinforcement). Day-1 winning experiences did not interact with day-2 experiences in 1-month losers or winners. Therefore, multiple experiences sometimes reinforce each other, but how they combine to influence behaviour depends on an individual's actual or perceived fighting ability.

Cerebellar hemorrhage (CH) is considered a predictive factor for poor outcome after intracranial hemorrhage because of the high risk of brainstem compression. Hence, predictors of early mortality in patients with spontaneous CH are clinically valuable. However, the predictors of death within 7 days of CH onset have not yet been studied. In this study, 70 patients with acute spontaneous CH were retrospectively analyzed. The patients were divided into the first-week mortality group (n = 15, died within 7 days) and survival group (n = 55, survived at discharge). The association between first-week mortality and clinical characteristics was investigated using a multivariate logistic regression. The initial Glasgow coma scale (GCS) values (5.0 ± 2.8) in the first-week mortality group were significantly lower than those in the survival group (12.8 ± 3.3) (p < 0.001). Brainstem compression was indicative of first-week mortality (p < 0.001). GCS scores ≤8 (odds ratio, OR = 32.344, p = 0.003) and brainstem compression (OR = 14.417, p = 0.009) were strong predictors of first-week mortality in patients with CH. This is the first study showing that GCS scores ≤8 on arrival and brainstem compression are strong predictive factors for first-week mortality in patients with CH. These patients were about 32 and 14.5 times, respectively, more likely to die within 7 days.

In cranioplasty, neurosurgeons use bone grafts to repair skull defects. To ensure the protection of intracranial tissues and recover the original head shape for aesthetic purposes, a custom-made pre-fabricated prosthesis must match the cranial incision as closely as possible. In our previous study (Liao et al. in Med Biol Eng Comput 49:203-211, 2011), we proposed an algorithm consisting of the 2D snake and image registration using the patient's own diagnostic low-resolution and defective high-resolution computed tomography (CT) images to repair the impaired skull. In this study, we developed a 3D multigrid snake and employed multiresolution image registration to improve the computational efficiency. After extracting the defect portion images, we designed an image-trimming process to remove the bumped inner margin that can facilitate the placement of skull implants without manual trimming during surgery. To evaluate the performance of the proposed algorithm, a set of skull phantoms were manufactured to simulate six different conditions of cranial defects, namely, unilateral, bilateral, and cross-midline defects with 20 or 40% skull defects. The overall image processing time in reconstructing the defect portion images can be reduced from 3 h to 20 min, as compared with our previous method. Furthermore, the reconstruction accuracies using the 3D multigrid snake were superior to those using the 2D snake.

Objective: The study aimed to evaluate whether the inflammatory marker "high-sensitivity C-reactive protein (hsCRP)" level was associated with impaired heart rate recovery at 1 min after exercise termination (HRR-1) in middle-aged patients with severe obstructive sleep apnea (OSA)., Methods: Thirty middle-aged male patients (40-64 years old) with severe OSA (apnea-hypopnea index [AHI] ≥ 30 h(-1)) and 30 subjects without OSA (AHI < 5 h(-1)), matched with age and body mass index (BMI), were recruited. All subjects underwent an overnight polysomnography and completed a symptom-limited maximal exercise test. Cardiopulmonary parameters included peak oxygen consumption (VO(2peak)) and heart rate response during and immediately after exercise. Fasting blood samples were drawn for hsCRP analysis., Result: Patients with severe OSA had significantly higher hsCRP levels (0.18 vs. 0.07 mg/dl, P < 0.01), lower reduced HRR-1, peak heart rate, and VO(2peak) values than those in the controls. The hsCRP levels significantly correlated with HRR-1 in the OSA group (r = -0.69, P < 0.01) after adjustment for VO(2peak) (r = -0.66, P < 0.01). Furthermore, stepwise multiple regression analysis showed that HRR-1 and AHI were significant predictors of hsCRP levels in all participants (adjusted R(2) = 0.53, P < 0.01)., Conclusions: Blunted HRR was shown in middle-aged men with severe OSA, and it was associated with high hsCRP levels significantly.

