Wavy Architecture Thin-Film Transistor for Ultrahigh Resolution Flexible Displays.

A novel wavy-shaped thin-film-transistor (TFT) architecture, capable of achieving 70% higher drive current per unit chip area when compared with planar conventional TFT architectures, is reported for flexible display application. The transistor, due to its atypical architecture, does not alter the turn-on voltage or the OFF current values, leading to higher performance without compromising static power consumption. The concept behind this architecture is expanding the transistor's width vertically through grooved trenches in a structural layer deposited on a flexible substrate. Operation of zinc oxide (ZnO)-based TFTs is shown down to a bending radius of 5 mm with no degradation in the electrical performance or cracks in the gate stack. Finally, flexible low-power LEDs driven by the respective currents of the novel wavy, and conventional coplanar architectures are demonstrated, where the novel architecture is able to drive the LED at 2 × the output power, 3 versus 1.5 mW, which demonstrates the potential use for ultrahigh resolution displays in an area efficient manner.

Retrospective study of outcomes after extended resection for tracheobronchial adenoid cystic carcinoma.

OBJECTIVE: Tracheobronchial adenoid cystic carcinoma is a rare, slow-growing malignancy with a considerable propensity for local extension that may require complex airway resection to achieve tumor-free margins. The objective of this study was to assess whether our experience supports complex airway resection for tracheobronchial adenoid cystic carcinoma. METHODS: Consecutive patients who underwent curative resection for tracheobronchial adenoid cystic carcinoma at our institution between 1970 and 2019 were included retrospectively and classified as having had complex or standard resection. Complex surgery included total tracheal replacement, associated esophageal resection, pneumonectomy, total laryngectomy with tracheal resection, and carinal resection. Standard surgery included tracheal resection, bronchoplastic resection, lobectomy, and bilobectomy. We obtained data from medical records, referring physicians, patients, relatives, and public death records. RESULTS: Of 59 included patients, 38 had complex and 21 had standard surgery. All 4 (6.8%) patients who died postoperatively had undergone complex surgery. Postoperative morbidity was 32.2% overall and was significantly higher after complex surgery (P = .043). Overall 5- and 10-year survival rates were 81.5% and 60.2%, with no significant differences between groups (P = .31). By univariate analysis, T4 tumor and microscopically detectable tumor in the operative specimen margins and gross tumor in the operative specimen margins were associated with poorer survival (P < .05). In the subgroup with microscopically detectable tumor resection, survival was significantly better with adjuvant radiotherapy (P < .05). CONCLUSIONS: Complex resection for extended tracheobronchial adenoid cystic carcinoma may achieve local control and satisfying long-term survival. However, this demanding procedure is associated with high postoperative morbidity and mortality rates. Because adjuvant radiotherapy improved outcomes after resection resulting in microscopically detectable tumor in the operative specimen margins, expected outcomes after resection with no detectable tumor in the margins must be compared to those after resection resulting in microscopically detectable tumor in the margins plus radiotherapy, according to the operative risk.

A Patient-Centered Model of Fast-Track Lung Cancer Diagnosis.

INTRODUCTION: Despite the increasing importance of digital resources in modern life over the past decades, little is known about the impact of internet-based solutions on patient's health. We aimed to study the potential benefit of a digital platform helping patients to deal with abnormal chest CT scan revealing possible lung cancer. METHODS: We set up a fast-track lung cancer diagnosis pathway through a secure online platform. Patient-generated information combined with online review of their imaging enables preplanning of further investigations ahead of clinical assessment. We compared outcomes of "self-referred" patients (patient group), who directly fill out the online questionnaire, to general practitioner-driven patients (GP group), who were referred by their GP. RESULTS: From June 2021 to June 2022, we included 125 patients (61% males, median age 67 years, IQR 56.9-72.5): 41% in the patient group and 59% in the GP group. No difference was found between groups in terms of time from contact to first appointment (median 5 days in both groups, P = .6), percentage of pathways including prebooked tests (94% vs. 92%, P = .6), number of scheduled invasive procedures (median 1, IQR 1-2 vs. 2, IQR 1-2, P = .4) and in final cancer diagnosis (76% vs. 78%, P = .4). CONCLUSION: A lung cancer diagnosis pathway directly accessible by patients through a secure online platform was feasible and as efficient as the usual general practitioner pathway. It demonstrated the benefit of leaning on new digital tools in order to answer to the new challenges of a patient-centered health care system.

