Addressing the ACGME Competency of Communicating with the Public through the Use of TEDx Talks.

OBJECTIVES: Competency-based public communication skills are not systematically taught in most medical curricula, reflecting a gap between medical knowledge and holistic patient care as trainees transition into clinicians. We sought to investigate the efficacy of technology, entertainment, and design (TED) talks in postgraduate year (PGY) training programs. METHODS: The authors organized an official internal TEDx event in which six PGY trainees volunteered as speakers. Two experienced physicians and two administrators also participated as speakers to provide trainees a didactic shadow learning experience. The remaining PGY trainees, along with clerks, physicians, nurses, pharmacists, and administrators, attended the conference. Before the event, speakers undertook individual training sessions and learned the principles of the presentation structure and storytelling mode. At the end of the event, a survey evaluating overall satisfaction in communication skills and professionalism was administered to all of the attendees. RESULTS: Survey participants totaled 104, with a response rate of 97.2%. TEDx talks improved trainees' levels of patient care, communication, and professionalism. Speakers reported the high level of satisfaction with the event (mean 4.96 on a 5-point Likert scale; standard deviation 0.20). Participants agreed that the shadowing experience was useful and that the event encouraged them to pursue interests outside the medical field. CONCLUSIONS: This study highlights that TED is successful in terms of participant satisfaction and training in communication and professionalism. Engaging and training PGY trainees through TED-style events could bridge the gap between acquired knowledge and professional competencies. The authors recommend the implementation of TED-style events in medical training programs.

Investigation of 3.3 kV 4H-SiC DC-FSJ MOSFET Structures.

This research proposes a novel 4H-SiC power device structure-different concentration floating superjunction MOSFET (DC-FSJ MOSFET). Through simulation via Synopsys Technology Computer Aided Design (TCAD) software, compared with the structural and static characteristics of the traditional vertical MOSFET, DC-FSJ MOSFET has a higher breakdown voltage (BV) and lower forward specific on-resistance (Ron,sp). The DC-FSJ MOSFET is formed by multiple epitaxial technology to create a floating P-type structure in the epitaxial layer. Then, a current spreading layer (CSL) is added to reduce the Ron,sp. The floating P-type structure depth, epitaxial layer concentration and thickness are optimized in this research. This structure can not only achieve a breakdown voltage over 3300 V, but also reduce Ron,sp. Under the same conditions, the Baliga Figure of Merit (BFOM) of DC-FSJ MOSFET increases by 27% compared with the traditional vertical MOSFET. Ron,sp is 25% less than that of the traditional vertical MOSFET.

Copper(I)-Catalyzed Nitrile-Addition/N-Arylation Ring-Closure Cascade: Synthesis of 5,11-Dihydro-6H-indolo[3,2-c]quinolin-6-ones as Potent Topoisomerase-I Inhibitors.

In this paper, we present a copper(I)-catalyzed nitrile-addition/N-arylation ring-closure cascade for the synthesis of 5,11-dihydro-6H-indolo[3,2-c]quinolin-6-ones from 2-(2-bromophenyl)-N-(2-cyanophenyl)acetamides. Using CuBr and t-BuONa in dimethylformamide (DMF) as the optimal reaction conditions, the cascade reaction gave the target products, in high yields, with a good substrate scope. Application of the cascade reaction was demonstrated on the concise total syntheses of alkaloid isocryptolepine. Further optimization of the products from the cascade reaction led to 3-chloro-5,12-bis[2-(dimethylamino)ethyl]-5,12-dihydro-6H-[1,3]dioxolo[4',5':5,6]indolo[3,2-c]quinolin-6-one (2k), which exhibited the characteristic DNA topoisomerase-I inhibitory mechanism of action with potent in vitro anticancer activity. Compound 2k actively inhibited ARC-111- and SN-38-resistant HCT-116 cells and showed in vivo activity in mice bearing human HCT-116 and SJCRH30 xenografts. The interaction of 2k with the Top-DNA cleavable complex was revealed by docking simulations to guide the future optimization of 5,11-dihydro-6H-indolo[3,2-c]quinolin-6-ones as topoisomerase-I inhibitors.