Acute stroke patients commonly suffer from hyperglycemia. However, the relationship between hyperglycemia and poor outcome after discharge of patients with acute cerebellar hemorrhage (CH) had not been hitherto investigated.Sixty-two patients with acute spontaneous CH were retrospectively analyzed. The consciousness level, blood glucose/sugar (BS) on arrival and maximum diameter of hematoma, etc., were obtained. Patient prognosis was scored by the Glasgow Outcome Scale (GOS) at discharge and we divided them into good outcome (GOS score of 4 or 5) and poor outcome (GOS score of 1 or 2 or 3) groups. The association between early outcome and clinical characteristics were investigated by multivariate logistic regression. There were 33 (53.4%) patients in the poor outcome group and 29(46.6%) in the good outcome group. The initial BS was significantly higher in the poor outcome group (186.4±57 mg/dl) compared with good outcome group (136.6±31.1 mg/dl)(p<0.001). BS≥140 mg/dl (OR=25.217, p=0.008) and maximum diameter of hematoma ≥3 cm (OR=216.422, p<0.001) were independently correlated with poor outcome. We report the first study that hyperglycemia (BS≥140 mg/dl) on arrival and maximum diameter of hematoma ≥3 cm were found to be strong predictive factors of poor outcome at discharge in patients with acute spontaneous CH.

Meningeal hemangiopericytoma (HPC) is a clinicopathologically well-characterized malignancy with a high tendency to recur locally and to metastasize outside the central nervous system (CNS). We render clinicopathologic features of 12 cases of this uncommon tumor to further elucidate the relationship between the status of the DNA-repair enzyme O(6)-methylguanine-DNA methyltransferase (MGMT) and the prognosis. Twenty-five specimens of meningeal HPC belonging to 12 patients were obtained at a single institution from 1992 to 2001. Correlations of histologic parameters, immunohistochemical study and clinical features were assessed. This series included five men and seven women with a median age of 37.5 years at the first surgery. The median post-operative follow-up period was 7.6 years. Six patients (55%) had single or multiple local tumor recurrences. The mean time to recurrence was 6.7 years. Distant metastasis occurred in three patients (27%) at a mean time of 6.5 years after first operation. The most frequent metastatic sites were liver and lung. Histopathologically, eight primary tumors (67%) belonged to WHO grade II, while four primary tumors (33%) belonged to WHO grade III. Immunohistochemically, 18% primary tumors exhibited 3+ to 4+ nuclear staining for MGMT protein, 18% exhibited 2+ staining, and 64% exhibited 0 to 1+ staining. The overall survival rate was 67 and 33% for primary tumors with 0 to 1+ and 2+ to 4+ MGMT staining, respectively (P = 0.018). The study illustrates aggressive behavior of meningeal HPC and the prognostic value of the status of MGMT protein expression.

Clear cell meningioma is an uncommon variant of meningiomas that often occurs in young patients, shows a proclivity for spinal intradural extramedullary and cerebellopontine angle, and follows an aggressive clinical course. We render clinicopathologic features of ten cases of this rare tumor to further elucidate its behavior. Fifteen specimens of clear cell meningioma belonging to ten patients were obtained at a single institution from 2001 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included eight men and two women with a mean age of 62.1 years at the first surgery. The mean post-operative follow-up period was 3.9 years. Four patients (40%) had single or multiple local tumor recurrences. The mean time to recurrence was 2.3 years. Seven tumors (46.7%) were combined with chordoid features. There was a wide range of MIB-1 labeling indices (4.4-33.5%, mean 15.8%), which were higher in recurrent tumors, tumors with chordoid features, and tumors with necrosis. There was no correlation between MIB-1 labeling indices and brain invasion. The study illustrates aggressive behavior of clear cell meningioma and frequently combined chordoid features in our cases.