Cardiovascular risk factors, diet and lifestyle among European, South Asian and Chinese adolescents in Canada.

OBJECTIVE: The authors previously reported that adult South Asian immigrants to Canada have an increased risk of cardiovascular disease (CVD) compared to their European and Chinese counterparts. It is unknown whether these ethnic differences also exist among adolescents, and whether they are related to diet and lifestyle. The objective of the present study was to assess the prevalence of CVD risk factors among apparently healthy adolescents in the three largest ethnic population groups in Canada (European, South Asian and Chinese). METHODS: A cross-sectional study among secondary school students in the Greater Toronto Area was undertaken. A total of 203 adolescents from 62 GTA secondary schools were recruited (48% Europeans, 35% Chinese and 18% South Asians) with a mean age of 17.3±1 years; 72% were female. RESULTS: Similar to adults, South Asian adolescents have increased rates of CVD risk factors compared with their European and Chinese peers, including higher prevalence of low high-density lipoprotein levels (P=0.001), high triglycerides (P=0.006) and high triglyceride/high-density lipoprotein levels (P<0.001), despite no significant differences in dietary intake among the ethnic groups. European adolescents had higher rates of self-reported intensity of physical activity (P=0.002) than their Chinese or South Asian peers. CONCLUSIONS: Similar to adult data, South Asian adolescents have comparably higher rates of CVD risk factors compared with their European or Chinese peers, which could partly be attributed to lower physical activity in South Asian adolescents. Whether the findings in these selected samples of healthy adolescents can be generalized to their respective populations requires further validation.

Long-term Results and Functional Outcomes After Surgical Repair of Benign Laryngotracheal Stenosis.

BACKGROUND: Laryngotracheal resection and anastomosis (LTRA) is a reliable treatment for benign subglottic laryngotracheal stenosis (BSLTS), but data on functional outcomes are scarce. We assessed the surgical and functional outcomes of LTRA in BSLTS. METHODS: We retrospectively reviewed consecutive patients who underwent LTRA for BSLTS in 2007 to 2018. The 30-day outcomes were mortality, complications, and success rate. At the last follow-up, patients completed functional questionnaires (visual analog scale [VAS] and modified Medical Research Council scale for dyspnea, a VAS for swallowing, and the Voice Handicap Index) and assessed quality of life. RESULTS: Of 43 patients with BSLTS, 28 underwent the modified Pearson technique, and 15 Grillo's procedure. During the first 30 days, no patients died, the postoperative complication rate was 44%, and the success rate was 95%. After a mean follow-up of 53 months in 38 patients (88%), 7 patients had restenosis and 36 had late surgical success (95%). In the 34 patients who completed the questionnaires (79%), mean VAS dyspnea scores decreased significantly during rest (-5.4 ± 4.2) and exercise (-5.6 ± 4.4) (P < .001). A trend toward a decrease in modified Medical Research Council scale was found (P = .057; grade 0 in 62% of patients). The Voice Handicap Index indicated that voice impairment was absent to moderate in 30 patients (88%) and severe in 4 (12%). The VAS dysphagia scores were not significantly different before and after surgery. Quality of life gains were reported by 85% of patients. CONCLUSIONS: Laryngotracheal resection and anastomosis for BSLTS is safe and provides excellent surgical and functional outcomes with an improved quality of life. Laryngotracheal resection and anastomosis is a valid treatment option for BSLTS.

Natural history of glucose intolerance in patients with cystic fibrosis: ten-year prospective observation program.

OBJECTIVE: To determine prospectively the long-term natural history of glucose homeostasis in adult patients with cystic fibrosis (CF). STUDY DESIGN: Between 1996 and 2005, a total of 971 modified oral glucose tolerance tests (OGTTs) were performed in 329 patients with CF without recognized CF-related diabetes (CFRD). Patients were classified as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), CFRD without fasting hyperglycemia (FH), or CFRD with FH. Data were collected at baseline from the Toronto Cystic Fibrosis database. RESULTS: On first OGTT, 63% of the 257 patients with pancreatic insufficiency (PI) had NGT, 23% had IGT, 11% had CFRD without FH, and 3% had CFRD with FH. Burkholderia cepacia complex colonization was correlated with worsening glucose tolerance category. There was a weak inverse relationship among weight, body mass index, forced expiratory volume in 1 minute, and 2-hour plasma glucose obtained during OGTT. Of the 168 PI patients who had a second OGTT, 17% improved their category of glucose tolerance, 70% remained unchanged, and 13% worsened. A similar trend was seen during the progression between any one test to a subsequent test. CONCLUSIONS: Annual screening of glucose tolerance in patients with CF reveals highly variable results over time. Fluctuating levels of insulin resistance, probably with variable degrees of ongoing inflammation, affect the results and hinder prediction of future development of CFRD. Home glucose monitoring following abnormal OGTT results was essential in establishing the diagnosis of CFRD.

