Painless thyroiditis mimicking relapse of hyperthyroidism during or after potassium iodide or thionamide therapy for Graves' disease resulting in remission.

The diagnosis of painless thyroiditis (PT) during antithyroid drug (ATD) treatment of Graves' disease (GD) is difficult. We evaluated the thyroidal radioactive iodine uptake (RAIU) in 100 patients with relapsed thyrotoxicosis during or after careful ATD treatment. The RAIU was <5%/5 h in 35 patients (35%) (Group A - PT), 5%-15%/5 h in 6 patients (6%) (Group B - indefinite) and >15%/5 h in 59 patients (59%) (Group C - relapsed GD [rGD]). TSH receptor antibody (TBII) was positive in 4 (11.4%), 3 (50.0%) and 39 (only 66.1%) patients in Groups A, B and C, respectively. In Group A, the serum fT4 level spontaneously normalized after 35 (26-56) days, sometimes followed by transient hypothyroidism, confirming the diagnosis of PT. Nineteen (54.3%) had been treated with potassium iodide, and PT frequently occurred ironically when the ATD dosage was reduced. PT repeatedly occurred in nine patients. All went into remission smoothly or developed hypothyroidism, except one patient with strongly positive TBII who developed rGD after the resolution of PT (PT on GD). In 10 (50%) of 20 patients with negative TBII despite rGD in Group C, TBII became positive afterwards. In conclusion, it is important to recognize that PT can occur in the clinical course of GD, resulting in frequent remission despite relapse of PT. The thyroid function reflects the balance between the stimulating TBII activity and the responsiveness of the thyroid tissue (sometimes unresponsive and other times autostimulated). The RAIU is still a valuable tool in cases of ambiguous thyrotoxicosis.

Iodide-sensitive Graves' hyperthyroidism and the strategy for resistant or escaped patients during potassium iodide treatment.

The effectiveness of potassium iodide (KI) (100 mg/day) was evaluated in 504 untreated patients with Graves' hyperthyroidism (GD). Initial response to KI within 180 days, the effect of additional methylmercaptoimidazole (MMI) or radioactive iodine (RI) in resistant or escaped patients, and long-term prognosis were evaluated. Serum fT4 levels became low or normal in 422 patients (83.7%, KI-sensitive group) without serious side effects. Among these patients, serum TSH levels became high (n = 92, hypothyroid) or normal (n = 78) in 170 patients (33.7%) (KI-sensitive with a recovered TSH response, Group A), but remained suppressed in 252 patients (50.0%) (KI-sensitive with TSH suppression, Group B). Serum fT4 levels decreased but remained high in 82 patients (16.3%) (KI-resistant, Group C). Older patients, or those with small goiter and mild GD were more KI-sensitive with a recovered TSH response than others. Escape from KI effect occurred in 0%, 36% and 82% in Group A, B and C, respectively. Patients in Group B and C were successfully treated with additional low-dosage MMI or RI. After 2-23 years' treatment (n = 429), remission (including possible remission) and spontaneous hypothyroidism were significantly more frequent in Group A (74.3% and 11.1%, respectively,) than in Groups B (46.3% and 2.8%, respectively) or C (53.6% and 1.5%, respectively) (p < 0.0001). In conclusion, a high KI sensitivity with a recovered TSH response was observed in about a third of the patients in GD associated with a better prognosis. Additional MMI or RI therapy was effective in escaped or KI-resistant patients with suppressed TSH level.

Impact of Mg level on lattice relaxation in a p-AlGaN hole source layer and attempting excimer laser annealing on p-AlGaN HSL of UVB emitters.

