Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

Effects of androgens on the leptin system in immature male Atlantic salmon parr.

Leptin modulates all levels of the reproductive endocrine axis in mammals, and in turn, both leptin and the leptin receptor are regulated by sex steroids. The aim of this study was to investigate if sex steroids regulate the leptin system also in fish. Immature one-year old male Atlantic salmon parr were implanted with Silclear capsules that were either empty or filled with 11-ketoandrostenedione (11KA) or testosterone (T) and the effects of 35-days treatment were investigated on measures of maturation, gene expression of leptin (lepa1, lepa2), leptin receptor (lepra1) and circulating plasma leptin. Both 11-KA and T stimulated the reproductive axis by increasing testes weight and up-regulated pituitary lh-ß mRNA levels and for T also fsh-ß. T up-regulated transcription levels of lepa1 and lepra1 in the pituitary, while 11-KA had no effect. Leptin receptor expression in the testis was unaltered by either androgen. T up-regulated lepa1 mRNA levels significantly also in the liver, but had no effect on lepa2, and 11KA did not affect hepatic gene expression of either lepa1 or lepa2. Plasma leptin levels did not differ significantly between treatments. The results indicate that androgens regulate gene expression of leptin and the leptin receptor in different tissues in fish and that the effects of leptin might be tissue specific considering plasma levels remained unaltered. Overall, the results suggest a role for leptin in fish reproduction, where sex steroids are able to regulate components of the leptin system differentially in liver and important tissues of the reproductive axis.

Developmental exposure to the SSRI citalopram causes long-lasting behavioural effects in the three-spined stickleback (Gasterosteus aculeatus).

Selective Serotonin re-uptake inhibitors (SSRIs) are a class of psychotropic drugs used to treat depression in both adolescents and pregnant or breast-feeding mothers as well as in the general population. Recent research on rodents points to long-lasting behavioural effects of pre- and perinatal exposure to SSRIs which last into adulthood. In fish however, studies on effects of developmental exposure to SSRIs appears to be non-existent. In order to study effects of developmental SSRI exposure in fish, three-spine sticklebacks were exposed to 1.5 µg/l of the SSRI citalopram in the ambient water for 30 days, starting two days post-fertilisation. After approximately 100 days of remediation in clean water the fish were put through an extensive battery of behavioural tests. Feeding behaviour was tested as the number of bites against a piece of food and found to be increased in the exposed fish. Aggression levels were measured as the number of bites against a mirror image during 10 min and was also found to be significantly increased in the exposed fish. Novel tank behaviour and locomotor activity was tested in an aquarium that had a horizontal line drawn half-way between the bottom and the surface. Neither the latency to the first transition to the upper half, nor the number of transitions or the total time spent in the upper half was affected by treatment. Locomotor activity was significantly reduced in the exposed fish. The light/dark preference was tested in an aquarium where the bottom and walls were black on one side and white on the other. The number of transitions to the white side was significantly reduced in the exposed fish but there was no effect on the latency to the first transition or the total time spent in the white half. The results in the current study indicate that developmental SSRI exposure causes long-lasting behavioural effects in fish and contribute to the existing knowledge about SSRIs as environmental pollutants.

Evidence of reduced bladder capacity during nighttime in children with monosymptomatic nocturnal enuresis.