Urethral caruncle with intestinal metaplasia: A case report and literature review.

A 66-year-old female presented with a urethral caruncle. Histological features of incomplete intestinal metaplasia were reported. Only five previous cases of intestinal metaplasia in urethral caruncles have been reported. The mechanism of this tissue transformation remains unclear but theorised aetiologies include embryological and infective causes. Intestinal metaplasia carries a malignant potential in other organs, most notably the bladder. Therefore we recommend urethral caruncles be completely excised with prolonged follow up for atypical variants.

Lung transplantation for idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is characterized by relentlessly progressive lung function impairment that is consistently fatal in the absence of lung transplantation, as no curative pharmacological treatment exists. The pace of progression varies across patients, and acute life-threatening exacerbations occur unpredictably, causing further sharp drops in lung function. Recently introduced antifibrotic agents slow the pace of disease progression and may improve survival but fail to stop the fibrotic process. Moreover, the magnitude and kinetics of the response to these drugs cannot be predicted in the individual patient. These characteristics require that lung transplantation be considered early in the course of the disease. However, given the shortage of donor lungs, lung transplantation must be carefully targeted to those patients most likely to benefit. Current guidelines for lung transplantation listing may need reappraisal in the light of recent treatment advances. Patients with IPF often have multiple comorbidities such as coronary heart disease, frailty, and gastro-oesophageal reflux disease (GERD). Consequently, extensive screening for and effective treatment of concomitant conditions is crucial to appropriate candidate selection and outcome optimisation. A multidisciplinary approach is mandatory. Pulmonologists with expertise in IPF must work closely with lung transplant teams. Careful consideration must be given to preoperative optimisation, surgical technique, and pulmonary rehabilitation to produce the best post-transplantation outcomes.

Acute effect of equicaloric meals varying in glycemic index and glycemic load on arterial stiffness and glycemia in healthy adults: a randomized crossover trial.

BACKGROUND/OBJECTIVES: Dietary carbohydrate quality and quantity fluctuate but it is unknown which attribute takes precedence in vascular health preservation. We investigated all four permutations of glycemic index (GI) and glycemic load (GL) on acute vascular and glycemic responses. SUBJECTS/METHODS: Twenty-one healthy adults were screened for this crossover trial. Seventeen (8 M:9 F; 26.7 ± 12.3 y; BMI 22.2 ± 2.8 kg/m2) entered randomization and completed the study, receiving four isocaloric meals, varying in GI and GL, in random order at least 3 days apart. The four meals included either chickpeas (GI = 28, GL = 14, 50 g available carbohydrates (CHO)), a small potato portion (GI = 85, GL = 14, CHO = 17 g), pasta (GI = 45, GL = 42, CHO = 94 g) or a large potato portion (GI = 85, GL = 42, CHO = 50 g) as the source of carbohydrate. Augmentation index (AIx) and central and peripheral blood pressure were measured fasting, 1, 2, 3, and 4 h post-consumption. Capillary blood glucose was analyzed fasting, 15, 30, 45, 60, 90, 120, 180, and 240 min. RESULTS: A reduction in AIx from baseline was observed 4 h following the chickpeas (low GI-low GL) (p = 0.046). The incremental area under blood glucose curves were significantly higher 2 h post-consumption following high compared with low GL meals (p < 0.001). Despite doubling carbohydrates, there was no difference in glycemic response between the large potato (high GI-high GL) and the pasta (low GI-high GL) meals. No significant differences in AIx or blood pressure were seen between meals. CONCLUSIONS: Low GI, low-carbohydrate meals may support a healthy vascular tone. Varying meal GI and GL results in different glycemic profiles, which are not necessarily predicted by carbohydrate content. Further investigations on cardiometabolic profiles to meals varying in GI and GL are warranted.

