Colorectal specialization and survival in colorectal cancer.

AIM: It is recognized that higher surgeon volume is associated with improved survival in colorectal cancer. However, there is a paucity of national studies that have evaluated the relationship between surgical specialization and survival. METHOD: We used the Surveillance, Epidemiology, and End Results Medicare cancer registry to examine the association between colorectal specialization (CRS) and disease-specific survival (DSS) between 2001 and 2009. A total of 21,432 colon cancer and 5893 rectal cancer patients who underwent elective surgical resection between 2001 and 2009 were evaluated. Univariate and multivariate Cox survival analysis was used to identify the association between surgical specialization and cancer-specific survival. RESULTS: Colorectal specialists performed 16.3% of the colon and 27% of the rectal resections. On univariate analysis, specialization was associated with improved survival in Stage II and Stage III colon cancer and Stage II rectal cancer. In multivariate analysis, however, CRS was associated with significantly improved DSS only in Stage II rectal cancer [hazard ratio (HR) 0.70, P = 0.03]. CRS was not significantly associated with DSS in either Stage I (colon HR 1.14, P = 0.39; rectal HR 0.1.26, P = 0.23) or Stage III (colon HR 1.06, P = 0.52; rectal HR 1.08, P = 0.55) disease. When analysis was limited to high volume surgeons only, the relationship between CRS and DSS was unchanged. CONCLUSIONS: CRS is associated with improved DSS following resection of Stage II rectal cancer. A combination of factors may contribute to long-term survival in these patients, including appropriate surgical technique, multidisciplinary treatment decisions and guideline-adherent surveillance. CRS probably contributes positively to these factors resulting in improved survival.

Magnetism in single metalloorganic complexes formed by atom manipulation.

The magnetic properties of molecular structures can be tailored by chemical synthesis or bottom-up assembly at the atomic scale. We used scanning tunneling microscopy to study charge and spin transfer in individual complexes of transition metals with the charge acceptor, tetracyanoethylene (TCNE). The complexes were formed on a thin insulator, Cu2N on Cu(100), by manipulation of individual atoms and molecules. The Cu2N layer decouples the complexes from Cu electron density, enabling direct imaging of the TCNE molecular orbitals as well as spin-flip inelastic electron tunneling spectroscopy. Results were obtained at low temperature down to 1 K and in magnetic fields up to 7 T in order to resolve splitting of spin states in the complexes. We also performed spin-polarized density functional theory calculations to compare with the experimental data. Our results indicate that charge transfer to TCNE leads to a change in spin magnitude, Kondo resonance, and magnetic anisotropy for the metal atoms.

Electrical spin injection from an organic-based ferrimagnet in a hybrid organic-inorganic heterostructure.

We report the successful extraction of spin-polarized current from the organic-based room temperature ferrimagnetic semiconductor V[TCNE](x) (x∼2, TCNE: tetracyanoethylene; T(C)∼400 K, E(G)∼0.5 eV, σ(300 K)∼10(-2) S/cm) and its subsequent injection into a GaAs/AlGaAs light-emitting diode. The spin current tracks the magnetization of V[TCNE](x∼2), is weakly temperature dependent, and exhibits heavy-hole-light-hole asymmetry. This result has implications for room temperature spintronics and the use of inorganic materials to probe spin physics in organic and molecular systems.

Spin injection/detection using an organic-based magnetic semiconductor.

The new paradigm of electronics, 'spintronics', promises to extend the functionality of information storage and processing in conventional electronics. The principal spintronics device, the 'spin valve', consists of two magnetic layers decoupled by a spin-transporting spacer, which allows parallel (on) and antiparallel (off) alignment of the magnetizations (spins) of the two magnetic layers. The device resistance then depends on the spin alignment controlled by the external magnetic field. In pursuit of semiconductor spintronics, there have been intensive efforts devoted to develop room-temperature magnetic semiconductors and also to incorporate both inorganic semiconductors and carbon-based materials as the spin-transporting channels. Molecule/organic-based magnets, which allow chemical tuning of electronic and magnetic properties, are a promising new class of magnetic materials for future spintronic applications. Here, we report the realization of an organic-based magnet as an electron spin polarizer in the standard spintronics device geometry. A thin non-magnetic organic semiconductor layer and an epitaxial ferromagnetic oxide film were employed to form a hybrid magnetic tunnel junction. The results demonstrate the spin-polarizing nature of the organic-based magnetic semiconductor, vanadium(TCNE: tetracyanoethylene)(x) (x approximately 2; T(c) approximately 400 K), and its function as a spin injector/detector in hybrid magnetic multilayer devices.