INTRODUCTION: Bladder capacity in children with nocturnal enuresis is assessed by maximal voided volumes (MVV) obtained through daytime frequency volume (FV) charts. Although a degree of association has been demonstrated, daytime MVV does not consistently correspond with the nocturnal bladder capacity (NBC) in monosymptomatic nocturnal enuresis (MNE). It was hypothesized that isolated reduced NBC is a common phenomenon in children with nocturnal enuresis, despite normal daytime bladder function. OBJECTIVE: The aim of this study was to evaluate NBC in children with MNE and normal daytime voided volumes. Specifically, it aimed to determine the prevalence and degree of reduced NBC when using nocturnal urine production (NUP) during wet nights as a surrogate estimate of NBC. Furthermore, it aimed to investigate the relationship between NBC and desmopressin response. MATERIALS AND METHODS: Data from 103 children aged 5-15 years consecutively treated for MNE in a tertiary referral centre and with normal MVV on daytime FV charts were collected for this cohort study. Home recordings were completed for 2 weeks at baseline and during desmopressin dose titration. Estimated nocturnal bladder capacity (eNBC) was assessed separately each night as the total NUP causing a wet night. If NUP during a wet night was less than MVV, it was considered to be reduced eNBC during that particular night. RESULTS: Surprisingly, 82% (n = 84) of the children with MNE and normal daytime MVV experienced at least one wet night, with NUP below the daytime MVV indicative of a reduced eNBC. For 84 patients, mean percentage of wet nights with reduced eNBC (NUP below MVV) was 49% (SD ± 31). A total of 11% of children with frequently reduced eNBC (>40% of wet nights with reduced eNBC) responded to desmopressin (Summary Fig.). Of the children with frequently reduced NBC, 91% experienced wet nights, with NUP <65% of expected bladder capacity (EBC). CONCLUSIONS: A significant proportion of children with MNE and normal MVV during the daytime frequently experienced wet nights, with a NUP well below their MVV and even <65% of EBC. This indicated that bladder reservoir dysfunction during sleep is relatively common in MNE. This abnormality was not reflected on daytime recordings, and thus nighttime data with NUP must be collected. This phenomenon may explain treatment failure to desmopressin, despite adequate antidiuretic response.

Electrical properties of GaSb/InAsSb core/shell nanowires.

Temperature dependent electronic properties of GaSb/InAsSb core/shell and GaSb nanowires have been studied. Results from two-probe and four-probe measurements are compared to distinguish between extrinsic (contact-related) and intrinsic (nanowire) properties. It is found that a thin (2-3 nm) InAsSb shell allows low barrier charge carrier injection to the GaSb core, and that the presence of the shell also improves intrinsic nanowire mobility and conductance in comparison to bare GaSb nanowires. Maximum intrinsic field effect mobilities of 200 and 42 cm(2) Vs(-1) were extracted for the GaSb/InAsSb core/shell and bare-GaSb NWs at room temperature, respectively. The temperature-dependence of the mobility suggests that ionized impurity scattering is the dominant scattering mechanism in bare GaSb while phonon scattering dominates in core/shell nanowires. Top-gated field effect transistors were fabricated based on radial GaSb/InAsSb heterostructure nanowires with shell thicknesses in the range 5-7 nm. The fabricated devices exhibited ambipolar conduction, where the output current was studied as a function of AC gate voltage and frequency. Frequency doubling was experimentally demonstrated up to 20 kHz. The maximum operating frequency was limited by parasitic capacitance associated with the measurement chip geometry.

Time-resolved X-ray diffraction investigation of the modified phonon dispersion in InSb nanowires.

The modified phonon dispersion is of importance for understanding the origin of the reduced heat conductivity in nanowires. We have measured the phonon dispersion for 50 nm diameter InSb (111) nanowires using time-resolved X-ray diffraction. By comparing the sound speed of the bulk (3880 m/s) and that of a classical thin rod (3600 m/s) to our measurement (2880 m/s), we conclude that the origin of the reduced sound speed and thereby to the reduced heat conductivity is that the C44 elastic constant is reduced by 35% compared to the bulk material.

Measurements of light absorption efficiency in InSb nanowires.

We report on measurements of the light absorption efficiency of InSb nanowires. The absorbed 70 fs light pulse generates carriers, which equilibrate with the lattice via electron-phonon coupling. The increase in lattice temperature is manifested as a strain that can be measured with X-ray diffraction. The diffracted X-ray signal from the excited sample was measured using a streak camera. The amount of absorbed light was deduced by comparing X-ray diffraction measurements with simulations. It was found that 3.0(6)% of the radiation incident on the sample was absorbed by the nanowires, which cover 2.5% of the sample.

Excellent liver retransplantation outcomes in hepatitis C-infected recipients.

