Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial.

Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (-1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.

Interfacial States and Fano-Feshbach Resonance in Graphene-Silicon Vertical Junction.

Interfacial quantum states are drawing tremendous attention recently because of their importance in design of low-dimensional quantum heterostructures with desired charge, spin, or topological properties. Although most studies of the interfacial exchange interactions were mainly performed across the interface vertically, the lateral transport nowadays is still a major experimental method to probe these interactions indirectly. In this Letter, we fabricated a graphene and hydrogen passivated silicon interface to study the interfacial exchange processes. For the first time we found and confirmed a novel interfacial quantum state, which is specific to the 2D-3D interface. The vertically propagating electrons from silicon to graphene result in electron oscillation states at the 2D-3D interface. A harmonic oscillator model is used to explain this interfacial state. In addition, the interaction between this interfacial state (discrete energy spectrum) and the lateral band structure of graphene (continuous energy spectrum) results in Fano-Feshbach resonance. Our results show that the conventional description of the interfacial interaction in low-dimensional systems is valid only in considering the lateral band structure and its density-of-states and is incomplete for the ease of vertical transport. Our experimental observation and theoretical explanation provide more insightful understanding of various interfacial effects in low-dimensional materials, such as proximity effect, quantum tunneling, etc. More important, the Fano-Feshbach resonance may be used to realize all solid-state and scalable quantum interferometers.

Clinical Significance of Bioimpedance Spectroscopy in Critically Ill Patients.

BACKGROUND: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. METHODS: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge. RESULTS: Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between -1 and 1 L), hyper OH status (OH volume < -1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days. CONCLUSION: Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.

A Study of Vertical Transport through Graphene toward Control of Quantum Tunneling.

Vertical integration of van der Waals (vdW) materials with atomic precision is an intriguing possibility brought forward by these two-dimensional (2D) materials. Essential to the design and analysis of these structures is a fundamental understanding of the vertical transport of charge carriers into and across vdW materials, yet little has been done in this area. In this report, we explore the important roles of single layer graphene in the vertical tunneling process as a tunneling barrier. Although a semimetal in the lateral lattice plane, graphene together with the vdW gap act as a tunneling barrier that is nearly transparent to the vertically tunneling electrons due to its atomic thickness and the transverse momenta mismatch between the injected electrons and the graphene band structure. This is accentuated using electron tunneling spectroscopy (ETS) showing a lack of features corresponding to the Dirac cone band structure. Meanwhile, the graphene acts as a lateral conductor through which the potential and charge distribution across the tunneling barrier can be tuned. These unique properties make graphene an excellent 2D atomic grid, transparent to charge carriers, and yet can control the carrier flux via the electrical potential. A new model on the quantum capacitance's effect on vertical tunneling is developed to further elucidate the role of graphene in modulating the tunneling process. This work may serve as a general guideline for the design and analysis of vdW vertical tunneling devices and heterostructures, as well as the study of electron/spin injection through and into vdW materials.

Atomic-Monolayer Two-Dimensional Lateral Quasi-Heterojunction Bipolar Transistors with Resonant Tunneling Phenomenon.

High-frequency operation with ultrathin, lightweight, and extremely flexible semiconducting electronics is highly desirable for the development of mobile devices, wearable electronic systems, and defense technologies. In this work, the experimental observation of quasi-heterojunction bipolar transistors utilizing a monolayer of the lateral WSe2-MoS2 junctions as the conducting p-n channel is demonstrated. Both lateral n-p-n and p-n-p heterojunction bipolar transistors are fabricated to exhibit the output characteristics and current gain. A maximum common-emitter current gain of around 3 is obtained in our prototype two-dimensional quasi-heterojunction bipolar transistors. Interestingly, we also observe the negative differential resistance in the electrical characteristics. A potential mechanism is that the negative differential resistance is induced by resonant tunneling phenomenon due to the formation of quantum well under applying high bias voltages. Our results open the door to two-dimensional materials for high-frequency, high-speed, high-density, and flexible electronics.

Dual-mode operation of 2D material-base hot electron transistors.

