Gun energy filter for a low energy electron microscope.

In a Low Energy Electron Microscope (LEEM) the sample is illuminated with an electron beam with typical electron landing energies from 0-100 eV. The energy spread of the electron beam is determined by the characteristics of the electron source. For the two most commonly used electron sources, LaB6 and cold field emission W, typical energy spreads ΔE are 0.75 and 0.25 eV at full width half maximum, respectively. Here we present a design for a LEEM gun energy filter, that reduces ΔE to ∼100 meV. Such a filter has been incorporated in the IBM/SPECS AC-LEEM system at IBM. Experimental results are presented and found to be in excellent agreement with expectations.

Pulmonary Complications in Esophagectomy Based on Intraoperative Fluid Rate: A Single-Center Study.

OBJECTIVES: Esophagectomy is associated with significant morbidity and mortality. The authors assessed the relationship between intraoperative fluid (IOF) administration and postoperative pulmonary outcomes in patients undergoing a transthoracic, transhiatal, or tri-incisional esophagectomy. DESIGN: Retrospective cohort study (level 3 evidence). SETTING: Tertiary care referral center. PARTICIPANTS: Patients who underwent esophagectomy from 2007 to 2017. INTERVENTIONS: The IOF rate (mL/kg/h) was the predictor variable analyzed both as a continuous and binary categorical variable based on median IOF rate for this cohort (11.90 mL/kg/h). MEASUREMENTS: Primary outcomes included rates of acute respiratory distress syndrome (ARDS) within ten days after esophagectomy. Secondary outcomes included rates of reintubation, pneumonia, cardiac or renal morbidity, intensive care unit admission, length of stay, procedure-related complications, and mortality. Multivariate regression analysis determined associations between IOF rate and postoperative outcomes. Analysis was adjusted for age, sex, body mass index, procedure type, year, and thoracic epidural use. MAIN RESULTS: A total of 1,040 patients comprised this cohort. Tri-incisional esophagectomy was associated with a higher hospital mortality rate (7.8%) compared with transthoracic esophagectomy (2.6%, p = 0.03) or transhiatal esophagectomy (0.7%, p = 0.01). Regression analysis revealed a higher IOF rate was associated with greater ARDS within ten days (adjusted odds ratio [OR] = 1.03, p = 0.01). For secondary outcomes, a higher IOF rate was associated with greater hospital mortality (adjusted OR = 1.05, p = 0.002), although no significant association with 30-day hospital mortality was identified. CONCLUSIONS: Increased IOF administration during esophagectomy may be associated with worse postoperative pulmonary complications, specifically ARDS. Future well-powered studies are warranted, including randomized, controlled trials comparing liberal versus restrictive fluid administration in this surgical population.

Antinausea Protocol Reduces Hospital Length of Stay for Laparoscopic Nissen Fundoplication.

OBJECTIVE: The perioperative course of patients undergoing laparoscopic Nissen fundoplication (LNF) was reviewed to determine whether the use of a new treatment protocol consisting of total intravenous anesthesia (TIVA) plus triple antiemetic therapy was associated with shorter hospital length of stay (HLOS). DESIGN: Retrospective cohort. SETTING: Single academic center. PARTICIPANTS: The study comprised 448 patients. Fifty-four patients undergoing LNF who received TIVA were compared with 394 who received standard inhalational anesthesia (non-TIVA) between January 2010 and June 2017. INTERVENTIONS: Patients who received TIVA were compared with those who received non-TIVA. MEASUREMENTS AND MAIN RESULTS: In multivariate analysis, TIVA was significantly associated with reduced HLOS (odds ratio 2.91, 95% confidence interval 1.47-5.78) and a 7.8% reduction in cost of care (p < 0.01). Female sex, length of surgery, and older age all were negatively associated with length of stay. The association between the use of TIVA and reduced HLOS and institutional cost was compared using univariate and multivariate analyses. CONCLUSIONS: The use of TIVA in patients undergoing uncomplicated LNF shortens HLOS and is associated with reduced cost of care. This study illustrates that communication among surgeons and anesthesiologists results in improved patient care.

Effect of Vigorous Physical Activity on Executive Control in Middle-School Students.

