Sympathetic predominance before tourniquet deflation is associated with a reduction in arterial blood pressure after tourniquet deflation during total knee arthroplasty.

High dependency of arterial blood pressure (ABP) on enhanced sympathetic activity, which maintains vascular tone, leads to hypotension after hemodynamic insults that blunt the sympathetic activity. Therefore, we hypothesized that sympathovagal balance before tourniquet deflation (TD) determines the extent of a reduction in ABP after TD during total knee arthroplasty (TKA). Fifty-four hypertensive female patients undergoing TKA under spinal anesthesia were analyzed. The sympathovagal balance [low-to-high frequency ratio of heart rate variability (LF/HF)] before TD was defined as (LF/HF during 5 min before TD-preanesthetic LF/HF)/preanesthetic LF/HF (%). An increase in its value represents a shift in sympathovagal balance toward sympathetic predominance. The percent change in the mean ABP (MAP) after TD was defined as (minimum MAP during 10 min after TD-averaged MAP during 5 min before TD)/averaged MAP during 5 min before TD (%). Simple linear regression was performed to assess the correlation between the sympathovagal balance before TD and change in MAP after TD. The correlation was also assessed by multiple linear regression controlling for age, duration of tourniquet inflation, and spinal anesthesia-induced hypotension. Thirty-two minutes (on average) after tourniquet inflation, the MAP was decreased by 12.1 (-3.0 to 47.9) % [mean (range)] upon TD (P<0.001). The sympathovagal balance before TD was negatively proportional to the change in MAP after TD in both simple and multiple linear regression models (R2=0.323 and 0.340, P<0.001). A shift in sympathovagal balance toward sympathetic predominance before TD is associated with a decrease in ABP after TD.

Efficacy and safety of ultrasound-guided high-intensity focused ultrasound for uterine fibroids: a preliminary experience.

The objective of this prospective cohort study was to evaluate the therapeutic efficacy and safety of ultrasound-guided high-intensity focussed ultrasound (HIFU) in the treatment of uterine fibroids. Twenty premenopausal women with symptomatic fibroids underwent ultrasound-guided HIFU therapy. Twenty-two fibroids with a median baseline volume of 127.0 cm3 (range 18.5-481.2 cm3) were treated. The percentages fibroid volume reduction were 46.9 (range -8.8-73.1) at 1-month, 57.4 (-51.5-95.2) at 3-month, 60.1 (-18.9-97.8) at 6-month and 75.9 (-33.7-99.3) at 12-month, after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores were reduced by 40.7% (0-59.3%) at 3-month, 45.5% (0-70.4%) at 6-month and 44.9% (0-71.4%) at 12-month after treatment. Three patients required subsequent surgical interventions. No significant complications were encountered. Ultrasound-guided HIFU appears to be effective and safe for the treatment of symptomatic uterine fibroids in selected patients. Impact statement What is already known on this subject? Ultrasound-guided high-intensity focussed ultrasound (HIFU) is a relatively new uterine-sparing treatment for fibroids. Most clinical reports are from China, which suggest that this treatment is a safe and effective modality. However, in many other countries, HIFU treatment for fibroids, especially using ultrasound as image guidance, is still considered novel with limited clinical experience. What do the results of this study add? This preliminary report adds to our limited local experience on HIFU and provides reassurance on our continual utilisation of this treatment modality for fibroids. With the increasing demand of uterine-sparing alternatives, experiences shared among different countries are important to make this treatment modality generalisable and universally acceptable. What are the implications of these findings for clinical practice and/or further research?Ultrasound-guided HIFU (USgHIFU) can potential be offered as an alternative treatment modality for women with fibroids.

Changes in the Ratio of T Helper 1 to T Helper 2 Signature Cytokines in Patients Undergoing Living Donor Liver Transplantation Surgery: A Prospective Controlled Study.

