General Oriented Synthesis of Precise Carbon-Confined Nanostructures by Low-Pressure Vapor Superassembly and Controlled Pyrolysis.

Earth-abundant metal-based nanostructured materials have been widely studied for potential energy conversion and storage. However, controlled synthesis of functional nanostructures with high electron conductivity, high reaction activity, and structural stability is still a formidable challenge for further practical applications. Herein, for the first time, we develop a facile, efficient, and general method for the oriented synthesis of precise carbon-confined nanostructures by low-pressure vapor superassembly of a thin metal-organic framework (MOF) shell and subsequent controlled pyrolysis. The selected nanostructured metal oxide precursors not only act as metal ion sources but also orient the superassembly of gaseous organic ligands through the coordination reactions under the low-pressure condition, resulting in the formation of a tunable MOF shell on their surfaces. This strategy is further successfully extended to obtain various precise carbon-confined nanostructures with diverse compositions and delicate morphologies. Notably, these as-prepared carbon-confined architectures exhibit outstanding electrochemical performances in water splitting and lithium storage. The remarkable performances are mainly attributed to the synergistic effect from appropriate chemical compositions and stable carbon-confined structures. This synthetic approach and proposed mechanism open new avenues for the development of functional nanostructured materials in many frontier fields.

General Oriented Formation of Carbon Nanotubes from Metal-Organic Frameworks.

Carbon nanotubes (CNTs) are of great interest for many potential applications because of their extraordinary electronic, mechanical and structural properties. However, issues of chaotic staking, high cost and high energy dissipation in the synthesis of CNTs remain to be resolved. Here we develop a facile, general and high-yield strategy for the oriented formation of CNTs from metal-organic frameworks (MOFs) through a low-temperature (as low as 430 °C) pyrolysis process. The selected MOF crystals act as a single precursor for both nanocatalysts and carbon sources. The key to the formation of CNTs is obtaining small nanocatalysts with high activity during the pyrolysis process. This method is successfully extended to obtain various oriented CNT-assembled architectures by modulating the corresponding MOFs, which further homogeneously incorporate heteroatoms into the CNTs. Specifically, nitrogen-doped CNT-assembled hollow structures exhibit excellent performances in both energy conversion and storage. On the basis of experimental analyses and density functional theory simulations, these superior performances are attributed to synergistic effects between ideal components and multilevel structures. Additionally, the appropriate graphitic N doping and the confined metal nanoparticles in CNTs both increase the densities of states near the Fermi level and reduce the work function, hence efficiently enhancing its oxygen reduction activity. The viable synthetic strategy and proposed mechanism will stimulate the rapid development of CNTs in frontier fields.

Rapid-charging aluminium-sulfur batteries operated at 85 °C with a quaternary molten salt electrolyte.

Molten salt aluminum-sulfur batteries are based exclusively on resourcefully sustainable materials, and are promising for large-scale energy storage owed to their high-rate capability and moderate energy density; but the operating temperature is still high, prohibiting their applications. Here we report a rapid-charging aluminium-sulfur battery operated at a sub-water-boiling temperature of 85 °C with a tamed quaternary molten salt electrolyte. The quaternary alkali chloroaluminate melt - possessing abundant electrochemically active high-order Al-Cl clusters and yet exhibiting a low melting point - facilitates fast Al3+ desolvation. A nitrogen-functionalized porous carbon further mediates the sulfur reaction, enabling the battery with rapid-charging capability and excellent cycling stability with 85.4% capacity retention over 1400 cycles at a charging rate of 1 C. Importantly, we demonstrate that the asymmetric sulfur reaction mechanism that involves formation of polysulfide intermediates, as revealed by operando X-ray absorption spectroscopy, accounts for the high reaction kinetics at such temperature wherein the thermal management can be greatly simplified by using water as the heating media.

Insights into Dietary Different Co-Forms of Lysine and Glutamate on Growth Performance, Muscle Development, Antioxidation and Related Gene Expressions in Juvenile Grass Carp (Ctenopharyngodon idellus).