Follicular carcinoma of the thyroid with aggressive metastatic behavior in a pregnant woman: report of a case and review of the literature.

Distant metastases as initial presentation of follicular carcinoma of the thyroid is rare, especially in young patients. We report the clinical and pathological features of a 33-year old pregnant patient with follicular carcinoma of the thyroid who presented with widespread bone and lung metastases at the time of diagnosis. the resected tumor had a focal insular component that showed extensive vascular invasion spreading beyond the thyroid capsule, and was associated with widespread bone and lung metastases. Despite its aggressive behavior, the tumor had low mitotic activity and Ki-67 nuclear labeling index. tumor cells showed high microvascular density and down-regulation of E-cadherin, a calcium-dependent trans-membrane epithelial protein molecule known to promote intercellular adhesion. We suggest that architectural differentiation of the tumor and cell proliferation rate are not reliable markers of metastatic behavior in this particular thyroid neoplasm. Microvascular density and down-regulation of E-cadherin expression in the tumor should be included among histologic hallmarks of metastatic potential. the role of pregnancy in the aggressive behavior of this tumor is discussed along with a literature review.

Changes in response to insulin and the effects of varying glucose tolerance on whole-body protein metabolism in patients with cystic fibrosis.

BACKGROUND: Diabetes mellitus has been reported to increase whole-body protein breakdown and thus loss of lean body mass. Cystic fibrosis-related diabetes (CFRD) is associated with undernutrition and increased mortality. OBJECTIVE: We hypothesized that CFRD is associated with increased whole-body protein breakdown, which results in negative protein balance, and that correction of the glucose intolerance with insulin therapy would normalize whole-body protein metabolism. DESIGN: Rates of whole-body protein turnover and protein balance were measured in 28 adults with cystic fibrosis (17 M, 11 F). Subjects were assessed with a modified oral-glucose-tolerance test and categorized as having normal glucose tolerance, impaired glucose tolerance, or CFRD with and without fasting hyperglycemia; then they were compared with previously diagnosed CFRD adults already receiving insulin therapy. Indexes of protein turnover were calculated from [15N]glycine and 15N in urinary urea. RESULTS: Analysis of variance for the 28 subjects showed that whole-body protein breakdown was highest (P<0.05) in patients with CFRD. Whole-body protein synthesis was not significantly affected by impaired glucose tolerance. Significant (P<0.05) improvement in net protein synthesis occurred in the CFRD group 3 mo after insulin therapy was administered. Follow-up studies of 3 subjects with CFRD showed significant improvement in net protein synthesis after insulin therapy. Monitoring of the protein homeostasis of the impaired glucose tolerance group gave clues to the progression of their metabolic homeostasis. CONCLUSION: CFRD has an adverse effect on protein homeostasis by increasing net protein synthesis.

The non-glycemic effects of incretin therapies on cardiovascular outcomes, cognitive function and bone health.

The incretin therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors, have been developed to lower blood glucose levels in patients with Type 2 diabetes. However, in addition to being a treatment strategy to improve metabolic control, incretin therapies have shown effects independent of glycemic control, including the potential to positively impact cardiovascular events, cognitive deficits and bone mineral density. This paper outlines the non-glycemic effects of incretin therapies on cardiovascular disease, cognitive function and bone health.

InAs/Si Hetero-Junction Nanotube Tunnel Transistors.

Hetero-structure tunnel junctions in non-planar gate-all-around nanowire (GAA NW) tunnel FETs (TFETs) have shown significant enhancement in 'ON' state tunnel current over their all-silicon counterpart. Here we show the unique concept of nanotube TFET in a hetero-structure configuration that is capable of much higher drive current as opposed to that of GAA NW TFETs.Through the use of inner/outer core-shell gates, a single III-V hetero-structured nanotube TFET leverages physically larger tunneling area while achieving higher driver current (ION) and saving real estates by eliminating arraying requirement. Numerical simulations has shown that a 10 nm thin nanotube TFET with a 100 nm core gate has a 5×normalized output current compared to a 10 nm diameter GAA NW TFET.

Median Nerve Injury following K-wire Fixation of Bennett's Fracture-Lessons Learned.