Vertical hot electron transistors incorporating atomically-thin 2D materials, such as graphene or MoS2, in the base region have been proposed and demonstrated in the development of electronic and optoelectronic applications. To the best of our knowledge, all previous 2D material-base hot electron transistors only considered applying a positive collector-base potential (VCB > 0) as is necessary for the typical unipolar hot-electron transistor behavior. Here we demonstrate a novel functionality, specifically a dual-mode operation, in our 2D material-base hot electron transistors (e.g. with either graphene or MoS2 in the base region) with the application of a negative collector-base potential (VCB < 0). That is, our 2D material-base hot electron transistors can operate in either a hot-electron or a reverse-current dominating mode depending upon the particular polarity of VCB. Furthermore, these devices operate at room temperature and their current gains can be dynamically tuned by varying VCB. We anticipate our multi-functional dual-mode transistors will pave the way towards the realization of novel flexible 2D material-based high-density and low-energy hot-carrier electronic applications.

Atomic-Monolayer MoS2 Band-to-Band Tunneling Field-Effect Transistor.

The experimental observation of band-to-band tunneling in novel tunneling field-effect transistors utilizing a monolayer of MoS2 as the conducting channel is demonstrated. Our results indicate that the strong gate-coupling efficiency enabled by two-dimensional materials, such as monolayer MoS2 , results in the direct manifestation of a band-to-band tunneling current and an ambipolar transport.

A comorbidity index for mortality prediction in Chinese patients with ESRD receiving hemodialysis.

BACKGROUND AND OBJECTIVES: Chinese patients with ESRD have different comorbidity patterns than white patients with ESRD and require a validated comorbidity index. The objective of this study was to develop a new index for mortality prediction in 2006-2009 Taiwanese incident hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were retrieved from 2005 to 2010 Taiwan National Health Insurance claim records, and follow-up was available until December 31, 2010. The same comorbid conditions as the US Renal Data System (USRDS) index that occurred during a 12-month period from 9 months before to 3 months after dialysis initiation were used to construct the index. Integer weight of the comorbid conditions was derived from coefficient estimates of Cox regression for all-cause mortality, and the index was internally validated. The performance of the index was assessed by discrimination, calibration, and reclassification. RESULTS: A total of 30,303 hemodialysis patients were included in this study. The weight for individual comorbid conditions of this index differed from that of the USRDS index. The performance of this index was similar to that of USRDS and Charlson indices in terms of model fit statistics, overall predictive ability, discrimination, and calibration. Hosmer-Lemeshow test showed that all three indices demonstrated significant differences between predicted and observed mortality rates. When patients were categorized by the predicted 2.5-year survival probabilities, the index achieved a net reclassification improvement of 4.71% (P<0.001), referenced to USRDS index. CONCLUSIONS: Compared with USRDS index, this new index demonstrated better reclassification ability, but future studies should address the clinical significance.

Sudden death due to medulloblastoma: a case report.

PURPOSE: Medulloblastoma is one of the notorious CNS malignancies for subtle and atypical clinical presentations, causing rapid neurological deterioration and death, especially in pediatric patients. The delay in diagnosis leads to painful remorse, conflicts, and lawsuits for parents and medical staff. CASE REPORT: We report a 2 year old girl with initial presentation of febrile pyuria. Soon after admission, a generalized clonic-tonic seizure attacked to her and led to an impression of febrile convulsion. However, an unusual postical slowness of pupils to light stimulation propelled a further investigation. A contrast enhanced brain computer tomography (CT) unexpectedly showed a mass occupied the fourth ventricle resulting in obstructive hydrocephalus and compressed adjacent brain stem and cerebellum. The disease rapidly progressed and she died 18 hours after an emergent decompression with extraventricular drainage (EVD) installation. Cytology of cerebrospinal fluid proved medulloblastoma. CONCLUSION: This case report highlights the importance of clinical suspicion, such as a trivial but unusual presentation, a lagged pupil response to light stimulation. A brain CT scan should be done to rule out any possibility of an organic lesion. Close monitor is required in order to catch and treat medulloblastoma early. However, once discovered, the cancer has spread.

Above-11%-efficiency organic-inorganic hybrid solar cells with omnidirectional harvesting characteristics by employing hierarchical photon-trapping structures.