BACKGROUND: The balance between T helper 1 (Th1) and T helper 2 (Th2) signature cytokines plays a critical role in the immune response. The aim of this study was to evaluate the Th1 to Th2 cytokine ratio in healthy persons and patients with cirrhotic hepatitis and to investigate changes in the Th1 to Th2 cytokine ratio during living donor liver transplantation (LDLT) surgery. METHODS: Eighty patients were allocated to each of the donor and recipient groups. In the recipient group, signature cytokines-interferon gamma (IFN-γ) and tumor necrosis factor α (TNF-α) as Th1 and interleukin 6 (IL-6) and interleukin 10 (IL-10) as Th2-were quantified after induction of anesthesia (baseline, stage 1), 60 minutes after the start of the anhepatic phase (stage 2), and 60 minutes after reperfusion (stage 3). In the donor group, cytokine levels were analyzed only at stage 1. The Th1/Th2 cytokine ratios at baseline and over time during surgery in the recipient group were evaluated. RESULTS: At stage 1, the recipient group exhibited higher levels of all cytokines than the donor group. However, the IFN-γ/IL-6, IFN-γ/IL-10, TNF-α/IL-6, and TNF-α/IL-10 ratios of the groups were comparable. The levels of all cytokines, except IFN-γ, increased during LDLT. The IFN-γ/IL-6, IFN-γ/IL-10, TNF-α/IL-6, and TNF-α/IL-10 ratios declined significantly during LDLT. CONCLUSIONS: The preoperative Th1/Th2 cytokine ratios were similar in healthy persons and patients with cirrhotic hepatitis. During LDLT surgery, Th2 activity was enhanced, as indicated by a shift in the Th1/Th2 cytokine ratio toward Th2.

Highly Dispersible Buckled Nanospring Carbon Nanotubes for Polymer Nano Composites.

We propose the unique structure of highly dispersible single-walled carbon nanotubes (SWCNTs) in various solvents and polymers using the ZnO nano particle template. Buckled nanospring-shaped carbon nanotubes (NS-CNTs) were synthesized by a chemical reaction of ZnO nanoparticles with acid-treated SWCNTs and then dissolving ZnO through chemical etching. The unique structure of distorted hexagonal NS-CNTs encircled around ZnO nanoparticles was formed by the bending of SWCNTs caused by the agglomeration of chemically adsorbed Zn(OH)2, which is further crystallized as the polycrystalline ZnO inner core. The highly dispersible NS-CNTs could be incorporated in the poly[(vinylidenefluoride-co-trifluoroethylene] [P(VDF-TrFE)] copolymer, one of widely studied ferro- and piezo-electric polymer, up to the value of 15 wt% as nanofillers. The relative dielectric constant (K) of polymer nanocomposite, at 1 kHz, was greatly enhanced from 12.7 to the value of 62.5 at 11 wt% of NS-CNTs, corresponding to a 492% increase compared to that of pristine P(VDF-TrFE) with only a small dielectric loss tangent (D) of 0.1.

Ovarian Reserve After Ultrasound-Guided High-Intensity Focused Ultrasound for Uterine Fibroids: Preliminary Experience.

OBJECTIVE: To determine the effect on ovarian reserve of ultrasound-guided high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids. METHODS: We performed a mid-study analysis of markers of ovarian reserve using data from a prospective cohort study evaluating the safety of ultrasound-guided HIFU for uterine fibroids. Blood samples obtained from 12 women with uterine fibroids less than one week before treatment were used for measurement of serum anti-Mullerian hormone (AMH), and this testing was repeated in the first, third, sixth, and 12th month after ultrasound-guided HIFU treatment. RESULTS: Fourteen fibroids from 12 patients were treated using ultrasound-guided HIFU. The median baseline fibroid volume was 101.2 cm(3) (range 18.5 to 349.2 cm(3)). The median treatment time was 140.5 minutes (46 to 192 minutes), and median sonication time was 1449 seconds (range 541 to 2445 seconds). The median energy delivered was 575 521.5 joules (range 216 400 to 898 273 joules). The median AMH levels (ng/mL) before treatment and at one, three, six, and 12 months after treatment were 0.3 (range 0.01 to 1.94), 0.47 (0.01 to 1.43), 0.205 (0.01 to 1.81), 0.26 (0 to 2.37), and 0.06 (0.02 to 1.04), respectively. There was no significant difference between the AMH levels before and at any time after treatment. No patient became amenorrheic or reported symptoms suggestive of menopause after treatment. CONCLUSION: Our preliminary experience suggests that ovarian reserve does not seem to be affected by ultrasound-guided HIFU in the treatment of uterine fibroids.

Drug driven psychoses and legal responsibility or insanity in six Western Pacific nations.

Prompted by four questions, forensic mental health clinicians from Russia, China, Japan, Hong Kong, Australia and New Zealand provided information on both the legislative basis and current practice concerning the relationship between legal insanity, intoxication and drug induced psychosis in their six Pacific Rim Countries which account for nearly 20% of the world's population. Details of the survey for each contributing nation are provided. While there are significant variations in practice that have been shaped by regional legal, clinical and cultural influences there is considerable similarity in the legislation underpinning how these issues are considered. Consequently there remain similar challenges for each nation. In none of the legislative bases was the issue of drug induced psychosis specifically addressed. The authors conclude that evolving pharmaco-neuropsychiatric knowledge, societal values and patterns of substance misuse require nations to consider developments in scientific and clinical knowledge to support their interpretations of the relationship between altered mental states as a result of substance use and the legal construct of insanity.