Bennett's fracture is a relatively common injury. The fracture is unstable due to the displacing forces acting on the distal fragment and very commonly treated by stabilization with Kirschner wires. This would seem a relatively safe procedure, and injury to the median nerve has never been reported. We present this unusual complication following one such procedure with the evaluation of a safe approach utilizing the relevant surgical and radiological anatomy.

The metabolic syndrome in healthy, multiethnic adolescents in Toronto, Ontario: the use of fasting blood glucose as a simple indicator.

BACKGROUND: The prevalence of the metabolic syndrome (MetS) is increasing worldwide and prevention represents a major challenge. Usually identified in middle age, the MetS has pediatric roots and there are variable incidence rates between ethnic groups. Due to the difficulty of diagnosis, it remains largely undetected in adolescents. OBJECTIVES: To assess the presence of the MetS features in healthy, normal-weight, multiethnic adolescents and to determine whether fasting blood glucose (FBG) could function as a simple indicator of its presence. METHODS: A convenience sample of secondary school students was used in a cross-sectional study. General linear model ANCOVA adjusted for multiple pairwise comparisons by the post hoc Tukey-Kramer test was used to assess differences among the tertiles of FBG. RESULTS: A total of 182 adolescents from 62 Greater Toronto Area secondary schools in Ontario were recruited (44% Caucasian, 34% South Asian and 22% Chinese), with a mean (+/- SD) age of 17.4+/-0.9 years, a mean body mass index of 22.1+/-3.4 kg/m2 and a mean FBG of 4.92+/-0.4 mmol/L. Analysis with general linear model ANCOVA across the tertiles of FBG (3.83 mmol/L to 4.78 mmol/L, 4.79 mmol/L to 5.08 mmol/L, and 5.09 mmol/L to 6.45 mmol/L) showed significant linear increases of body mass index (P<0.005), waist circumference (P<0.001), systolic blood pressure (P<0.001) and diastolic blood pressure (P<0.05) with increasing FBG. Stepwise multiple regression analysis indicated systolic blood pressure (beta=0.0078, partial R2=0.039, P=0.007) and waist circumference (beta=0.0081, partial R2=0.025, P=0.035) were independent predictors of the increased FBG level. CONCLUSIONS: MetS markers were present in a sample of healthy multiethnic adolescents in the Greater Toronto Area. FBG could be used as a simple indicator of the MetS to allow for early detection of the presence of the MetS and the introduction of preventive lifestyle measures. Further studies with larger sample sizes should address the accuracy of FBG for diagnosing the MetS.

Supplementation of conventional therapy with the novel grain Salba (Salvia hispanica L.) improves major and emerging cardiovascular risk factors in type 2 diabetes: results of a randomized controlled trial.

OBJECTIVE: To determine whether addition of Salba (Salvia hispanica L.), a novel whole grain that is rich in fiber, alpha-linolenic acid (ALA), and minerals to conventional treatment is associated with improvement in major and emerging cardiovascular risk factors in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using a single-blind cross-over design, subjects were randomly assigned to receive either 37 +/- 4 g/day of Salba or wheat bran for 12 weeks while maintaining their conventional diabetes therapies. Twenty well-controlled subjects with type 2 diabetes (11 men and 9 women, aged 64 +/- 8 years, BMI 28 +/- 4 kg/m2, and A1C 6.8 +/- 0.9%) completed the study. This study was set in the outpatient clinic of the Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada. RESULTS: Compared with the control treatment, Salba reduced systolic blood pressure (SBP) by 6.3 +/- 4 mmHg (P < 0.001), high-sensitivity C-reactive protein (hs-CRP) (mg/l) by 40 +/- 1.6% (P = 0.04), and vonWillebrand factor (vWF) by 21 +/- 0.3% (P = 0.03), with significant decreases in A1C and fibrinogen in relation to the Salba baseline but not with the control treatment. There were no changes in safety parameters including liver, kidney and hemostatic function, or body weight. Both plasma ALA and eicosapentaenoic polyunsaturated fatty acid levels were increased twofold (P < 0.05) while consuming Salba. CONCLUSIONS: Long-term supplementation with Salba attenuated a major cardiovascular risk factor (SBP) and emerging factors (hs-CRP and vWF) safely beyond conventional therapy, while maintaining good glycemic and lipid control in people with well-controlled type 2 diabetes.