The purpose of this pilot study was to examine the acute effect of vigorous physical activity on executive control in eighth grade students from the U.S. Participants were eighth grade students (N = 68; 26 girls, 42 boys) recruited from one middle school located in the Mountain West region of the U.S. Two groups of participants were assigned to receive either a vigorous physical activity or a sedentary condition within a counter-balanced cross-over design using a 2-week washout. Both groups were administered Trails Making Tests A (TMT-A) and B (TMT-B) at 20- and 25-min post-treatment, respectively. Mixed design ANOVA tests with repeated measures examined differences between treatments on TMT-A and TMT-B performance and the modifying effect of sex. Students who completed the physical activity condition displayed a faster time to completion on the TMT-B compared to students who completed the sedentary condition (Mean difference = -6.5 s, p = 0.026, d = 0.42). There were no differences between treatment groups on TMT-A and no sex × treatment interactions (p > 0.05). This pilot study suggests that vigorous physical activity may improve executive control in middle-school students and adds to the existent literature that continues to examine the emerging link between physical activity and cognition in school-based settings.

Acute Exercise and Academic Achievement in Middle School Students.

(1) The purpose of this study was to examine the acute effects of aerobic exercise, resistance exercise, and non-exercise on measures of academic achievement and cognition in pre-adolescent students. (2) In a randomized crossover design, sixty-three participants with a mean age of 13.7 ± 0.47 years completed 20 min of aerobic exercise, resistance exercise, or non-exercise with a period of seven days between each bout. Immediately after each bout, participants were tested for academic achievement and cognitive performance. Academic achievement was assessed using standardized, age-appropriate mathematics tests. Cognition was measured using the Dot, Word, and Color tasks of the Stroop Test (Victoria version). (3) Participants scored significantly higher on the mathematics tests (F1,62 = 4.50, p = 0.038) and all elements of the Stroop Test (Dot: F1,62 = 8.14, p = 0.006; Word: F1,62 = 9.90, p = 0.003; Color: F1,62 = 7.57, p = 0.008) following acute resistance exercise as compared to non-exercise. Math test performance was not statistically different between the aerobic and resistance exercise treatments (F1,62 = 0.214, p = 0.645), but participants did perform significantly better on all elements of the Stroop Test following resistance exercise as compared to aerobic exercise (Dot: F1,61 = 25.82, p < 0.001; Word: F1,62 = 14.73, p < 0.001; Color: F1,62 = 20.14, p < 0.001). (4) Resistance exercise acutely influenced academic achievement and cognition in a positive manner. Such results add to the growing body of research that may support an increase in the prescription of varied exercise modalities within school settings for the purposes of improving academic performance and student health.

Children's Physical Activity Levels Following Participation in a Classroom-Based Physical Activity Curriculum.

A classroom-based physical activity curriculum offers an opportunity for students to be active during the school day to combat declining physical activity levels among this population. The effects of classroom-based physical activity curriculum on children of different weight categories is relatively unknown. Therefore, the purpose of this study was to examine the differences in physical activity levels between male and female students, and between students of different weight categories following participation in a classroom-based physical activity curriculum intervention. A total of 210 3rd to 5th grade (age = 9.1 ± 0.1) students from one U.S. elementary school participated in a 4-week intervention. Students' physical activity levels were measured using pedometers, quantified by step counts pre- and post-intervention. Results from the study indicated that students' physical activity levels increased after participation in the intervention; male students' physical activity levels were higher than female students. Additionally, there was an increase in physical activity levels regardless of weight categories, with students of healthy weight exhibiting the most increase following participation in the intervention. In view of the improvement of children's physical activity levels following their participation in a classroom-based physical activity curriculum, it is recommended that training and resources be provided for teachers to easily implement the curriculum during the school day.

Trends in Sedentary and Physical Activity Behaviors in Incarcerated Adolescent Boys During a Sports, Play, and Recreation for Kids Program.

PURPOSE: To examine the trends in total and segmented sedentary and physical activity behaviors during a Sports, Play, and Recreation for Kids (SPARK) program in incarcerated adolescent boys. DESIGN: Longitudinal trend analysis. SETTING: Two juvenile justice facilities. SUBJECTS: Eighty-six adolescent boys (mean age = 17.1 ± 1.0 years). INTERVENTION: Sports, Play, and Recreation for Kids implemented over 36 weeks. MEASURES: Sedentary times and physical activity were examined at baseline and at 3 follow-up time points at 12, 24, and 36 weeks after SPARK implementation. Physical activity was assessed using the percentage of accelerometer wear time within each segment for sedentary (%SED) and moderate-to-vigorous physical activity (%MVPA). ANALYSIS: Trends in %SED and %MVPA were assessed using 2 × 4 doubly multivariate analysis of variance tests. RESULTS: For the total week, there was a significantly lower %SED (mean difference = -10.6%, P < .001) and significantly higher %MVPA (mean difference = +3.0%, P < .001) at the 24-week follow-up compared to baseline. There were also significantly lower %SED and higher %MVPA before school, after school, and during the weekends at 24-week follow-up compared to baseline ( P < .01). CONCLUSION: There were significantly lower sedentary times and higher levels of physical activity during the middle portions of the SPARK intervention in incarcerated adolescent boys, highlighting the potential of this intervention to affect sedentary and physical activity behaviors in the population.