Stimulation of the Internal Ribosome Entry Site (IRES)-Dependent Translation of Enterovirus 71 by DDX3X RNA Helicase and Viral 2A and 3C Proteases.

The translation of enterovirus 71 (EV71) is mediated by an internal ribosome entry site (IRES)-dependent manner. EV71 IRES comprises five highly structured domains (domains II-VI) in the 5'-untranslated region of the viral mRNA. A conserved AUG triplet residing in domain VI is proposed to be the ribosome entry site. It is thus envisaged that the highly structured conformation of domain VI may actually reduce the accessibility of the AUG triplet to the ribosome. This study identified a DEAD-box family RNA helicase, DDX3X, that positively regulated the EV71 IRES-dependent translation. The helicase activity of DDX3X was required for the stimulation of EV71 IRES activity; however, DDX3X was no longer important for the IRES activity when the secondary structure of domain VI was destabilized. DDX3X interacted with the truncated eIF4G which bound specifically to domain V. Thus, we proposed that DDX3X might bind to domain VI or a region nearby via the interaction with the truncated eIF4G, and subsequently unwound the secondary structure of domain VI to facilitate ribosome entry. Additionally, we demonstrated that the viral 2Apro and 3Cpro enhanced the IRES-dependent translation via their protease activities. Together, these results indicate that DDX3X is an important RNA helicase involved in EV71 IRES-dependent translation and that IRES translation is enhanced by viral infection, partly mediated by viral protease activity.

Warpage Characteristics and Process Development of Through Silicon Via-Less Interconnection Technology.

In this study, through silicon via (TSV)-less interconnection using the fan-out wafer-level-packaging (FO-WLP) technology and a novel redistribution layer (RDL)-first wafer level packaging are investigated. Since warpage of molded wafer is a critical issue and needs to be optimized for process integration, the evaluation of the warpage issue on a 12-inch wafer using finite element analysis (FEA) at various parameters is presented. Related parameters include geometric dimension (such as chip size, chip number, chip thickness, and mold thickness), materials' selection and structure optimization. The effect of glass carriers with various coefficients of thermal expansion (CTE) is also discussed. Chips are bonded onto a 12-inch reconstituted wafer, which includes 2 RDL layers, 3 passivation layers, and micro bumps, followed by using epoxy molding compound process. Furthermore, an optical surface inspector is adopted to measure the surface profile and the results are compared with the results from simulation. In order to examine the quality of the TSV-less interconnection structure, electrical measurement is conducted and the respective results are presented.

Microwave-promoted, metal- and catalyst-free decarboxylative α,ß-difunctionlization of secondary α-amino acids via pseudo-four-component reactions.

A microwave-promoted, metal- and catalyst-free decarboxylative α,ß-difunctionlization of secondary α-amino acids via a pseudo-four-component coupling of proline, aldehyde, and 1,3-diketone to generate multifunctionalized pyrano[2,3-b]pyrrole and pyrrolizinone derivatives is reported.

Magnetic nanoparticle-based platform for characterization of histidine-rich proteins and peptides.

In this study, we developed a platform that can be used to rapidly enrich polyhistidine(His)-tagged proteins/peptides from complex samples selectively using the Fe3O4@Al2O3 magnetic nanoparticles (MNPs) as the affinity probes. At pH 7, the dissociation constant between poly-His, i.e., His6, and the Fe3O4@Al2O3 MNPs was ~10(-5) M and the trapping capacity was ~100 nmol/mg for His6. Enrichment was achieved by vigorously mixing the sample solution (<2 µL) and the MNPs (1-3 µg) by pipetting directly onto a matrix-assisted laser desorption/ionization (MALDI) plate for 10 s. The time for the enrichment and the sample volume required for analysis are therefore greatly reduced. After enrichment, the MNP-target species conjugates were promptly isolated by positioning a magnet on the edge of the sample well to aggregate the conjugates into a small spot within ~5 s so that the nontarget species could be easily removed. Additionally, the problem of finding "sweet spots" on the target species during the MALDI mass spectrometry (MS) analysis was greatly reduced by magnetically isolating the target species on the MALDI plate. The limit of detection for His6 was, therefore, as low as ~400 amol. His6 and AHHAHHAAD AHHAHHAAD spiked in a protein digest and in human plasma, respectively, were used as the samples to demonstrate the practicability of this approach in selective enrichment of His-rich peptides from complex samples. We also characterized His6-tagged proteins enriched on-plate by the Fe3O4@Al2O3 MNPs followed by on-plate tryptic digestion, selective enrichment, and MALDI-MS analysis. This approach can be used to determine quickly whether His6-tagged species are present in a sample. In addition, cell lysates containing recombinant Shiga-like toxins tagged with His6 were used as the samples to further demonstrate that the feasibility of this approach in analyzing very complex samples. The entire analysis process, including the on-plate enrichment and enzymatic digestion followed by MALDI-MS analysis, can be completed within 10 min.