Magnetic bistability and nucleation of magnetic bubbles in a layered 2D organic-based magnet [Fe(TCNE)(NCMe)2][FeCl4].

The 2D layered organic-based magnet [Fe(TCNE)(NCMe)2][FeCl4] (TCNE=tetracyanoethylene) exhibits a unique macroscopic magnetic bistability between the field-cooled and zero-field-cooled states, which cannot be explained by either superparamagnetic behavior or spin freezing due to spin glass order. This magnetic bistability is described through consideration of the ensemble of uncoupled 2D Ising layers and their magnetization reversal initiated by a field-induced nucleation of magnetic bubbles in individual layers. The bubble nucleation rate strongly depends on the external field and temperature resulting in anomalous magnetic relaxation.

Bonding, backbonding, and spin-polarized molecular orbitals: basis for magnetism and semiconducting transport in V[TCNE]x approximately 2.

X-ray absorption spectroscopy (XAS) and magnetic circular dichroism (MCD) at the V L{2,3} and C and N K edges reveal bonding and backbonding interactions in films of the 400 K magnetic semiconductor V[TCNE]x approximately 2. In V spectra, d{xy}-like orbitals are modeled assuming V2+ in an octahedral ligand field, while d{z{2}} and d{x{2}-y{2}} orbitals involved in strong covalent sigma bonding cannot be modeled by atomic calculations. C and N MCD, and differences in XAS from neutral TCNE molecules, reveal spin-polarized molecular orbitals in V[TCNE]x approximately 2 associated with weaker pi bonding interactions that yield its novel properties.

Inversion of magnetoresistance in organic semiconductors.

We report that organic semiconductors such as alpha-sexithiophene (alpha-6T) have magnetoresistance (MR) with unexpected sign changes; depending on applied voltage, temperature, and layer thickness, the resistance may either increase or decrease upon application of a small magnetic field (<100 mT). We propose that MR and the inversion of MR are due to the role of hyperfine interaction in a magnetic field, as illustrated by the recombination-limited regime.

Photoinduced magnetism and random magnetic anisotropy in organic-based magnetic semiconductor V(TCNE){x} films, for x approximately 2.

The V(TCNE){x}, x approximately 2 is an organic-based amorphous ferrimagnet, whose magnetic behavior is significantly affected in the low field regime by the random magnetic anisotropy. It was determined that this material has thermally reversible persistent change in both magnetization and conductivity driven by the optical excitation. Here, we report results of a ferrimagnetic resonance study of the photoinduced magnetism in V(TCNE){x} film. Upon optical excitation (lambda approximately 457.9 nm), the ferrimagnetic resonance spectra display substantial changes in their linewidths and line shifts, which reflect a substantial increase in the random magnetic anistropy. The results reflect the role of magnetic anisotropy in disordered magnets and suggest a novel mechanism of photoinduced magnetism in V(TCNE){x} induced by the increased structural disorder in the system.

Multiple photonic responses in films of organic-based magnetic semiconductor V(TCNE)x, x approximately 2.

Concomitant photoinduced magnetic and electrical phenomena are reported for the organic-based magnetic semiconductor V(TCNE)x (x approximately 2; TCNE=tetracyanoethylene; magnetic ordering temperature Tc approximately 400 K). Upon optical excitation (457.9 nm), the system can be trapped in a thermally reversible photoexcited state, which exhibits reduced magnetic susceptibility and increased conductivity with a simultaneous change in IR absorption spectrum. The multiple photonic effects in V(TCNE)x are proposed to originate from structural changes induced by internal excitation in (TCNE)- anions, which lead to relaxation to a long-lived metastable state.

Viscous behavior in a quasi-1D fractal cluster glass.

The spin glass transition of a quasi-1D organic-based magnet ([MnTPP][TCNE]) is explored using both ac and dc measurements. A scaling analysis of the ac susceptibility shows a spin glass transition near 4 K, with a viscous decay of the thermoremanent magnetization recorded above 4 K. We propose an extension to a fractal cluster model of spin glasses that determines the dimension of the spin clusters (D) ranging from approximately 0.8 to over 1.5 as the glass transition is approached. Long-range dipolar interactions are suggested as the origin of this low value for the apparent lower critical dimension.

Cataract surgery in a patient with Brown-McLean syndrome.