The study aimed to compare the effects of crystalline L-lysine and L-glutamate (CAA), Lys-Glu dipeptide (KE) on the growth and muscle development of grass carp (Ctenopharyngodon idellus), and related molecular mechanisms. Five experimental diets (CR, 0.5% CAA, 1.5% CAA, 0.5% KE, 1.5% KE) containing Lys and Glu as free (Lys and Glu, CAA) dipeptide (Lys-Glu, KE) forms were prepared, respectively. A total of 450 juvenile grass carp with an initial weight of 10.69 ± 0.07 g were randomly assigned to 15 cages, and 5 treatments with 3 replicates of 30 fish each for 61 days of feeding. The results showed that the group of 0.5% KE exhibited the best growth performances according to the indicator's weight gain rate (WGR) and specific growth rate (SGR), although no statistically significant occurred among all groups; diet supplemented with 0.5% CAA significantly elevated the condition factor (CF) and viscerasomatic index (VSI) of juvenile grass carp. Diet supplemented with different Lys and Glu co-forms at different levels promoted the muscle amino acid content compared with those of CR group. Comparing with the CR group and other groups, the hardness of 0.5% CAA group significantly increased, and the springiness of 0.5% KE group excelled. Both the muscle fiber diameter and density of 0.5% KE group showed significant difference with those of the CR group, and a negative correlation between them was also observed. To uncover the related molecular mechanism of the differences caused by the different co-forms of Lys and Glu, the effect of different diets on the expressions of protein absorption, muscle quality, and antioxidation-related genes was analyzed. The results suggested that comparing with those of CR group, the dipeptide KE inhibited the expressions of genes associated with protein metabolism, such as AKT, S6K1, and FoxO1a but promoted PCNA expression, while the free style of CAA would improve the FoxO1a expression. Additionally, the muscle development-related genes (MyoD, MyOG, and Myf5) were significantly boosted in CAA co-form groups, and the expressions of fMYHCs were blocked but fMYHCs30 significantly promoted in 0.5% KE group. Finally, the effect of different co-forms of Lys and Glu on muscle antioxidant was examined. The 0.5% CAA diet was verified to increase GPX1a but obstruct Keap1 and GSTP1 expressions, resulting in enhanced SOD activity and reduced MDA levels in plasma. Collectively, the different co-forms of Lys and Glu influenced the growth of juvenile grass carp, and also the muscle development and quality through their different regulation on the protein metabolism, muscle development- and antioxidative-related genes.

Learning curve for magnetic resonance imaging/ultrasound fusion prostate biopsy in detecting prostate cancer using cumulative sum analysis.

Background: Targeted magnetic resonance (MR) with ultrasound (US) fusion-guided biopsy has been shown to improve detection of prostate cancer. The implementation of this approach requires integration of skills from radiologists and urologists. Objective methods for assessment of learning curves, such as cumulative sum (CUSUM) analysis, may be helpful in identifying the presence and duration of a learning curve. The aim of this study is to determine the learning curve for MR/US fusion-guided biopsy in detecting clinically significant prostate cancer using CUSUM analysis. Materials and methods: Retrospective analysis was performed in this institutional review board-approved study. Two urologists implemented an MR/US fusion-guided prostate biopsy program between March 2015 and September 2017. The primary outcome measure was cancer detection rate (CDR) stratified by Prostate Imaging Reporting and Data System (PI-RADS) scores assigned on the MR imaging. Cumulative sum analysis quantified actual cancer detection versus a predetermined target satisfactory CDR of MR/US fusion biopsies in a sequential case-by-case basis. For this analysis, satisfactory performance was defined as >80% CDR in patients with PI-RADS 5, >50% in PI-RADS 4, and <20% in PI-RADS 1-3. Results: Complete data were available for MR/US fusion-guided biopsies performed on 107 patients. The CUSUM learning curve analysis demonstrated intermittent underperformance until approximately 50 cases. After this inflection point, there was consistently good performance, evidence that no further learning curve was being encountered. Conclusions: At a new center implementing MR/US fusion-guided prostate biopsy, the learning curve was approximately 50 cases before a consistently high performance for prostate cancer detection.

PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer.

BACKGROUND: While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification. METHODS: In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score. CSPC was defined as a Gleason score ≥7. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals (CI). P values were reported as two-sided with p < 0.05 considered statistically significant. ROC curves were generated for assessing the predictive value of tests and sensitivity + specificity optimization was performed to determine optimal testing cutoffs. RESULTS: A total of 327 patients with 709 lesions total were analyzed. PSAD and PI-RADS scores provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PI-RADS: 0.72, combined: 0.78, p < 0.001). When controlling for PI-RADS score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02-105, p < 0.001). The optimal cutoff of PSAD ≥ 0.1 ng/ml/cc shows that a high versus low PSAD was roughly equivalent to an increase in 1 in PI-RADS score for the presence of CSPC (4% of PI-RADS ≤3 PSAD low, 6% of PI-RADS 3 PSAD high vs. 5% of PI-RADS 4 PSAD low, 22% of PI-RADS 4 PSAD high vs. 29% of PI-RADS 5 PSAD low, 46% of PI-RADS 5 PSAD high were found to have CSPC). CONCLUSIONS: PSAD with a cutoff of 0.1 ng/ml/cc appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MP-MRI.