A gene delivery system based on the N-terminal domain of human topoisomerase I.

The N-terminal 200 amino acid residues of topoisomerase I (TopoN) is highly positive in charge and has DNA binding activity, without DNA sequence and topological specificity. Here, a fusion protein (6 x His-PTD-TopoN) containing a hexahistidine (6 x His) tag, a membrane penetration domain and TopoN (amino acid 3-200) was designed and developed. The protein can bind to different sizes (3.0-8.0 kb) and forms (circular and linear) of DNA and translocates the bound DNA to the nucleus. The protein also showed low cytotoxicity to GF-1 grouper fish fin cells that were previously very sensitive and difficult to transfect in vitro. Maintaining the hexahistidine tag increased the protein's transfection efficiency in COS7 African green monkey kidney cells and simplified the purification process. The plasmid pEGFP-N1 was delivered into COS7 cells by the protein in ATP- and temperature-dependent manners. The results indicate that the binding ability of TopoN is very useful for DNA delivery and the carrier protein can be expressed in Escherichia coli without removal of the hexahistidine tag.

Coexistence of ovarian cancer and renal cell carcinoma.

Coexistence of ovarian cancer and renal cell carcinoma (RCC) is extremely rare. Only one case was diagnosed in a total of 584 patients with RCC from 1982 to 2002 at our hospital. A 58-year-old woman presented with an enlarged girdle length for 3 months. Computed tomography scan showed a right cystic adnexal mass measuring 10 x 10 cm, and another tumor measuring 3 x 2 cm at the right kidney. She underwent debulking surgery and radical nephrectomy. Pathologic examination revealed right ovarian clear-cell carcinoma with peritoneal, omental, and fallopian tube metastasis, and conventional clear-cell renal carcinoma. RCC was strongly positive in epithelial membrane antigen (EMA) staining and negative in estrogen receptors (ER), progesterone receptors (PR), 34betaE12 (high molecular weight cytokeratin), and vimentin staining. Ovarian clear-cell carcinoma showed weakly positive results in EMA staining and negative results in ER, PR, 34betaE12, and vimentin staining. Although chemotherapy was given, the patient died of disseminated ovarian cancer metastasis 20 months after operation. In conclusion, coexistence of RCC and ovarian cancer is rare and the pathogenesis remains to be clarified.

Primary primitive neuroectodermal tumor of the urinary tract.

Primary primitive neuroectodermal tumor (PNET) of the urinary tract is a rare disease with aggressive behavior and poor prognosis. We analyzed 851 cases of urinary tract malignancies in our hospital between 1984 and 2004. Only three (0.035%) cases with PNET of the urinary tract were identified. Presenting symptoms included flank pain and hematuria. The first case was a 44-year-old man with left renal PNET who underwent hand-assisted laparoscopic radical nephrectomy and adjuvant chemotherapy. There was no recurrent tumor at the 4-year follow-up. The second case was a 75-year-old woman with right renal PNET with inferior vena cava (IVC) thrombosis extending to the right atrium. The patient underwent right radical nephroureterectomy and IVC thrombectomy with cardiopulmonary bypass. She died of metastatic disease 7 months later. The third case was a 45-year-old man with left ureteral PNET. Left ureteral segmental resection and partial cystectomy were performed. Tumor recurrence was noted 7 years later. The patient died of disseminated disease 1 year after the discovery of recurrence. Urinary tract PNET appears to be an aggressive malignancy. Long-term survival is possible if complete resection is performed at an early stage.