Mg-doped p-type semiconducting aluminium-gallium-nitride hole source layer (p-AlGaN HSL) materials are quite promising as a source of hole 'p' carriers for the ultraviolet-B (UVB) light-emitting diodes (LEDs) and laser diodes (LDs). However, the p-AlGaN HSL has a central issue of low hole injection due to poor activation of Mg atoms, and the presence of unwanted impurity contamination and the existence of a localized coherent state. Therefore, first the impact of the Mg level on the crystallinity, Al composition and relaxation conditions in the p-AlGaN HSL were studied. An increasing trend in the lattice-relaxation ratios with increasing Mg concentrations in the p-AlGaN HSL were observed. Ultimately, a 40%-60% relaxed and 1.4 µm thick p-AlGaN HSL structure with total threading dislocation densities (total-TDDs) of approximately ∼8-9 × 108 cm-2 was achieved, which almost matches our previous design of a 4 µm thick and 50% relaxed n-AlGaN electron source layer (ESL) with total-TDDs of approximately ∼7-8 × 108 cm-2. Subsequently, structurally a symmetric p-n junction for UVB emitters was accomplished. Finally, the influence of excimer laser annealing (ELA) on the activation of Mg concentration and on suppression of unwanted impurities as well as on the annihilation of the localized energy state in the p-AlGaN HSL were thoroughly investigated. ELA treatment suggested a reduced Ga-N bonding ratio and increased Ga-O, as well as Ga-Ga bonding ratios in the p-AlGaN HSL. After ELA treatment the localized coherent state was suppressed and, ultimately, the photoluminescence emission efficiency as well as conductivity were drastically improved in the p-AlGaN HSL. By using lightly polarized p-AlGaN HSL assisted by ELA treatment, quite low resistivity in p-type AlGaN HSL at room temperature (hole concentration is ∼2.6 × 1016 cm-3, the hole mobility is ∼9.6 cm2 V1 s-1 and the resistivity is ∼24.39 Ω. cm) were reported. ELA treatment has great potential for localized activation of p-AlGaN HSL as well as n- and p-electrodes on n-AlGaN and p-AlGaN contact layers during the flip-chip (FC) process in low operating UVB emitters, including UVB lasers.

Silicon twisted cone structure produced by optical vortex pulse with structure evaluation by radiation hydrodynamic simulation.

We demonstrate a radiation hydrodynamic simulation of optical vortex pulse-ablated microcone structures on silicon (Si) substrates. Doughnut-shaped craters were formed by single pulse irradiation on the Si substrate, and a twisted cone structure with a height of 3.5 µm was created at the center of the irradiation spot by the circularly polarized optical vortex pulse. A two-dimensional (2-D) radiation hydrodynamic simulation reproduced the cone structure well with a height of 3 µm. The central part of the incident laser power was lowered from the initial profile due to plasma shielding over the laser pulse duration for an inverted double-well laser profile. The acute tip shape of the silicon surface can survive over the laser irradiation period.

Laser-Induced Phosphorus-Doped Conductive Layer Formation on Single-Crystal Diamond Surfaces.

A laser-induced doping method was employed to incorporate phosphorus into an insulating monocrystalline diamond at ambient temperature and pressure conditions. Pulsed laser beams with nanosecond duration (20 ns) were irradiated on the diamond substrate immersed in a phosphoric acid liquid, in turns, and a thin conductive layer was formed on its surface. Phosphorus incorporation in the depth range of 40-50 nm below the irradiated surface was confirmed by secondary ion mass spectroscopy (SIMS). Electrically, the irradiated areas exhibited ohmic contacts even with tungsten prober heads at room temperature, where the electrical resistivity of irradiated areas was greatly decreased compared to the original surface. The temperature dependence of the electrical conductivity implies that the surface layer is semiconducting with activation energies ranging between 0.2 eV and 54 meV depending on irradiation conditions. Since after laser treatment no carbon or graphitic phases other than diamond is found (the D and G Raman peaks are barely observed), the incorporation of phosphorus is the main origin of the enhanced conductivity. It was demonstrated that the proposed technique is applicable to diamond as a new ex situ doping method for introducing impurities into a solid in a precise and well-controlled manner, especially with electronic technology targeting of smaller devices and shallower junctions.

The long-term follow-up of patients with thionamide-treated Graves' hyperthyroidism.