The Brown-McLean syndrome is defined by corneal edema that involves the peripheral 2.0 to 3.0 mm of cornea, sparing the central cornea. This syndrome is usually associated with previous cataract surgery but has been reported rarely in patients with other predisposing factors such as angle-closure glaucoma or spontaneous lens absorption with iridodonesis. We describe the clinical course of a 50-year-old man with myotonic dystrophy who had Brown-McLean syndrome with no identifiable predisposition for peripheral corneal edema. Although this syndrome appears to be the result of peripheral endothelial dysfunction, this patient was able to tolerate cataract extraction without developing central corneal edema.

The role of public clinics in preventable hospitalizations among vulnerable populations.

OBJECTIVE: To determine if the availability of public ambulatory clinics affects preventable hospitalization (PH) rates of low-income and elderly populations. DATA SOURCES: PH rates were calculated using elderly and low-income discharges from 1995-97 Virginia hospital discharge data. Other data sources include the 1990 Census, the 1998 Area Resource File, the 1996 American Hospital Association Survey, the Virginia Department of Health, the Virginia Primary Care Association, and the Bureau of Primary Health Care. STUDY DESIGN: Multiple linear regression was used to evaluate the relationship between ambulatory clinic availability and PH rates, controlling for population and other provider characteristics in a cross-section of zip code clusters. DATA EXTRACTION METHODS: Clusters with populations of at least 2,000 were assembled from zip codes in each county in the state of Virginia. Overlapping medical market service areas were constructed around the population centroid of each cluster. PRINCIPAL FINDINGS: Populations in medically underserved areas (MUAs) served by a Federally Qualified Health Center had significantly lower PH rates than did other MUA populations. The presence of a free clinic had a marginally significant association with lower PH rates. CONCLUSIONS: The availability of public ambulatory clinics is associated with better access to primary care among low-income and elderly populations.

Solvent dependence of the structure and magnetic ordering of ferrimagnetic manganese(III) meso-tetraphenylporphyrin tetracyanoethenide, [MnTPP]+[TCNE]*-.

Tetraphenylporphinatomanganate(III) tetracyanoethenide, [MnTPP][TCNE], is the prototype of a growing family of linear chain (1-D) coordination polymers that magnetically order as ferrimagnets. [MnTPP][TCNE].xS [S = PhMe (x = 2), 1,2-C(6)H(4)Me(2) (x = 1), 1,2-C(6)H(4)Cl(2) (x = 3), 1,2,4-C(6)H(3)Cl(3) (x = 2), and 1,3-C(6)H(4)Cl(2) (x = 2)] have been prepared and structurally and magnetically characterized. All form 1-D chain structures with intrachain Mn.Mn separations ranging from 9.202 to 10.218 A. The 173 K crystal structure of [MnTPP][TCNE].2PhMe has been rerefined, revealing that the [TCNE](*)(-) is 2-fold-disordered and coordinated to Mn(III) by a pair of trans cyano nitrogen atoms to form parallel one-dimensional chains. The two orientations of [TCNE](*)(-) are related by a 180 degrees rotation about the diagonal axis joining the trans nitrogen atoms bound to Mn(III). The major form has an occupancy of 83.3(4)% with a Mn-N(TCNE) distance of 2.328(3) A and a MnNC angle of 146.8(8) degrees. The minor form, with 16.7(4)% occupancy, has a Mn-N(TCNE) distance of 2.176(15) A and a MnNC angle of 152.3(39) degrees. Lattice packing and molecular bonding imply static as opposed to dynamic disorder. The magnetic properties depend on the type and quantity of the solvent present in the structure. Desolvation via heating in n-octane (127 degrees C), n-dodecane (216 degrees C), and/or vacuum thermolysis (175 degrees C) leads to numerous different desolvated materials with differing magnetic properties. At higher temperatures the magnetic susceptibility can be fit by the Curie-Weiss expression, chi varies with (T - theta)(-1), with theta = 44, 52, 72, 55, and 77 K for the toluene, 1,2-xylene, 1,2-dichlorobenzene, 1,3-dichlorobenzene, and 1,2,4-trichlorobenzene solvates, respectively. The T(c)'s were taken as the maximum in 10 Hz chi'(T) and are 7.8, 9.2, 11.3, 10.8, and 8.2 K for the PhMe, 1,2-xylene, 1,2-dichlorobenzene, 1,3-dichlorobenzene, and 1,2,4-trichlorobenzene solvates, respectively. Upon desolvation the T(c)'s increase for the PhMe, 1,2-xylene, 1,2,4-trichlorobenzene solvates and decrease for the 1,2- and 1,3-dichlorobenezene solvates. The compounds show one-dimensional ferrimagnetic exchange behavior at high temperatures with intrachain exchange of J/k(b) = -63, -99, -234, -100, and -200 K for toluene, 1,2-xylene, 1,2-dichlorobenzene, 1,3-dichlorobenzene, and 1,2,4-trichlorobenzene solvates, respectively, as determined from fits to the Seiden expression, which models isolated 1-D interactions among alternating S = 2 classical and S = (1)/(2) quantum spins. For variation in the temperature at which the peak occurs per decade of frequency, phi, (DeltaT(f)/T(f))/Delta(log omega) is 0.167, 0.168, 0.066, 0.171, and 0.024 for toluene, 1,2-xylene, 1,2-dichlorobenzene, 1,3-dichlorobenzene, and 1,2,4-trichlorobenzene, respectively, typical of spin glass behavior. Since [TCNE](*)(-) is only disordered for the PhMe solvate and all five solvates exhibit spin glass behavior, the spin glass behavior cannot be attributed to this disorder.