UNLABELLED: Survival outcomes for liver retransplantation (LRTx) after graft loss in HCV patients (HCV-LRTx) are generally considered inferior to those after non-HCV-LRTx. Between January 1, 2005 and June 30, 2011, our center performed 663 LTx, including 116 (17.5%) LRTx, 41 (35.3%) of which were more than 90 d after the LTx. Twenty-nine (70.7%) LRTx were performed in HCV antibody-positive individuals. We compared patient demographics, baseline characteristics and outcomes of our HCV-LRTx group with the HCV-LRTx patients from the most recent OPTN database covering the same time period. Our Kaplan-Meier HCV-LRTx one-, three-, and five-yr HCV-LRTx patient survival rates were 86.2%, 79.0%, and 72.4%, respectively compared with the OPTN one-, three-, and five-yr HCV-LRTx survival rates of 73.3%, 59.0%, and 51.3% respectively. Likewise, our graft survival rates were higher than OPTN rates at all time points studied. We performed a higher percentage of HCV-LRTx as simultaneous liver/kidney transplants (SLK) (37.9% vs. 21.8%) and recorded shorter warm (30 ± 4 vs. 45 ± 23 min) and cold ischemic times (5:44 ± 1:53 vs. 7:36 ± 3:12 h:min). CONCLUSION: In our experience, HCV-LRTx patient and graft survival rates are comparable to LTx survival rates and are higher than the rates described by OPTN.

Synthesis and properties of antimonide nanowires.

Antimonide semiconductors are suitable for low-power electronics and long-wavelength optoelectronic applications. In recent years research on antimonide nanowires has become a rapidly growing field, and nano-materials have promising applications in fundamental physics research, for tunnel field-effect transistors, and long-wavelength detectors. In this review, we give an overview of the field of antimonide nanowires, beginning with a description of the synthesis of these nano-materials. Here we summarize numerous reports on antimonide nanowire growth, with the aim to give an overall picture of the distinctive properties of antimonide nanowire synthesis. Secondly, we review the data on the physical properties and emerging applications for antimonide nanowires, focusing on applications in electronics and optics.

Diameter-Dependent photocurrent in InAsSb nanowire infrared photodetectors.

Photoconductors using vertical arrays of InAs/InAs(1-x)Sb(x) nanowires with varying Sb composition x have been fabricated and characterized. The spectrally resolved photocurrents are strongly diameter dependent with peaks, which are red-shifted with diameter, appearing for thicker wires. Results from numerical simulations are in good agreement with the experimental data and reveal that the peaks are due to resonant modes that enhance the coupling of light into the wires. Through proper selection of wire diameter, the absorptance can be increased by more than 1 order of magnitude at a specific wavelength compared to a thin planar film with the same amount of material. A maximum 20% cutoff wavelength of 5.7 µm is obtained at 5 K for a wire diameter of 717 nm at a Sb content of x = 0.62, but simulations predict that detection at longer wavelengths can be achieved by increasing the diameter. Furthermore, photodetection in InAsSb nanowire arrays integrated on Si substrates is also demonstrated.

Diameter limitation in growth of III-Sb-containing nanowire heterostructures.

The nanowire geometry offers significant advantages for exploiting the potential of III-Sb materials. Strain due to lattice mismatch is efficiently accommodated, and carrier confinement effects can be utilized in tunneling and quantum devices for which the III-Sb materials are of particular interest. It has however proven difficult to grow thin (below a few tens of nanometers), epitaxial III-Sb nanowires, as commonly no growth is observed below some critical diameter. Here we explore the processes limiting the diameter of III-Sb nanowires in a model system, in order to develop procedures to control this effect. The InAs-GaSb heterostructure system was chosen due to its great potential for tunneling devices in future low-power electronics. We find that with increasing growth temperature or precursor partial pressures, the critical diameter for GaSb growth on InAs decreases. To explain this trend we propose a model where the Gibbs-Thomson effect limits the Sb supersaturation in the catalyst particle. This understanding enabled us to further reduce the nanowire diameter down to 32 nm for GaSb grown on 21 nm InAs stems. Finally, we show that growth conditions must be carefully optimized for these small diameters, since radial growth increases for increased precursor partial pressures beyond the critical values required for nucleation.

Single InAs/GaSb nanowire low-power CMOS inverter.

III-V semiconductors have so far predominately been employed for n-type transistors in high-frequency applications. This development is based on the advantageous transport properties and the large variety of heterostructure combinations in the family of III-V semiconductors. In contrast, reports on p-type devices with high hole mobility suitable for complementary metal-oxide-semiconductor (CMOS) circuits for low-power operation are scarce. In addition, the difficulty to integrate both n- and p-type devices on the same substrate without the use of complex buffer layers has hampered the development of III-V based digital logic. Here, inverters fabricated from single n-InAs/p-GaSb heterostructure nanowires are demonstrated in a simple processing scheme. Using undoped segments and aggressively scaled high-κ dielectric, enhancement mode operation suitable for digital logic is obtained for both types of transistors. State-of-the-art on- and off-state characteristics are obtained and the individual long-channel n- and p-type transistors exhibit minimum subthreshold swings of SS = 98 mV/dec and SS = 400 mV/dec, respectively, at V(ds) = 0.5 V. Inverter characteristics display a full signal swing and maximum gain of 10.5 with a small device-to-device variability. Complete inversion is measured at low frequencies although large parasitic capacitances deform the waveform at higher frequencies.