Nanostructured Thin Film Silicon Anodes for Li-Ion Microbatteries.

Thin film microbatteries require electrode materials with high areal specific capacities and good cyclability. Use of vapor-deposited silicon thin films as anodes in Li-ion microbatteries offers the advantage of high capacity as well as compatibility with other processes used for microsystem fabrication. Unfortunately, monolithic silicon films greater than 200 nm in thickness pulverize during lithiation and delithiation. We have used metal-assisted-chemical-etching of sputter-deposited amorphous silicon films to make nanoporous silicon layers and arrays of silicon nanopillars as a means of achieving anodes with high areal capacity and good cyclability. We have compared the performance of these nanostructured layers with the performance of monolithic silicon films in Li half-cells. A reduced first cycle coulombic efficiency was observed in all cases and was attributed to the irreversible formation of Li2O due to the presence of oxygen in the sputter-deposited silicon films. This was controlled through modifications of the sputtering conditions. As expected, monolithic films thicker than 200 nm showed poor cycling performance due to pulverization of the film. Nanoporous silicon showed good initial cycling performance but the performance degraded due to porosity collapse and delamination. Arrays of silicon nanopillars made from 750 nm silicon films exhibited good cycling, rate performance and an areal capacity (0.20 mA h cm(-2)) 1.6 times higher than what could be obtained with monolithic Si films with similar cyclability.

Synthesis and Characterization of Cobalt/Palladium Multilayer Film and Nanodiscs on Polyethylene Terephthalate Substrate.

Cobalt/Palladium (Co/Pd) multilayer film and nanodisc samples were fabricated on polyethylene terephthalate (PET) substrates. The effects of surface roughness and grain size of PET substrate, the Co/Pd layer and the Au intermediate layer on the magnetic properties of these samples were investigated. We observed that the coercivity for Co/Pd films deposited directly on a smoother PET substrate is significantly smaller when compared with Co/Pd films deposited at the same time on Au buffer layer. The patterned Co/Pd nanodisc array exhibited a larger coercivity than the corresponding continuous film due to lower probability of finding nucleation sites in reduced film area.

Metal assisted anodic etching of silicon.

Metal assisted anodic etching (MAAE) of Si in HF, without H2O2, is demonstrated. Si wafers were coated with Au films, and the Au films were patterned with an array of holes. A Pt mesh was used as the cathode while the anodic contact was made through either the patterned Au film or the back side of the Si wafer. Experiments were carried out on P-type, N-type, P(+)-type and N(+)-type Si wafers and a wide range of nanostructure morphologies were observed, including solid Si nanowires, porous Si nanowires, a porous Si layer without Si nanowires, and porous Si nanowires on a thick porous Si layer. Formation of wires was the result of selective etching at the Au-Si interface. It was found that when the anodic contact was made through P-type or P(+)-type Si, regular anodic etching due to electronic hole injection leads to formation of porous silicon simultaneously with metal assisted anodic etching. When the anodic contact was made through N-type or N(+)-type Si, generation of electronic holes through processes such as impact ionization and tunnelling-assisted surface generation were required for etching. In addition, it was found that metal assisted anodic etching of Si with the anodic contact made through the patterned Au film essentially reproduces the phenomenology of metal assisted chemical etching (MACE), in which holes are generated through metal assisted reduction of H2O2 rather than current flow. These results clarify the linked roles of electrical and chemical processes that occur during electrochemical etching of Si.

Synthesis of free-standing, curved Si nanowires through mechanical failure of a catalyst during metal assisted chemical etching.

The fabrication of orderly arrays of free-standing, curved Si nanowires over large areas (1 cm × 1 cm) was demonstrated by means of interference lithography and intentional mechanical failure of a perforated Au catalyst during metal assisted chemical etching. Photoresist microgrooves were deposited on the perforated Au film to cause uneven etching which resulted in the build-up of bending stresses in the Au film to the point of catastrophic failure. By considering the initial positions of the holes in the perforated Au film relative to the photoresist constraints, the precise location of the fracture can be predicted using simple beam mechanics. Therefore, the type of curved nanowires obtained can be designed with a high degree of reliability and control. Four distinct types of nanowire arrangements were demonstrated for this study.

Thermoporometry characterization of silica microparticles and nanowires.