Introduction of Microwave Ablation Into a Renal Ablation Practice: Valuable Lessons Learned.

OBJECTIVE: The purpose of this study was to evaluate the early outcomes of percutaneous microwave ablation (MWA) for clinical stage T1 (cT1) renal masses when performed within a high-volume ablation practice with critical emphasis on procedural safety. MATERIALS AND METHODS: A retrospective review of a percutaneous renal ablation registry identified 26 patients with a total of 27 cT1 renal masses treated with MWA between 2011 and 2017. Mean patient age was 63.8 years and 16 (61.5%) patients were male. Mean renal mass size ± SD was 2.3 ± 0.8 cm (range, 1.1-4.7 cm). The main outcome parameters investigated were technical success, local tumor progression, survival rates, and complications. Complications were categorized using the Clavien-Dindo classification system. Rates of local progression-free and cancer-specific survival (PFS and CSS, respectively) were estimated using the Kaplan-Meier method. RESULTS: Technical success was 100% on contrast-enhanced CT or MRI performed immediately after renal MWA. Twenty-four patients (92%) with 25 tumors had follow-up imaging for 3 months or longer (mean, 20.6 ± 11.6 months), with no local tumor recurrences identified. Estimated 3-year local PFS and CSS were 96% and 94%, respectively. The overall complication rate was 19.2%; two patients (7.7%) experienced minor complications (grade I or II) and three patients (11.5%) experienced major bleeding or urinary-related complications (grade III or higher), including one death. CONCLUSION: This study suggests that percutaneous MWA is a promising minimally invasive treatment option for cT1 renal masses. Nonetheless, major bleeding and urinary-related complications can occur, and further studies are needed to determine optimal patient and tumor selection for renal MWA.

Physical Activity and Health-Related Fitness of Adolescents within the Juvenile Justice System.

BACKGROUND: The purpose of this study was to examine the physical activity patterns and health-related fitness levels of adolescents within the Juvenile Justice System. METHODS: Participants included 68 adolescents (Mean age = 17.1 ± 1.0 years) in two secure Juvenile Justice correctional facilities in the Western USA. Moderate-to-vigorous physical activity (MVPA) was monitored for one week using the ActiGraph GT9X accelerometer. Health-related fitness was measured using the FITNESSGRAM test battery. RESULTS: Adolescents averaged 43.3±21.6 minutes of MVPA per weekday compared to 42.7±27.5 per weekend day. During school hours, adolescents accumulated 17.1±9.0 minutes of MVPA compared to 5.9±3.4 minutes before school and 21.0±13.6 minutes after school. Adolescents averaged 18.9±11.0 push-ups, 44.5±26.4 curl-ups, 34.7±24.8 PACER laps, and 22.1%±10.0% body fat. CONCLUSIONS: Adolescents within the Juvenile Justice System are falling short of the recommended 60 minutes of MVPA per day and 30 minutes of MVPA during school and also need to improve their health-related fitness, especially cardiorespiratory endurance.

Fit "N" Cool Kids: The Effects of Character Modeling and Goal Setting on Children's Physical Activity and Fruit and Vegetable Consumption.

Efforts to decrease the risk of overweight and obesity should focus on children's physical activity (PA) and fruit and vegetable (FV) consumption. Within school-based interventions, there is insufficient evidence on the effectiveness of the use of character modeling and goal setting to determine changes in step counts, MVPA, and FV consumption. Study participants were 187 students in grades 4 and 5 from 2 Title 1 elementary schools in the Southwest United States. The intervention was a quasi-experimental character modeling and goal setting program. New Lifestyles NL-1000 activity monitors were used to assess number of steps taken and MVPA by the participants. Fruit and vegetable consumption was measured by direct observation. School day steps, MVPA, and FV consumption were recorded at baseline, intervention, and during a 10-week follow-up. There were not differences between groups at baseline. Steps and MVPA were statistically significantly (P < .05; Δ = ~2500 steps and ~5 minutes of MVPA) greater in the intervention compared with the control group over time. Fruit and vegetable consumption was not significantly (P = .308) greater in the intervention compared with the control group over time. Students in the intervention school were significantly more active than students in the control school during the intervention phase and at follow-up. The findings reported here would suggest that character modeling and goal setting can increase PA among elementary aged children but did not increase FV consumption.