Hierarchical structures consisting of micropyramids and nanowires are used in Si/PEDOT:PSS hybrid solar cells to achieve a power conversion efficiency (PCE) up to 11.48% with excellent omnidirectionality. The structure provides a combined concepts of superior light trapping ability, significant increase of p-n junction areas, and short carrier diffusion distance, improving the photovoltaic characteristics including short-circuit current density, fill factor, and PCE. The enhancement of power generation is up to 253.8% at high incident angles, showing the outstanding omnidirectional operation ability of hybrid cells with hierarchical Si surfaces. This properly designed hierarchical-structured device paves a promising way for developing low-cost, high-efficiency, and omnidirectional solar applications in the future.

An energy-harvesting scheme employing CuGaSe2 quantum dot-modified ZnO buffer layers for drastic conversion efficiency enhancement in inorganic-organic hybrid solar cells.

We demonstrated a promising route to enhance the performance of inverted organic photovoltaic (OPV) devices by the incorporation of CuGaSe2 (CGS) quantum dots (QDs) into the ZnO buffer layer of P3HT:PCBM-based devices. The modification of QDs provides better band alignment between the organic/cathode interface, improves ZnO crystal quality, and increases photon absorption, leading to more effective carrier transport/collection. By employing this energy-harvesting scheme, short-circuit current density, open-circuit voltage, and fill factor of the OPV device after CGS QD modification are improved by 9.43%, 7.02% and 6.31%, respectively, giving rise to a 23.8% enhancement in the power conversion efficiency.

Peritoneal dialysis as compared with hemodialysis is associated with higher overhydration but non-inferior blood pressure control and heart function.

BACKGROUND/AIMS: Fluid overload is an important factor causing cardiovascular complications in dialysis patients. We compared fluid status, blood pressure (BP) and heart function between peritoneal dialysis (PD) patients and hemodialysis (HD) patients. METHODS: We recruited 94 PD and 75 HD patients in our hospital. Fluid status was assessed by bioimpedance spectroscopy. Home BP was recorded. Use of antihypertensives was retrieved by chart review. In each group, 39 patients received echocardiographic examinations. RESULTS: PD patients' fluid status was similar to that of predialysis HD patients. PD patients had lower systolic BP. E/E' and left ventricular mass index (LVMI) showed no significant intergroup difference. In multiple linear regression analyses, overhydration (OH)/extracellular water ratio >0.15 was associated with higher systolic BP, E/E' and LVMI. CONCLUSIONS: While PD was associated with higher OH but non-inferior BP control and heart function, OH was indeed related to poor BP control, diastolic dysfunction and left ventricular hypertrophy.

Significant efficiency enhancement of hybrid solar cells using core-shell nanowire geometry for energy harvesting.

A novel strategy employing core-shell nanowire arrays (NWAs) consisting of Si/regioregular poly(3-hexylthiophene) (P3HT) was demonstrated to facilitate efficient light harvesting and exciton dissociation/charge collection for hybrid solar cells (HSCs). We experimentally demonstrate broadband and omnidirectional light-harvesting characteristics of core-shell NWA HSCs due to their subwavelength features, further supported by the simulation based on finite-difference time domain analysis. Meanwhile, core-shell geometry of NWA HSCs guarantees efficient charge separation since the thickness of the P3HT shells is comparable to the exciton diffusion length. Consequently, core-shell HSCs exhibit a 61% improvement of short-circuit current for a conversion efficiency (η) enhancement of 31.1% as compared to the P3HT-infiltrated Si NWA HSCs with layers forming a flat air/polymer cell interface. The improvement of crystal quality of P3HT shells due to the formation of ordering structure at Si interfaces after air mass 1.5 global (AM 1.5G) illumination was confirmed by transmission electron microscopy and Raman spectroscopy. The core-shell geometry with the interfacial improvement by AM 1.5G illumination promotes more efficient exciton dissociation and charge separation, leading to η improvement (∼140.6%) due to the considerable increase in V(oc) from 257 to 346 mV, J(sc) from 11.7 to 18.9 mA/cm(2), and FF from 32.2 to 35.2%, which is not observed in conventional P3HT-infiltrated Si NWA HSCs. The stability of the Si/P3HT core-shell NWA HSCs in air ambient was carefully examined. The core-shell geometry should be applicable to many other material systems of solar cells and thus holds high potential in third-generation solar cells.