We present the results of a systematic study on the porosity of silica microparticles and nanowires prepared by glancing angle deposition-metal-assisted chemical etching (GLAD-MACE) and interference lithography-metal-assisted chemical etching (IL-MACE) techniques using the thermoporometry (TPM) method. Good agreement was obtained between our TPM results and published data provided by the suppliers of silica microparticles. TPM characterization of the GLAD-MACE and IL-MACE nanowires was carried out on the basis of parameters obtained from TPM experiments on microparticles. Our nanowires showed a similar trend but lower values of the pore volume and surface area than nanowires prepared by MACE with AgNO3 solution. We attribute the enhanced bioanalysis performance of the GLAD-MACE nanowires based devices to the increased pore volume and total surface area of the nanowires.

Fabrication of nanostructures on polyethylene terephthalate substrate by interference lithography and plasma etching.

We report results of an attempt to create nanostructures on polyethylene terephthalate substrate using the interference lithography and plasma etching technique. Methods to create nanogrooves, nanopillars, nanofins and nanoholes have been presented. The effects of chemical and physical etching associated with plasma etching on the synthesis of nanostructures were examined in detail. Different etch rates and anisotropy as a function of plasma power and pressure were reported and explained, offering good understanding of the physics of the etching process. Ways to improve anisotropy have been suggested and experimentally verified. We show that this method can produce nanostructured substrate with wide surface coverage and good uniformity. The flexibility of this method was demonstrated in that the period and shapes of the nanopattern can be varied easily without resorting to complicated fabrication processes and machinery. Our method brings forth an easy and cost-effective way to create uniform nanostructures on a large area in a controllable fashion.

Droplet spreading on a two-dimensional wicking surface.

The dynamics of droplet spreading on two-dimensional wicking surfaces were studied using square arrays of Si nanopillars. It was observed that the wicking film always precedes the droplet edge during the spreading process causing the droplet to effectively spread on a Cassie-Baxter surface composed of solid and liquid phases. Unlike the continual spreading of the wicking film, however, the droplet will eventually reach a shape where further spreading becomes energetically unfavorable. In addition, we found that the displacement-time relationship for droplet spreading follows a power law that is different from that of the wicking film. A quantitative model was put forth to derive this displacement-time relationship and predict the contact angle at which the droplet will stop spreading. The predictions of our model were validated with experimental data and results published in the literature.

Vertical etching with isolated catalysts in metal-assisted chemical etching of silicon.

Metal assisted chemical etching with interconnected catalyst structures has been used to create a wide array of organized nanostructures. However, when patterned catalysts are not interconnected, but are isolated instead, vertical etching to form controlled features is difficult. A systematic study of the mechanism and catalyst stability of metal assisted chemical etching (MACE) of Si in HF and H(2)O(2) using Au catalysts has been carried out. The effects of the etchants on the stability of Au catalysts were examined in detail. The role of excess electronic holes as a result of MACE was investigated via pit formation as a function of catalyst proximity and H(2)O(2) concentration. We show that a suppression of excess holes can be achieved by either adding NaCl to or increasing the HF concentration of the etching solution. We demonstrate that an electric field can direct most of the excess holes to the back of the Si wafer and thus reduce pit formation at the surface of Si between the Au catalysts. The effect of hydrogen bubbles, generated as a consequence of MACE, on the stability of Au catalysts has also been investigated. We define a regime of etch chemistry and catalyst spacing for which catalyst stability and vertical etching can be achieved.

Nanostructured Si-nanowire microarrays for enhanced-performance bio-analytics.

We demonstrate the fabrication of a novel platform based on Si nanowire arrays integrated with a programmable DNA-directed homogeneous-phase analyte-capture strategy for robust detection of bio-analytes. The nanofabrication process used, based on a combination of glancing-angle-deposition and metal-assisted-catalytic-etching, is capable of producing thousands of testing sites per chip, and the sites can be fabricated over entire wafers, with precise control of size and positioning, using conventional microelectronics technology. The analyte-capture strategy used eliminates the well-known interference of the heterogeneous-phase (substrate) with the capturing of analytes. We examine the effects of the nanoscale features of the substrates (nanowire porosity and clumping) on the coupling efficiency of analytes and show that the fabricated microarrays are robust, have high efficiency and capacity, and provide significantly enhanced signal-to-noise ratio detection.

Dynamics of wicking in silicon nanopillars fabricated with interference lithography and metal-assisted chemical etching.