Validation of an MRI-based prostate cancer prebiopsy Gleason score predictive nomogram.

Background: Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer (PCa). In this work, we derive and validate a nomogram that uses prostate multiparametric magnetic resonance imaging (MP-MRI) and clinical patient characteristics to predict biopsy Gleason scores (bGS). Materials and methods: A predictive nomogram was derived from 143 men who underwent MP-MRI prior to any prostate biopsy and then validated on an independent cohort of 235 men from a different institution who underwent MP-MRI for PCa workup. Screen positive lesions were defined as lesions positive on T2W and DWI sequences on MP-MRI. Prostate specific antigen (PSA) density, number of screen positive lesions, and MRI suspicion were associated with PCa Gleason score on biopsy and were used to generate a predictive nomogram. The independent cohort was tested on the nomogram and the most likely bGS was noted. Results: The mean PSA in the validation cohort was 9.25ng/mL versus 6.8ng/mL in the original cohort (p = 0.001). The distribution of Gleason scores between the 2 cohorts were not significantly different (p = 0.7). In the original cohort of men, the most probable nomogram generated Gleason score agreed with actual pathologic bGS findings in 61% of the men. In the validation cohort, the most likely nomogram predicted bGS agreed with actual pathologic bGS 51% of the time. The nomogram correctly identified any PCa versus non-PCa 63% of the time and clinically significant (Gleason score ≥ 7) PCa 69% of the time. The negative predictive value for clinically significant PCa using this prebiopsy nomogram was 74% in the validation group. Conclusions: A preintervention nomogram based on PSA and MRI findings can help narrow down the likely pathologic finding on biopsy. Validation of the nomogram demonstrated a significant ability to correctly identify the most likely bGS. This feasibility study demonstrates the potential of a prebiopsy prediction of bGS and based on the high negative predictive value, identification of men who may not need biopsies, which could impact future risk stratification for PCa.

Medical malpractice in stress urinary incontinence management: A 30-year legal database review.

BACKGROUND: The purpose of this study is to investigate the most common reasons for and judicial outcomes of malpractice claims related to stress urinary incontinence (SUI) management. MATERIALS AND METHODS: Using the Westlaw database, a search was performed using the terms "medical malpractice" or "negligence" in combination with "stress incontinence" or "stress urinary incontinence" between January 1, 1990 and January 1, 2020. Extracted information included trial date, demographic information, defendant profession, procedure performed, procedure complications, alleged malpractice, trial outcome, and monetary award. Data were analyzed using descriptive statistics. RESULTS: The Westlaw search yielded 79 case results. Of the cases, 70.4% (n = 38/54) had a defense verdict, 22.2% (n = 12/54) had a plaintiff verdict, and 7.4% (n = 4/54) were settled. The most commonly implicated procedure was mid-urethral sling (63.2%, n = 36/57). Among the plaintiffs, 48.4% (n = 61/126) claimed negligence in preoperative care, 33.3% (n = 42/126) claimed negligence in surgical performance, and 18.3% (n = 23/126) claimed negligence in postoperative care. Lack of informed consent was the most common complaint related to negligence in preoperative care (42.6%, n = 26/61). The average indemnity payment was $1,253,644 for preoperative care negligence, $1,254,491 for surgical performance negligence, and $2,239,198 for postoperative care negligence. Of the defendants, 63.4% (n = 52) were gynecologists and 36.6% (n = 30) were urologists. CONCLUSIONS: Negligent preoperative care, with a particular emphasis on failure to obtain informed consent, and negligent surgical performance are the leading causes of malpractice claims during SUI management. Mid-urethral sling was the most commonly litigated procedure. This study highlights key factors to consider in minimizing malpractice risk during SUI management.

A 30-Year Review of Cystectomy Litigation.

