Tuning Phase Transitions in 1T-TaS2 via the Substrate.

Phase transitions in 2D materials can lead to massive changes in electronic properties that enable novel electronic devices. Tantalum disulfide (TaS2), specifically the "1T" phase (1T-TaS2), exhibits a phase transition based on the formation of commensurate charge density waves (CCDW) at 180 K. In this work, we investigate the impact of substrate choice on the phase transitions in ultrathin 1T-TaS2. Doping and charge transfer from the substrate has little impact on CDW phase transitions. On the contrary, we demonstrated that substrate surface roughness is a primary extrinsic factor in CCDW transition temperature and hysteresis, where higher roughness leads to smaller transition hysteresis. Such roughness can be simulated via surface texturing of SiO2/Si substrates, which controllably and reproducibly induces periodic strain in the 1T-TaS2 and thereby enables the potential for engineering CDW phase transitions.

Identifying Prevalence and Risk Factors for Mild Cognitive Impairment in Adults Presenting for Urological Evaluation.

OBJECTIVE: To examine mild cognitive impairment (MCI) in a young and older adult urology population, and which external factors were associated with diminished cognitive status at baseline. METHODS: We enrolled patients >18 years of age presenting to a large, urban tertiary care center for a wide variety of urologic complaints. Cognitive status was determined by the Montreal Cognitive Assessment (MoCA) screening test. A score of 26-30 on the MoCA is considered cognitively intact, whereas <26 indicates MCI. Patient charts were retrospectively reviewed; a backwards-stepwise logistic regression was constructed to compare MCI with potential risk factors. RESULTS: One hundred ninety-seven patients were included. There were 10/33 (30%) patients aged 18-40 who had MCI. Moreover, 32/68 (47%) patients aged 41-64 had MCI. Of older adults age 65+, MCI was seen in 65/96 (68%) patients. Factors associated with MCI in age group 41-64 included opioid use. Patients with stone disease were less likely to demonstrate MCI, when compared to other general categories of urologic chief complaints. For patients in age group 65+, associations with MCI included a cancer-related chief complaint, increased age, depressive symptoms, and less education. There were no significant associations with MCI in age group 18-40. CONCLUSION: These results demonstrate a significant prevalence of MCI in an adult urology population and factors that may be associated with its prevalence. We believe that this study lays the groundwork for urology providers to be able to identify patients who may have MCI at baseline.

Electric-Field-Assisted Directed Assembly of Transition Metal Dichalcogenide Monolayer Sheets.

Directed assembly of two-dimensional (2D) layered materials, such as transition metal dichalcogenides, holds great promise for large-scale electronic and optoelectronic applications. Here, we demonstrate controlled placement of solution-suspended monolayer tungsten disulfide (WS2) sheets on a substrate using electric-field-assisted assembly. Micrometer-sized triangular WS2 monolayers are selectively positioned on a lithographically defined interdigitated guiding electrode structure using the dielectrophoretic force induced on the sheets in a nonuniform field. Triangular sheets with sizes comparable to the interelectrode gap assemble with an observed preferential orientation where one side of the triangle spans across the electrode gap. This orientation of the sheets relative to the guiding electrode is confirmed to be the lowest energy configuration using semianalytical calculations. Nearly all sheets assemble without observable physical deformation, and postassembly photoluminescence and Raman spectroscopy characterization of the monolayers reveal that they retain their as-grown crystalline quality. These results show that the field-assisted assembly process may be used for large-area bottom-up integration of 2D monolayer materials for nanodevice applications.

Definition of Success after Surgery for Female Stress Incontinence or Voiding Dysfunction: An Attempt at Standardization.

CONTEXT: There is currently no standardized definition of success for surgery for stress urinary incontinence (SUI) and voiding dysfunction (VD) in women. OBJECTIVE: To review the use of outcome measures (OMs) and definitions of success in the literature on SUI and VD surgery in women in an attempt to provide recommendations for future publications. EVIDENCE ACQUISITION: A PubMed search of all English language full-text articles on SUI and VD surgery in women published between 2010 and 2015 was performed. A list of randomized trials and prospective and retrospective studies was obtained. Specific objective and subjective OMs used to define success were reviewed. EVIDENCE SYNTHESIS: Some 95 articles met the inclusion criteria for SUI surgery outcomes. Most trials reported outcomes at 12 mo after surgery. The majority (n=48) reported their primary outcomes using both objective and subjective success measures, 24 defined success using subjective OMs alone, and 23 using objective OMs alone. The OMs most frequently used for objective success were a negative cough stress test (CST), a negative pad test, and the absence of retreatment for SUI. The definition of subjective success most often involved questionnaires. The questionnaires most frequently used were Patient Global Impression of Improvement (PGI-I), Urinary Distress Inventory (UDI)/UDI-6, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Medical Epidemiologic and Social Aspects of Aging (MESA). Only 11 studies on OMs used for VD surgery were published between 2010 and 2015. The two most common criteria used for success were measurement of postvoid residual urine (PVR) and subjective resolution of VD symptoms. CONCLUSIONS: There is great heterogeneity in the definition of success used after surgery for SUI or VD in women. For SUI surgery, we recommend use of the CST and a 1-h pad test for the definition of objective success, and of the UDI/UDI-6, Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ), ICIQ-SF, or PGI-I questionnaire for subjective success. For VD surgery, cure should include measurement of PVR and self-reported resolution of VD symptoms. PATIENT SUMMARY: We looked at the definition of success used for surgery for stress urinary incontinence (SUI) and voiding dysfunction (VD) in women. We found that there is great heterogeneity among studies, making study comparison extremely difficult. According to the outcome measures used most frequently, we make recommendations regarding the definition of cure for SUI and VD in women to be used in future publications.