Since there have been few reports on the long-term prognosis of Graves' hyperthyroidism, the prognosis of 549 Graves' hyperthyroidism patients initially treated with thionamide and followed for >8 (range: 8.6-36.4) years was studied, evaluating the change in the TSH binding inhibitor immunoglobulin activity (TBII). The distribution of the time required for the first disappearance of TBII was normal after logarithmic conversion, and the mean ± 2 SD was 1.5 (0.3-8.1) years. TBII became negative once within 5 years in 78.9% of patients. However, TBII re-elevation was observed in 47.8% of this group (fluctuating type). Remission was observed in 88.9% of the non-fluctuating type (smooth remission) and 37.2% of the fluctuating type patients. TBII remained positive for >5 years in 21.1% (smoldering type) of patients, with remission observed in only 19.8% of patients. Final remission was observed in 301 (54.8%) patients; the median time to remission was 6.8 (interquartile range: 4.0-10.9) years. A longer time until normalization of TBII and higher final thyroid weight were associated with a poor prognosis. Spontaneous hypothyroidism was observed in 6.0% of patients, independent of the TBII change. Our findings suggest that remission of Graves' hyperthyroidism mostly occurred after 4-11 years treatment. While predicting the prognosis before therapy was difficult, the clinical course may suggest a better prognosis if TBII disappears within five years without TBII fluctuation or enlargement of the goiter. Patients may safely wait more than five years to undergo ablative therapy if they hope to avoid permanent hypothyroidism.

Instantaneous Semiconductor-to-Conductor Transformation of a Transparent Oxide Semiconductor a-InGaZnO at 45 °C.

The emphasis on ubiquitous technology means that future technological applications will depend heavily on transparent conducting materials. To facilitate truly ubiquitous applications, transparent conductors should be fabricated at low temperatures (<50 °C). Here, we demonstrate an instantaneous (<100 ns) and low-temperature (<45 °C at the substrate) method, excimer laser irradiation, for the transformation of an a-InGaZnO semiconductor into a transparent highly conductive oxide with performance rivaling traditional and emerging transparent conductors. Our analysis shows that the instantaneous and substantial conductivity enhancement is due to the generation of a large amount of oxygen vacancies in a-InGaZnO after irradiation. The method's combination of low temperature, extremely rapid process, and applicability to other materials will create a new class of transparent conductors for the high-throughput roll-to-roll fabrication of future flexible devices.

Pulse-Width Dependence of the Cooling Effect on Sub-Micrometer ZnO Spherical Particle Formation by Pulsed-Laser Melting in a Liquid.

Sub-micrometer spherical particles can be synthesized by irradiating particles in a liquid with a pulsed laser (pulse width: 10 ns). In this method, all of the laser energy is supposed to be spent on particle heating because nanosecond heating is far faster than particle cooling. To study the cooling effect, sub-micrometer spherical particles are fabricated by using a pulsed laser with longer pulse widths (50 and 70 ns). From the increase in the laser-fluence threshold for sub-micrometer spherical particle formation with increasing pulse width, it is concluded that the particles dissipate heat to the surrounding liquid, even during several tens of nanoseconds of heating. A particle heating-cooling model considering the cooling effect is developed to estimate the particle temperature during laser irradiation. This model suggests that the liquid surrounding the particles evaporates, and the generated vapor films suppress heat dissipation from the particles, resulting in efficient heating and melting of the particles in the liquid. In the case of small particle sizes and large pulse widths, the particles dissipate heat to the liquid without forming such vapor films.

Direct growth of graphene on SiC(0001) by KrF-excimer-laser irradiation.

In this report, we propose a direct patterning method of graphene on the SiC(0001) surface by KrF-excimer-laser irradiation. In this method, Si atoms are locally sublimated from the SiC surface in the laser-irradiated area, and direct graphene growth is induced by the rearrangement of surplus carbon on the SiC surface. Using Raman microscopy, we demonstrated the formation of graphene by laser irradiation and observed the growth process by transmission electron microscopy and conductive atomic force microscopy. When SiC was irradiated by 5000 shots of the laser beam with a fluence of 1.2 J/cm2, two layers of graphene were synthesized on the SiC(0001) surface. The number of graphene layers increased from 2 to 5-7 with an increase in the number of laser shots. Based on the results of conductive-atomic force microscopy measurements, we conclude that graphene formation was initiated from the step area, after which the graphene grew towards the terrace area by further Si evaporation and C recombination with increasing laser irradiation.