INTRODUCTION: Annually the U.S. spends approximately $55.6 billion on malpractice and medical liability, with urology ranked 11th out of 25 specialties for number of malpractice claims. Our objective was to identify common causes for filing claims associated with cystectomy as well as corresponding payout outcomes. METHODS: Using the Westlaw® legal database, a search was conducted using the keywords, "cystectomy," "cystoprostatectomy" and "bladder removal" between January 1, 1990 and January 1, 2020. Each case was evaluated for plaintiff demographics, alleged malpractice claim, defendant specialty, resulting clinical outcome, resulting legal outcome including verdict and monetary award. Alleged malpractice claims were further subdivided based on whether the claimed negligence of duty was preoperative, perioperative or postoperative. Data were analyzed using Microsoft® Office Excel®. RESULTS: After accounting for irrelevant and duplicate cases the Westlaw search returned 42 unique cases. The most common indication for cystectomy was bladder cancer (69%). Preoperative negligence resulted in the highest average payout ($2,062,204.00) and accounted for 76% of filed claims, with delay in diagnosis accounting for the most common complaint (47%). Urologists made up the highest percentage of defendants sued, at 62%. CONCLUSIONS: The bulk of alleged malpractice in cystectomy cases is due to preoperative negligence, most predominantly in the delay of cancer diagnosis. Alleged cases of preoperative negligence also return the highest award for the plaintiff. This study sheds light on areas of concern that urologists should be aware of associated with cystectomy litigation.

Virtual grand rounds as a novel means for applicants and programs to connect in the era of COVID-19.

BACKGROUND: COVID-19 has disrupted the 2020-2021 residency application cycle with the cancellation of away rotations and in-person interviews. This study seeks to investigate the feasibility and utility of video conferencing technology (VCT) as an opportunity for applicants to interact with faculty from outside programs. METHODS: 18 prospective urology applicants were randomized to 6 urology programs to give a virtual grand rounds (VGR) talk. Presentations were recorded and analyzed to determine audience engagement. Students were surveyed regarding perceived utility of VGR. Faculty were surveyed to determine system usability of VCT and ability to evaluate the applicant. RESULTS: 17 students completed the survey, reporting a 100% satisfaction rate with VGR. A majority felt this was a useful way to learn about outside programs. 85 physicians completed the faculty survey, with nearly half feeling confident in their ability to evaluate the applicant. Video transcription data shows sessions were interactive with minimal distractions. CONCLUSIONS: VGR can be a useful means for medical students to express interest in programs as well as an additional marker for faculty to evaluate applicants.

HOT Graphene and HOT Graphene Nanotubes: New Low Dimensional Semimetals and Semiconductors.

We report a new graphene allotrope named HOT graphene containing carbon hexagons, octagons, and tetragons. A corresponding series of nanotubes are also constructed by rolling up the HOT graphene sheet. Ab initio calculations are performed on geometric and electronic structures of the HOT graphene and the HOT graphene nanotubes. Dirac cone and high Fermi velocity are achieved in a non-hexagonal structure of HOT graphene, implying that the honeycomb structure is not an indispensable condition for Dirac fermions to exist. HOT graphene nanotubes show distinctive electronic structures depending on their topology. The (0,1) n (n ≥ 3) HOT graphene nanotubes reveal the characteristics of semimetals, while the other set of nanotubes (1,0) n shows continuously adjustable band gaps (0~ 0.51 eV) with tube size. A competition between the curvature effect and the zone-folding approximation determines the band gaps of the (1,0) n nanotubes. Novel conversion between semimetallicity and semiconductivity arises in ultra-small tubes (radius < 4 Å, i.e., n < 3).

Electronic Properties of Vanadium Atoms Adsorption on Clean and Graphene-Covered Cu(111) Surface.

The electronic properties of vanadium atoms adsorbed on clean and graphene-covered Cu(111) surface have been systematically studied using ab initio theoretical method. Two coverages (1/9 ML and 1 ML) of vanadium adsorption are considered in this work. Our calculations indicate that V staying underneath the Cu surface is found to be the most stable adsorption site at the aforementioned two coverages for V/Cu(111). However, such adsorption may lead to undesired properties. Therefore, we introduce graphene as a buffer layer to effectively alleviate the direct interaction between V and Cu surface. The calculations show that electronic properties of the original graphene layer are significantly affected by the interactions of C atoms with the V adatoms; the Dirac point of graphene is "destroyed" as a consequence at both coverages. In the V/Gra/Cu(111) system, the interaction between graphene layer and the substrate Cu atoms remains weak as in the Gra/Cu(111) system. Moreover, a relatively low coverage of 1/9 ML gives rise to a spin-polarized system while a non-spin-polarized system is observed at the coverage of 1 ML. This finding offers a new way for the application of vanadium-based materials in reality.