Controlling the abruptness of axial heterojunctions in III-V nanowires: beyond the reservoir effect.

Heterostructure nanowires have many potential applications due to the avoidance of interface defects by lateral strain relaxation. However, most heterostructure semiconductor nanowires suffer from persistent interface compositional grading, normally attributed to the dissolution of growth species in the common alloy seed particles. Although progress has been made for some material systems, most binary material combinations remain problematic due to the interaction of growth species in the alloy. In this work we investigate the formation of interfaces in InAs-GaAs heterostructures experimentally and theoretically and demonstrate a technique to attain substantially sharper interfaces. We show that by pulsing the Ga source during heterojunction formation, In is pushed out before GaAs growth initiates, greatly reducing In carry-over. This procedure will be directly applicable to any nanowire system with finite nonideal solubility of growth species in the alloy seed particle and greatly improve the applicability of these structures in future devices.

Uniform and position-controlled InAs nanowires on 2" Si substrates for transistor applications.

This study presents a novel approach for indirect integration of InAs nanowires on 2'' Si substrates. We have investigated and developed epitaxial growth of InAs nanowires on 2'' Si substrates via the introduction of a thin yet high-quality InAs epitaxial layer grown by metalorganic vapor phase epitaxy. We demonstrate well-aligned nanowire growth including precise position and diameter control across the full wafer using very thin epitaxial layers (<300 nm). Statistical analysis results performed on the grown nanowires across the 2'' wafer size verifies our full control on the grown nanowire with 100% growth yield. From the crystallographic viewpoint, these InAs nanowires are predominantly of wurtzite structure. Furthermore, we show one possible device application of the aforementioned structure in vertical wrap-gated field-effect transistor geometry. The vertically aligned InAs nanowires are utilized as transistor channels and the InAs epitaxial layer is employed as the source contact. A high uniformity of the device characteristics for numerous transistors is further presented and RF characterization of these devices demonstrates an f(t) of 9.8 GHz.

High current density Esaki tunnel diodes based on GaSb-InAsSb heterostructure nanowires.

We present electrical characterization of broken gap GaSb-InAsSb nanowire heterojunctions. Esaki diode characteristics with maximum reverse current of 1750 kA/cm(2) at 0.50 V, maximum peak current of 67 kA/cm(2) at 0.11 V, and peak-to-valley ratio (PVR) of 2.1 are obtained at room temperature. The reverse current density is comparable to that of state-of-the-art tunnel diodes based on heavily doped p-n junctions. However, the GaSb-InAsSb diodes investigated in this work do not rely on heavy doping, which permits studies of transport mechanisms in simple transistor structures processed with high-κ gate dielectrics and top-gates. Such processing results in devices with improved PVR (3.5) and stability of the electrical properties.

Pedicle marrow signal hyperintensity on short tau inversion recovery- and t2-weighted images: prevalence and relationship to clinical symptoms.

BACKGROUND AND PURPOSE: Lumbar pedicle marrow hyperintense signal on T2- and STIR-weighted images is not an uncommon finding. We hypothesize that these marrow signal intensity changes and their behavior within the pedicle are associated with clinical symptoms and that their improvement or resolution correlates with clinical improvement. We investigated the prevalence of these pedicle marrow changes, associated morphologic abnormalities, and the relationship to symptoms over time. MATERIALS AND METHODS: Prevalence was evaluated prospectively in 246 patients and retrospectively in 400 patients. To analyze the relationship between changes in signal intensity over time and symptoms, a third group of 30 patients was followed clinically for assessment of pain and functional limitation and with MR studies for 18 months or until signal intensity changes resolved. RESULTS: The prevalence of pedicle marrow hyperintensity on T2 and STIR-weighted sequences was 1.7%. Associated morphologic abnormalities were pars interarticularis and pedicle fractures and degenerative facets. In the longitudinal study, pedicle marrow signal hyperintensity on T2- and STIR-weighted images resolved in 17 patients and persisted in 5 patients. The extent, intensity, and resolution of signal intensity changes significantly related to the degree of functional limitation (P = .01). CONCLUSIONS: Resolution of pedicle marrow hyperintensity on T2 and STIR-weighted images was associated with improved functional testing and a trend toward decreased pain.