Trends in physical activity, health-related fitness, and gross motor skills in children during a two-year comprehensive school physical activity program.

OBJECTIVES: The purpose of this study was to examine the trends in school-day step counts, health-related fitness, and gross motor skills during a two-year Comprehensive School Physical Activity Program (CSPAP) in children. DESIGN: Longitudinal trend analysis. METHODS: Participants were a sample of children (N=240; mean age=7.9±1.2 years; 125 girls, 115 boys) enrolled in five low-income schools. Outcome variables consisted of school day step counts, Body Mass Index (BMI), estimated VO2 Peak, and gross motor skill scores assessed using the Test of Gross Motor Development-3rd Edition (TGMD-3). Measures were collected over a two-year CSPAP including a baseline and several follow-up time-points. Multi-level mixed effects models were employed to examine time trends on each continuous outcome variable. Markov-chain transition models were employed to examine time trends for derived binary variables for school day steps, BMI, and estimated VO2 Peak. RESULTS: There were statistically significant time coefficients for estimated VO2 Peak (b=1.10mL/kg/min, 95% C.I. [0.35mL/kg/min-2.53mL/kg/min], p=0.009) and TGMD-3 scores (b=7.8, 95% C.I. [6.2-9.3], p<0.001). There were no significant changes over time for school-day step counts or BMI. Boys had greater change in odds of achieving a step count associating with 30min of school day MVPA (OR=1.25, 95% C.I. [1.02-1.48], p=0.044). CONCLUSIONS: A two-year CSPAP related to increases in cardio-respiratory endurance and TGMD-3 scores. School day steps and BMI were primarily stable across the two-year intervention.

Elementary physical education: A focus on fitness activities and smaller class sizes are associated with higher levels of physical activity.

Optimizing physical activity during physical education is necessary for children to achieve daily physical activity recommendations. The purpose of this study was to examine the relationship among various contextual factors with accelerometer measured physical activity during elementary physical education. Data were collected during 2015-2016 from 281 students (1st-5th grade, 137 males, 144 females) from a private school located in a metropolitan area of Utah in the U.S. Students wore accelerometers for 12 consecutive weeks at an accelerometer wear frequency of 3 days per week during physical education. A multi-level general linear mixed effects model was employed to examine the relationship among various physical education contextual factors and percent of wear time in moderate-to-vigorous physical activity (%MVPA), accounting for clustering of observations within students and the clustering of students within classrooms. Explored contextual factors included grade level, lesson context, sex, and class size. Main effects and interactions among the factors were explored in the multi-level models. A two-way interaction of lesson context and class size on %MVPA was shown to be statistically significant. The greatest differences were found to be between fitness lessons using small class sizes compared to motor skill lessons using larger class sizes (ß = 14.8%, 95% C.I. 5.7%-23.9% p < 0.001). Lessons that included a focus on fitness activities with class sizes that were < 25 students associated with significantly higher %MVPA during elementary physical education.

School Physical Activity Programming and Gross Motor Skills in Children.

OBJECTIVE: We examined the effect of a comprehensive school physical activity program (CSPAP) on gross motor skills in children. METHODS: Participants were 959 children (1st-6th grade; Mean age = 9.1 ± 1.5 years; 406 girls, 553 boys) recruited from 5 low-income schools receiving a year-long CSPAP intervention. Data were collected at the beginning of the school year and at a 36-week follow-up. Gross motor skills were assessed using the Test for Gross Motor Development (3rd ed.) (TGMD-3) instrument. Multi-level mixed effects models were employed to examine the effect of CSPAP on TGMD-3 scores, testing age and sex as effect modifiers and adjusting for clustering of observations within the data structure. RESULTS: There were statistically significant coefficients for time (ß = 8.1, 95% CI [3.9, 12.3], p < .001) and an age × time interaction (ß = -1.7, 95% CI [-2.3, -1.1], p < .001) on TGMD-3 total scores. Significant improvements were also seen for locomotor skills and ball skills sub-test scores. CONCLUSIONS: Children showed improved gross motor skill scores at the end of the 36-week CSPAP that were modified by age, as younger children displayed greater improvements in TGMD-3 scores compared to older children.