A claims data approach to defining an episode of care.

OBJECTIVE: To utilize health services research techniques in developing an episode of care using an administrative data set. This method is demonstrated for an episodic clinical condition, migraine. DATA SOURCES: Medicaid administrative data set of 3,372 patients with a diagnosis of migraine (ICD-9-CM 346.0, 346.1) in the state of Pennsylvania between May 1990 and March 1992. STUDY DESIGN: The duration of a migraine episode was measured by assessing the magnitude of resource utilization and the proportion of patients with charges in the period after the index migraine as compared to the period before the index migraine. A confidence interval (CI) was developed around each measure using bootstrap techniques. DATA COLLECTION METHODS: All charge data were extracted daily for a 113-day observation period surrounding each index migraine in order to observe the duration of impact of a migraine diagnosis on resource utilization. PRINCIPAL FINDINGS: The lower limits of both the 95% and 99% CIs for the difference in charges are greater than 0 for three weeks. The lower limits of both CIs for the difference in the proportion of patients with charges are above 0 for six weeks. CONCLUSIONS: Our analysis demonstrates that a health services research framework can be used to define an episode of care for a chronic disease category such as migraine. This method can be used to evaluate episodes of care for clinical studies of limited or episodic conditions and to complement clinical expertise in developing time horizons for clinical trials.

A claims data approach to defining an episode of care.

OBJECTIVE: To utilize health services research techniques in developing an episode of care using an administrative data set. This method is demonstrated for an episodic clinical condition, migraine. DATA SOURCES: Medicaid administrative data set of 3,372 patients with a diagnosis of migraine (ICD-9-CM 346.0, 346.1) in the state of Pennsylvania between May 1990 and March 1992. STUDY DESIGN: The duration of a migraine episode was measured by assessing the magnitude of resource utilization and the proportion of patients with charges in the period after the index migraine as compared to the period before the index migraine. A confidence interval (CI) was developed around each measure using bootstrap techniques. DATA COLLECTION METHODS: All charge data were extracted daily for a 113-day observation period surrounding each index migraine in order to observe the duration of impact of a migraine diagnosis on resource utilization. PRINCIPAL FINDINGS: The lower limits of both the 95% and 99% CIs for the difference in charges are greater than 0 for three weeks. The lower limits of both CIs for the difference in the proportion of patients with charges are above 0 for six weeks. CONCLUSIONS: Our analysis demonstrates that a health services research framework can be used to define an episode of care for a chronic disease category such as migraine. This method can be used to evaluate episodes of care for clinical studies of limited or episodic conditions and to complement clinical expertise in developing time horizons for clinical trials.