Co-registration of brain SPECT and MR images has been used extensively in clinical applications. The complementary features of two major co-registration methods--surface- and mutual-information-based (MI-based)--motivated us to study a hybrid-based scheme that uses the surface-based method to achieve a quick alignment, followed by the MI-based method for fine tuning. Computer simulations were conducted to evaluate the accuracy and robustness of surface-, MI-, and hybrid-based registration methods by designing different levels of noise and mismatch in the registration experiments. Results demonstrated that the hybrid surface-MI-based scheme outperforms both the surface- and MI-based methods in providing superior accuracy and success rates. Specifically, the translational and rotational errors were no more than 1 mm and 2°, respectively, with consistent success rates over 98%. Besides, the hybrid-based method saved 12-53% of the computation efforts, compared with using the MI-based method alone. We recommend the use of hybrid-based method when the orientational differences between the floating and reference images exceed 10°.

Genomic simple sequence repeat (SSR) markers are particularly valuable in studies of genetic diversity, evolution, genetic linkage map construction, quantitative trait loci tagging, and marker-assisted selection because of their multi-allelic nature, reproducibility, co-dominant inheritance, high abundance, and extensive genome coverage. The traditional methods of SSR marker development, such as genomic-SSR hybrid screening and microsatellite enrichment, have the disadvantages of high cost and complex operation. The selectively amplified microsatellite method is less costly and highly efficient as well as being simple and convenient. In this study, 252 sequences with SSRs were cloned from the rubber tree (Hevea brasiliensis) genome from which 258 SSR loci were obtained. The average repeat number was six. There were only 10 (3.9%) mononucleotide, trinucleotide, and pentanucleotide repeats, whereas the remaining 248 (96.1%) were dinucleotide repeats, including 128 (49.6%) GT/CA repeats, 118 (45.7%) GA/CT repeats, and 2 (0.8%) AT/TA repeats. A total of 126 primer pairs (see ESM) were successfully designed of which 36 primer pairs generated polymorphic products from 12 accessions of the cultivated species, 4 related species, and 3 species of the family Euphorbiaceae. In addition, investigations based on four genomic SSRs (GAR4, ACR22, CTR25, and GTR28) by cloning and sequencing provided evidence for cross-species/genera applicability, and homologous sequences were obtained from the rubber tree and Euphorbiaceae. Further analysis about the variation of the flanking regions of the four markers was carried out.

In neurosurgery, cranial incisions during craniotomy can be recovered by cranioplasty--a surgical operation using cranial implants to repair skull defects. However, surgeons often encounter difficulties when grafting prefabricated cranial plates into defective areas, since a perfect match to the cranial incision is difficult to achieve. Previous studies using mirroring technique, surface interpolation, or deformed template had limitations in skull reconstruction to match the patient's original appearance. For this study, we utilized low-resolution and high-resolution computed tomography images from the patient to repair skull defects, whilst preserving the original shape. Since the accuracy of skull reconstruction was associated with the partial volume effects in the low-resolution images and the percentage of the skull defect in the high-resolution images, the low-resolution images with intact skull were resampled and thresholded followed by active contour model to suppress partial volume artifacts. The resulting low-resolution images were registered with the high-resolution ones, which exhibited different percentages of cranial defect, to extract the incised cranial part. Finally, mesh smoothing refined the three-dimensional model of the cranial defect. Simulation results indicate that the reconstruction was 93.94% accurate for a 20% skull material removal, and 97.76% accurate for 40% skull material removal. Experimental results demonstrate that the proposed algorithm effectively creates a customized implant, which can readily be used in cranioplasty.