Spatially Selective, High-Density Placement of Polyfluorene-Sorted Semiconducting Carbon Nanotubes in Organic Solvents.

High-performance logic based on carbon nanotubes (CNTs) requires high-density arrays of selectively placed semiconducting CNTs. Although polymer-wrapping methods can allow CNTs to be sorted to a >99.9% semiconducting purity, patterning these polymer-wrapped CNTs is an outstanding problem. We report the directed self-assembly of polymer-coated semiconducting CNTs using self-assembled monolayers that bind CNTs into arrays of patterned trenches. We demonstrate that CNTs can be placed into 100 nm wide HfO2 trenches with an electrical connection yield as high as 90% and into 50 nm wide trenches with a yield as high as 70%. Our directed self-assembly method is an important step forward in pitch scaling.

Effect of a 12-Week Physical Activity Program on Gross Motor Skills in Children.

This study examined the effects of a 12-week Comprehensive School Physical Activity Program (CSPAP) on gross motor skill development in children from low-income families. Participants were 1,460 school-aged children (mean age = 8.4 ± 1.8 years; 730 girls, 730 boys) recruited from three schools receiving U.S. governmental financial assistance. Students were recruited from grades K-6. CSPAP was implemented over one semester during the 2014-2015 school year. Select gross motor skill items were assessed during each student's physical education class at baseline and at a 12-week follow-up using the Test for Gross Motor Development-2nd Edition (TGMD-2). Each student's TGMD-2 score was converted to a percentage of the total possible score. A 7 × 2 × 2 analysis of variance test with repeated measures was employed to examine the effects of age, sex, and time on TGMD-2 percent scores, adjusting for clustering within the data structure. There were greater TGMD-2 percent scores at follow-up compared with baseline (82.4% vs. 72.6%, mean difference = 9.8%, p < .001, Cohen's d = 0.67), and greater improvements were seen in younger children compared with older children (mean difference of change = 4.0%-7.5%, p < .01, Cohen's d = 0.30-0.55).

High-speed logic integrated circuits with solution-processed self-assembled carbon nanotubes.

As conventional monolithic silicon technology struggles to meet the requirements for the 7-nm technology node, there has been tremendous progress in demonstrating the scalability of carbon nanotube field-effect transistors down to the size that satisfies the 3-nm node and beyond. However, to date, circuits built with carbon nanotubes have overlooked key aspects of a practical logic technology and have stalled at simple functionality demonstrations. Here, we report high-performance complementary carbon nanotube ring oscillators using fully manufacturable processes, with a stage switching frequency of 2.82 GHz. The circuit was built on solution-processed, self-assembled carbon nanotube arrays with over 99.9% semiconducting purity, and the complementary feature was achieved by employing two different work function electrodes.

Unveiling the carrier transport mechanism in epitaxial graphene for forming wafer-scale, single-domain graphene.

Graphene epitaxy on the Si face of a SiC wafer offers monolayer graphene with unique crystal orientation at the wafer-scale. However, due to carrier scattering near vicinal steps and excess bilayer stripes, the size of electrically uniform domains is limited to the width of the terraces extending up to a few microns. Nevertheless, the origin of carrier scattering at the SiC vicinal steps has not been clarified so far. A layer-resolved graphene transfer (LRGT) technique enables exfoliation of the epitaxial graphene formed on SiC wafers and transfer to flat Si wafers, which prepares crystallographically single-crystalline monolayer graphene. Because the LRGT flattens the deformed graphene at the terrace edges and permits an access to the graphene formed at the side wall of vicinal steps, components that affect the mobility of graphene formed near the vicinal steps of SiC could be individually investigated. Here, we reveal that the graphene formed at the side walls of step edges is pristine, and scattering near the steps is mainly attributed by the deformation of graphene at step edges of vicinalized SiC while partially from stripes of bilayer graphene. This study suggests that the two-step LRGT can prepare electrically single-domain graphene at the wafer-scale by removing the major possible sources of electrical degradation.

Effect of a 12-Week Summer Break on School Day Physical Activity and Health-Related Fitness in Low-Income Children from CSPAP Schools.