Sulfonylurea-binding sites and ATP-sensitive K+ channels in alpha-TC glucagonoma and beta-TC insulinoma cells.

alpha-Cells secrete glucagon in a fuel-dependent fashion. We tested the hypothesis that alpha-cells contain sulfonylurea- and ATP-sensitive K+ channels. We studied two clonal lines of alpha-TC cells (simian virus 40 T-antigen induced glucagonoma cells) and for reference purposes, similarly transformed beta-TC insulinoma cells. alpha-TC cells each contained approximately 3000 high-affinity binding sites for the sulfonylurea [3H]glyburide. Whole-cell ATP- and tolbutamide-sensitive K+ currents of alpha-TC and beta-TC cells, relative to cell surface area, were comparable. In cell-attached membrane patches of alpha-TC cells, two types of K+ channels were observed. They had slope conductances of approximately 63 and 33 pS when the electrode contained 151 mM K+. Tolbutamide and diazoxide decreased and enhanced, respectively, the open probability of these channels. The membrane of alpha-TC cells depolarized periodically. This electrical activity was inhibited by diazoxide. A physiological mixture of amino acids enhanced glucagon release, and high glucose partially inhibited this release. Tolbutamide also enhanced glucagon release, whereas diazoxide inhibited it. Thus, alpha-TC glucagonoma cells contain ATP-sensitive K+ channels that regulate glucagon release, yet allow inhibition of hormone release by glucose.

A room-temperature molecular/organic-based magnet.

The reaction of bis(benzene)vanadium with tetracyanoethylene, TCNE, affords an insoluble amorphous black solid that exhibits field-dependent magnetization and hysteresis at room temperature. The critical temperature could not be estimated as it exceeds 350 kelvin, the thermal decomposition temperature of the sample. The empirical composition of the reported material is V(TCNE)x.Y(CH(2)Cl(2)) with x approximately 2 and Y approximately 1/2. On the basis of the available magnetic and infrared data, threedimensional antiferromagnetic exchange of the donor and acceptor spins resulting in ferrimagnetic behavior appears to be the mode of magnetic coupling.

Molecular/Organic ferromagnets.

Quantitative bulk ferromagnetic behavior has been established for the molecular/organic solid [Fe(III)(C(5)Me(5))(2)].(+)[TCNE].(-). Above 16 K the dominant magnetic interactions are along a 1-D chain and, near T(c), 3-D bulk effects as evidenced by the value of the critical exponents dominate the susceptibility. The extended McConnell model was developed and provides the synthetic chemist with guidance for making new molecular materials to study cooperative magnetic coupling in systems. Assuming the electron-transfer excitation arises from the POMO, ferromagnetic coupling by the McConnell mechanism requires stable radicals (neutral, cations/anions, or ions with small diamagnetic counterions) with a non-half-filled POMO. The lowest excited state formed via virtual charge transfer (retro or forward) must also have the same spin multiplicity and mix with the ground state. These requirements limit the structure of a radical to D(2d) or C>/=(3) symmetry where symmetry breaking distortions do not occur. Intrinsic doubly and triply degenerate orbitals are not necessary and accidental degeneracies suffice. To achieve bulk ferromagnetism, ferromagnetic coupling must be established throughout the solid and a microscopic model has been discussed. These requirements are met by [Fe(III)(C(5)Me(5))(2)].(+)[TCNE].(-). Additionally this model suggests that the Ni(III) and Cr(III) analogs should be antiferromagnetic and ferrimagnetic, respectively, as preliminary data suggest. Additional studies are necessary to test and further develop the consequences of these concepts. Some molecular/organic solids comprised of linear chains of alternating metallocenium donors (D) and cyanocarbon acceptors (A) with spin state S = 1/2 (...D.(+)A.(-)D.(+)A.(-)...) exhibit cooperative magnetic phenomena, that is, ferro-, antiferro-, ferri-, and metamagnetism. For [Fe(III)(C(5)Me(5))(2)].(+)[TCNE](-). (Me = methyl; TCNE = tetracyanoethylene), bulk ferromagnetic behavior is observed below the Curie temperature of 4.8 K. A model of configuration mixing of the lowest charge-transfer excited state with the ground state was developed to understand the magnetic coupling as a function of electron configuration and direction of charge transfer. This model predicts that ferromagnetic coupling requires stable radicals with a non-half-filled degenerate valence orbital and a charge-transfer excited state with the same spin multiplicity that mixes with the ground state. Ferromagnetic coupling must dominate in all directions to achieve a bulk ferromagnet. Thus, the primary, secondary, and tertiary structures are crucial considerations for the design of molecular/organic ferromagnets.

Magnetic resonance imaging in an unusual presentation of herpes encephalitis.

We report a patient with herpes simplex virus encephalitis who presented with left hemiparesis and progressed to aphasia and generalized spasticity. Computerized axial brain tomography with and without infusion of contrast medium was normal, as were the cerebrospinal fluid findings. However, magnetic resonance imaging scan and brain biopsy, were diagnostic of herpes simplex encephalitis.