Chordoid meningioma is an uncommon variant of meningioma, which histologically bears a great resemblance to chordoma and often follows an aggressive clinical course. We examine clinicopathologic features of 11 cases of this rare tumor to further elucidate its behavior. Thirteen specimens of chordoid meningioma belonging to 11 patients were obtained at a single institution from 1995 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included six men and five women with a mean age of 60.8 years at first surgery. Aside from one patient (case 5) who died of disease immediately after the first operation, the mean postoperative follow-up period for the other 10 patients was 41.4 months. Two patients each had a local tumor recurrence. The mean time to recurrence was 10.4 years. No systemic manifestations of Castleman syndrome, such as iron-refractory hypochromic/microcytic anemia and dysgammaglobulinemia, were found. Six tumors (46%) were classified as benign (grade I) and seven tumors (54%) atypical (grade II), if based solely on histologic grading irrespective of chordoid or clear cell components in our cases. Lymphoplasmacytic infiltrate was moderate in one tumor (7%), mild in eight tumors (62%), and absent in four tumors (31%). The inflammatory cells were predominantly T cells (CD3+), with only scarce B cells (CD20+). There was a wide range of MIB-1 labeling indices (0.3-25.8%, mean 7.5%), which increased following tumor recurrence. Our study demonstrates that chordoid meningiomas are not always associated with Castleman's Syndrome, and that this histologic category can be seen in the elderly as opposed to only in younger age groups.

To characterize the pathway of ceftriaxone penetration into intervertebral discs, rat-tail discs were collected and immersed in a ceftriaxone solution for an in vitro study. For this in vivo experiment, plasma and tail discs were collected 30 min after ceftriaxone administration (463.2 mg/kg, equal to 500 mg/kg disodium salt, iv). The ceftriaxone levels in the plasma and discs were determined with HPLC by a reversed-phase C18 column and a mobile phase of methanol and a 10 mM K(2)HPO(4) solution (pH 6.7) (21:79, v/v). The results indicate that ceftriaxone was undetectable by the in vitro model. The concentrations of ceftriaxone in plasma and in intervertebral discs were 147.4 ± 21.2 and 4.0 ± 1.7 µg/mL (as disodium salt), respectively. Our results suggest that a sufficient blood supply is required for the passive diffusion of ceftriaxone into intervertebral discs. The concentration ratio of ceftriaxone in intervertebral disc-to-plasma was about 2.7% at 30 min after ceftriaxone disodium administration (500 mg/kg, iv).

It has been suggested that the cerebellum participates in diverse neuropsychological functions by adjusting the sensory information acquired for the connected brain regions to support its processing capabilities. Nevertheless, the knowledge of how the cerebellum is modulated by the sensory information is far from clear. Function magnetic resonance imaging was exploited to investigate how the cerebellum activity and cerebrocerebellum interaction can be affected by the interaction between visual size and duration information during visual duration discrimination. The present findings support the sensory acquisition hypothesis that the cerebellum, together with extensive cortical networks, yields higher activation with incongruent sensory information to cope with increasing cortical computational demand. Furthermore, comprehensive intracerebellum connections are engaged in tasks with congruent sensory information for saving cortical computation with integrated sensory information.

This aim of this study was to characterize upper and lower trapezius muscle activity for patients experiencing frozen shoulder syndrome (FSS) compared to asymptomatic subjects. Fifteen patients suffering from unilateral FSS and 15 asymptomatic subjects voluntarily participated in this study. Data were gathered on electromyographic (EMG) activity obtained from the upper and lower trapezius muscles during maximal static arm elevations at six different testing positions: 60 and 120 degrees of flexion, abduction in the frontal plane, and abduction in the scapular plane. The group with FSS revealed increased upper trapezius EMG activity at the 60 degrees (mean difference = 12%, p < 0.003) and 120 degrees (mean difference = 24%, p < 0.004) testing positions, and increased lower trapezius EMG activity at the 120 degrees testing positions (mean difference = 6%, p < 0.002), compared to asymptomatic subjects. Higher ratios of the upper trapezius to lower trapezius EMG activity were also found in the patient group (p < 0.0005) compared to asymptomatic subjects. The results of this study indicate that the increased trapezius muscle activity may contribute to scapular substitution movement in compensation for impaired glenohumeral motion in patients with FSS. The insufficiency of the increased lower trapezius muscle activity should be an important consideration in the rehabilitation of patients experiencing FSS.