Remission after potassium iodide therapy in patients with Graves' hyperthyroidism exhibiting thionamide-associated side effects.

CONTEXT: Thionamides have various side effects. OBJECTIVE: The effectiveness of potassium iodide (KI) was evaluated in hyperthyroid patients who experienced side effects to thionamides. DESIGN AND SETTING: An observational study was conducted at an academic medical center. PATIENTS: Among 1388 patients with Graves' hyperthyroidism treated with thionamides, 204 (14.7%) exhibited side effects, and 44 were treated with KI and followed for 17.6 (median; range, 8.6-28.4) years. MAIN OUTCOME MEASURES: The primary endpoint was the initial response to KI, and the secondary endpoint was the long-term prognosis. RESULTS: The conditions of 29 (65.9%) of the 44 patients were well controlled with KI alone (10-400 mg/d) (A group), and 17 (38.6%) patients went into remission after 7.4 (1.9-23.0) years. The conditions of 15 (34.1%) patients were not controlled with KI alone (B group), even at a high dose (100-750 mg/d), but seven patients (15.9%) were controlled with a combination of KI and low-dose thionamides, resulting in remission after 7.2 (2.8-10.8) years. The initial parameters did not predict the response to KI or long-term prognosis. However, remission occurred in 70.8% of the patients treated with less than 200 mg of KI, compared with 35.0% of the patients who required 200 mg or more of KI (P < .05). CONCLUSIONS: Among hyperthyroid patients with thionamide-associated side effects, KI therapy was effective in two-thirds of cases, and about 40% of the patients experienced remission after KI therapy alone. The chance of remission was small among the patients refractory to KI.

Crystallization to polycrystalline silicon thin film and simultaneous inactivation of electrical defects by underwater laser annealing.

We propose a low-temperature laser annealing method of a underwater laser annealing (WLA) for polycrystalline silicon (poly-Si) films. We performed crystallization to poly-Si films by laser irradiation in flowing deionized-water where KrF excimer laser was used for annealing. We demonstrated that the maximum value of maximum grain size of WLA samples was 1.5 µm, and that of the average grain size was 2.8 times larger than that of conventional laser annealing in air (LA) samples. Moreover, WLA forms poly-Si films which show lower conductivity and larger carrier life time attributed to fewer electrical defects as compared to LA poly-Si films.

[Comparison MR cholangiopancreatography with 3D-fast recovery fast spin echo in several different slice thicknesses].

PURPOSE: To evaluate the technical quality and visibility of the biliary tree and pancreatic duct on magnetic resonance cholangiopancreatography (MRCP) images obtained with a single-breath-hold three-dimensional (3D) fast-recovery fast spin-echo (FRFSE) sequence in several different slice thicknesses. MATERIALS AND METHODS: As a fundamental study, tubes of various inside diameters filled gadolinium solutions were acquired at 1.5 T in 3D-FRFSE. We observed error rate changes of volume inside the tubes and the visibility of thinner tubes. MRCP was performed at 1.5 T in 8 consecutive patients (4 men and 4 women, aged 22-58 years). Seven radiologists graded images obtained with each slice thickness in a blind fashion. Furthermore, we compared 1.4 mm slice thickness images with 1.8 mm slice thickness images in a continuous rating scale for the same patient. We assessed differences in technical quality, overall visibility, and six individual ductal segments of the biliary tree and pancreatic duct. RESULTS: If slice thickness were thinner relative to diameter, the error rate would be closer to zero. But, when slice thickness was 0.8 mm, the error rate became clearly higher because of low intensity. In the fundamental study, we thought that the appropriate slice thickness is between 1.0 mm and 2.4 mm. The visibility of images of thinner tubes could be improved by having a thinner slice thickness. In particular, MRCP overall images generated from a 1.4 mm slice thickness were found to be significantly superior to those generated from a 1.8 mm slice thickness (p<0.001); this was also true as regards the pancreatic duct and cystic duct (p<0.01, p<0.05). CONCLUSION: We conclude that a 1.4 mm slice thickness is appropriate for MRCP.