Background. The purpose of this study was to examine the effect of a 12-week summer break on school day physical activity and health-related fitness (HRF) in children from schools receiving a Comprehensive School Physical Activity Program (CSPAP). Methods. Participants were school-aged children (N = 1,232; 624 girls and 608 boys; mean age = 9.5 ± 1.8 years) recruited from three low-income schools receiving a CSPAP. Physical activity and HRF levels were collected during the end of spring semester 2015 and again during the beginning of fall semester 2015. Physical activity was assessed using the Yamax DigiWalker CW600 pedometer. HRF measures consisted of body mass index (BMI) and the Progressive Aerobic Cardiovascular Endurance Run (PACER). Results. Results from a doubly MANCOVA analysis indicated that pedometer step counts decreased from 4,929 steps in the spring to 4,445 steps in the fall (mean difference = 484 steps; P < 0.001; Cohen's d = 0.30) and PACER laps decreased from 31.2 laps in the spring to 25.8 laps in the fall (mean difference = 5.4 laps; P < 0.001; Cohen's d = 0.33). Conclusions. Children from schools receiving a CSPAP intervention had lower levels of school day physical activity and cardiorespiratory endurance following a 12-week summer break.

Effect of Comprehensive School Physical Activity Programming on Cardiometabolic Health Markers in Children From Low-Income Schools.

BACKGROUND: The purpose of this study was to examine the effect of a 36-week Comprehensive School Physical Activity Program (CSPAP) on cardiometabolic health markers in children from low-income schools. METHODS: Participants were 217 school-aged children (mean age = 10.1 ± 1.1 years; 114 girls, 103 boys) recruited from 5 low-income elementary schools. Cardiometabolic health markers were collected in a fasted state at 2 time-points, before commencement of the CSPAP for classroom and school level clustering and the modifying effects of grade level and sex, there were statistically significant improvements in HDL cholesterol (Δ = 3.6 mg/dL, 95% CI: 1.4 mg/dL to 5.8 mg/dL, P = .039), triglycerides (Δ = -14.1 mg/dL, 95% CI: -21.4 mg/dL to -6.8 mg/dL, P = .022), and mean arterial pressure (Δ = -4.3 mmHg, 95% CI: -8.5 mmHg to -0.1 mmHg, P = .041) following the 36-week CSPAP intervention. Sixth-grade children showed decreases in LDL cholesterol (Δ = -15.3 mg/dL, 95% CI: -30.5 mg/dL to -0.1 mg/dL, P = .033). CONCLUSIONS: Improvements in specific cardiometabolic health markers were found following a 36-week CSPAP in children from low-income schools.

Comprehensive assessment of renal tumour complexity in a large percutaneous cryoablation cohort.

OBJECTIVE: To evaluate the association between renal tumour complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA). PATIENTS AND METHODS: Patients with renal tumours treated with PCA were identified using our prospectively maintained ablation registry (2003-2015). Salvage procedures and inherited tumour syndromes were excluded. The associations between R.E.N.A.L. nephrometry score (NS) and risk of complications, renal function impairment, local failure and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models. RESULTS: The cohort included 618 tumours treated during 580 procedures in 565 patients. The median (interquartile range [IQR]) follow-up was 34 (14.66) months. Complications (any grade) during a procedure (n[total] = 87, 15%) were more frequent with higher NS (NS 4-6: 10%; NS 7-9: 14%; NS 10-12: 36%; P < 0.001). Higher NS was independently associated with risk of complications (odds ratio [OR; per 1 point] = 1.3; 95% confidence interval [CI] 1.2-1.5; P < 0.001). Of all the NS components, tumour size was the most strongly associated with complication risk (OR 3.4; 95% CI 2.2-5.2; P < 0.001). The median (IQR) decline in glomerular filtration rate (GFR) from baseline was 9% (0, 22) at last follow-up. Each additional point in NS was associated with a 1.3% (95% CI 0.4-2.1; P = 0.005) greater GFR decline from baseline. NS was not significantly associated with local failure (n [total] = 14, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 5%; P = 0.32) or CSM (n [total] = 8, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 2%; P = 0.88). CONCLUSION: In high-complexity tumours PCA was associated with a tumour size-driven increased risk of post-procedural complications. Higher NS was associated with a small, clinically minor additional decline in renal function. Risks for local failure and CSM were low, regardless of tumour complexity.