InAs/GaSb heterostructure nanowires for tunnel field-effect transistors.

InAs/GaSb nanowire heterostructures with thin GaInAs inserts were grown by MOVPE and characterized by electrical measurements and transmission electron microscopy. Down-scaling of the insert thickness was limited because of an observed sensitivity of GaSb nanowire growth to the presence of In. By employing growth interrupts in between the InAs and GaInAs growth steps it was possible to reach an insert thickness down to 25 nm. Two-terminal devices show a diode behavior, where temperature-dependent measurements indicate a heterostructure barrier height of 0.5 eV, which is identified as the valence band offset between the InAs and GaSb. Three-terminal transistor structures with a top-gate positioned at the heterointerface show clear indications of band-to-band tunnelling.

Vertical InAs nanowire wrap gate transistors with f(t) > 7 GHz and f(max) > 20 GHz.

In this letter we report on high-frequency measurements on vertically standing III-V nanowire wrap-gate MOSFETs (metal-oxide-semiconductor field-effect transistors). The nanowire transistors are fabricated from InAs nanowires that are epitaxially grown on a semi-insulating InP substrate. All three terminals of the MOSFETs are defined by wrap around contacts. This makes it possible to perform high-frequency measurements on the vertical InAs MOSFETs. We present S-parameter measurements performed on a matrix consisting of 70 InAs nanowire MOSFETs, which have a gate length of about 100 nm. The highest unity current gain cutoff frequency, f(t), extracted from these measurements is 7.4 GHz and the maximum frequency of oscillation, f(max), is higher than 20 GHz. This demonstrates that this is a viable technique for fabricating high-frequency integrated circuits consisting of vertical nanowires.

Low- and standard-dose peginterferon alfa-2a for chronic hepatitis C, genotype 2 or 3: efficacy, tolerability, viral kinetics and cytokine response.

BACKGROUND: Chronic infection with hepatitis C, genotype 2/3, responds better than other genotypes to peginterferon and ribavirin treatment. We hypothesized that a lower dose of peginterferon would be as effective, but less toxic than standard doses. AIM: To test the hypothesis that a lower dose of peginterferon would be as effective as, but less toxic than, standard doses. METHODS: A total of 30 patients were treated with low-dose peginterferon alfa-2a (90 microg/week) and 27 patients with standard doses (180 microg/week) for 24 weeks in combination with 800 mg/day of ribavirin. Patients who failed treatment were offered 48 weeks of standard-dose treatment. Viral and serum inducible protein 10 (IP-10) levels were measured and early viral kinetic parameters were calculated. RESULTS: Sustained virological response was achieved in 68% of the low-dose and 87% of the standard-dose patients (per protocol, P = 0.79 for non-inferiority). Re-treatment was successful in all patients who tolerated full dose and duration. The standard-dose group had greater first-phase declines of viral levels and faster time to negativity. The second-phase slope was not dose-dependent. IP-10 induction was significantly greater with the standard dose. Although fatigue and general feeling during treatment were worse for standard dose, haematological toxicity and depression did not differ between groups. CONCLUSION: A lower dose of peginterferon is associated with some symptomatic benefit, but the response is not equivalent to standard dosing.

InSb heterostructure nanowires: MOVPE growth under extreme lattice mismatch.

We demonstrate the growth of InSb-based nanowire heterostructures by metalorganic vapour phase epitaxy and use it to integrate InSb on extremely lattice-mismatched III-V nanowire templates made of InAs, InP, and GaAs. Influence of temperature, V/III ratio, and diameter are investigated in order to investigate the growth rate and morphology. The range of growth temperatures used for InSb nanowire growth is very similar to that used for planar growth due to the nature of the precursor decomposition. This makes optimization of growth parameters very important, and more difficult than for most other nanowire III-V materials. Analysis of the InSb nanowire epitaxial quality when grown on InAs, InP, and GaAs, along with InSb segment and particle compositions are reported. This successful direct integration of InSb nanowires, on nanowire templates with unprecedented strain levels show great promise for fabrication of vertical InSb devices.