The capillary rise of liquid on a surface, or "wicking", has potential applications in biological and industrial processes such as drug delivery, oil recovery, and integrated circuit chip cooling. This paper presents a theoretical study on the dynamics of wicking on silicon nanopillars based on a balance between the driving capillary forces and viscous dissipation forces. Our model predicts that the invasion of the liquid front follows a diffusion process and strongly depends on the structural geometry. The model is validated against experimental observations of wicking in silicon nanopillars with different heights synthesized by interference lithography and metal-assisted chemical etching techniques. Excellent agreement between theoretical and experimental results, from both our samples and data published in the literature, was achieved.

Creation of nanostructures by interference lithography for modulation of cell behavior.

Emerging evidence of the striking differences that can be induced in the behavior of biological cells through topographical modulation of physically and chemically patterned nanostructured surfaces provides a great impetus for developing novel cellular-scale and sub-cellular-scale nanopatterned substrates and for employing them for exciting new applications in life and medical sciences and biotechnology. However, the lack of availability of cost-effective, large-surface-area nanofabricated substrates of appropriate dimensions and features has proved to be a major impediment for research in this area. Here, we demonstrate a simple and cost-effective method based on interference lithography to produce spatially precise and wide-surface-coverage silicon- and polymer-based nanostructures to study how cells react to nanoscale structures or surfaces.

Mimicking both petal and lotus effects on a single silicon substrate by tuning the wettability of nanostructured surfaces.

We describe a new method of fabricating large-area, highly scalable, "hybrid" superhydrophobic surfaces on silicon (Si) substrates with tunable, spatially selective adhesion behavior by controlling the morphologies of Si nanowire arrays. Gold (Au) nanoparticles were deposited on Si by glancing-angle deposition, followed by metal-assisted chemical etching of Si to form Si nanowire arrays. These surfaces were chemically modified and rendered hydrophobic by fluorosilane deposition. Au nanoparticles with different size distributions resulted in the synthesis of Si nanowires with very different morphologies (i.e., clumped and straight nanowire surfaces). The difference in nanowire morphology is attributed to capillary force-induced nanocohesion, which is due to the difference in nanowire porosity. The clumped nanowire surface demonstrated the lotus effect, and the straighter nanowires demonstrated the ability to pin water droplets while maintaining large contact angles (i.e., the petal effect). The high contact angles in both cases are explained by invoking the Cassie-Baxter wetting state. The high adhesion behavior of the straight nanowire surface may be explained by a combination of attractive van der Waals forces and capillary adhesion. We demonstrate the spatial patterning of both low- and high-adhesion superhydrophobicity on the same substrate by the simultaneous synthesis of clumped and straight silicon nanowires. The demonstration of hybrid superhydrophobic surfaces with spatially selective, tunable adhesion behavior on single substrates paves the way for future applications in microfluidic channels, substrates for biologically and chemically based analysis and detection where it is necessary to analyze a particular droplet in a defined location on a surface, and as a platform to study in situ chemical mixing and interfacial reactions of liquid pearls.

Converting carbon nanofibers to carbon nanoneedles: catalyst splitting and reverse motion.

Carbon nanoneedles (CNNs) were grown using a plasma-enhanced chemical vapor deposition process in which the source gas (C(2)H(2)) was turned off 10 min before the NH(3) flow and plasma were turned off. It is demonstrated that tubular carbon nanofibers (CNFs) grow while the source gas is on. However, once the source gas is turned off, the Ni catalyst at the top of each CNF splits to form a small catalyst that remains at the top of the tube and a larger catalyst that travels down the interior of the tube. We postulate that the motion of the bottom (larger) catalyst is driven by etching of the graphitic walls and 'cups' inside the CNF. This process, combined with slowing growth of the CNFs and etching of the material above the bottom catalyst, converts the carbon nanofibers to the final nanoneedle shape.

Interference lithographically defined and catalytically etched, large-area silicon nanocones from nanowires.

We report a simple and cost effective method for the synthesis of large-area, precisely located silicon nanocones from nanowires. The nanowires were obtained from our interference lithography and catalytic etching (IL-CE) method. We found that porous silicon was formed near the Au catalyst during the fabrication of the nanowires. The porous silicon exhibited enhanced oxidation ability when exposed to atmospheric conditions or in wet oxidation ambient. Very well located nanocones with uniform sharpness resulted when these oxidized nanowires were etched in 10% HF. Nanocones of different heights were obtained by varying the doping concentration of the silicon wafers. We believe this is a novel method of producing large-area, low cost, well defined nanocones from nanowires both in terms of the control of location and shape of the nanocones. A wide range of potential applications of the nanocone array can be found as a master copy for nanoimprinted polymer substrates for possible biomedical research; as a candidate for making sharp probes for scanning probe nanolithography; or as a building block for field emitting tips or photodetectors in electronic/optoelectronic applications.