Vaginal shape at resting pelvic MRI: predictor of pelvic floor weakness?

OBJECTIVE: The objective was to determine if alteration in vaginal shape seen on nonstraining pelvic magnetic resonance (MR) scans is associated with pelvic floor weakness. METHODS: Two readers classified the shape of the middle third of the vagina on resting T2-weighted axial images as normal or abnormal for 76 women with and without pelvic floor weakness. RESULTS: The sensitivity and specificity for diagnosing pelvic floor dysfunction were 84% and 68% for reader A and 41% and 91% for reader B. Interobserver agreement was fair (kappa=0.39). CONCLUSIONS: Architectural distortion of vaginal shape on routine pelvic MR imaging may suggest pelvic floor dysfunction but is not diagnostic.

An intra-articular ganglion cyst in a patient with juvenile idiopathic arthritis.

We report an intra-articular ganglion cyst (IAGC) presenting as knee pain and a mass in a patient with longstanding Juvenile Idiopathic Arthritis (JIA). We could not find a similar case of an IAGC occurring in the knee of JIA patients in the literature. IAGC may need to be included as a possibility in patients with inflammatory arthritis with new-onset knee pain, especially in those with a palpable mass. MRI was useful in distinguishing IAGC from more worrisome causes of a knee mass. Orthopedic input was helpful in diagnosis and treatment. In addition, methotrexate therapy was effective in bringing about a long-lasting remission.

Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma.

Chordomas of the sacrum require en bloc resection to reduce the risk of recurrence, but this may sacrifice nerves vital to bladder, bowel, and sexual function. High, mid-, and low sacral amputations have been previously classified based on nerve root sacrifice, not bony amputation. Sacrifice of the S-2 nerves or those above results in a high sacral amputation, but preserving the S-2 nerves converts it into a midsacral amputation. Preservation of the S-2 nerves has been shown to improve functional outcome, despite the bony osteotomy being unchanged. Thus, keeping the same bony amputation while preserving the S-2 nerve roots may allow for improved functional outcome while still achieving the same goal of oncological resection. Preservation of the S-2 nerves may be particularly difficult during amputation at the S-2 pedicle or above, and the authors describe their technique for preserving the S-2 nerves during partial sacrectomy at or just above the S-2 pedicle. Four cases of sacral chordoma resections are presented to illustrate the technique.

Solid-phase flexibility in Ag2Se semiconductor nanocrystals.

Nanocrystals are known to alter the relative stability of bulk solid phases. Here we test the limits of this effect on Ag2Se nanocrystals, a promising new electronic and infrared material. In the bulk, Ag2Se exhibits a solid-solid phase transition to a superionic conducting phase at moderate temperatures. We map this phase transition as a function of size, temperature, and surface treatment in Ag2Se core-only and core-shell nanocrystals. We show that the transition can be tuned not just below but also above the bulk phase-transition temperature. This phase flexibility has implications for applications in optoelectronic and phase-memory devices.

Circulating angiogenic modulatory factors predict survival and functional class in pulmonary arterial hypertension.

The diagnosis of pulmonary arterial hypertension (PAH) is frequently delayed. We hypothesized that circulating angiogenic modulatory protein levels might correspond with vascular remodeling activity and serve as sensitive biomarkers of PAH. Levels of soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR1), N-terminal brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and other biomarkers were measured in peripheral blood from 97 PAH patients, 16 first-degree relatives of idiopathic or heritable pulmonary arterial hypertension (HPAH) patients, and 56 controls, and correlated with disease, functional class, hemodynamic parameters, exercise capacity, and transplant-free survival. Endoglin expression was analyzed in lung tissues of six individuals with idiopathic or HPAH and four individuals without PAH. Levels of sEng, sVEGFR1, CRP, and NT-proBNP were elevated in Group I PAH of diverse etiologies, with sEng performing better than NT-proBNP in detecting PAH (receiver operator characteristic-area-under-the curve [ROC-AUC] of 0.82 ± 0.03 vs. 0.71 ± 0.05, P = 0.016). While sEng, sVEGFR1, and NT-proBNP correlated with New York Heart Association (NYHA) class, sEng levels were more sensitive than NT-proBNP in detecting NYHA Class I-II disease (ROC-AUC of 0.88 ± 0.05 vs. 0.67 ± 0.08, P = 0.028). sEng, sVEGFR1, CRP, and NT-proBNP predicted transplant-free survival by univariate Cox regression. After adjusting for NT-proBNP levels, each of the other three markers predicted transplant-free survival. In multivariate analysis, sEng and CRP were independent predictors of survival. Endoglin expression was markedly enhanced in the microvascular endothelium and endovascular lesions of PAH versus control lung tissues. Circulating angiogenic proteins sEng and sVEGFR1 are sensitive markers of prognosis and function in Group I PAH, including mildly symptomatic disease, and may provide unique noninvasive data reflecting underlying remodeling activity.

Constitutively active ALK2 receptor mutants require type II receptor cooperation.

Constitutively activating mutations in receptor kinases recruit downstream effector pathways independently of upstream signaling, with consequences ranging from developmental syndromes to cancer. Classic fibrodysplasia ossificans progressiva (FOP) is a congenital syndrome resulting from highly conserved activating mutations of the glycine-serine-rich (GS) regulatory domain of ACVR1, encoding bone morphogenetic protein (BMP) type I receptor ALK2, which lead to inappropriate signaling and heterotopic ossification of soft tissues. It is unclear if constitutively active mutant ALK2 receptors (caALK2) can function independently of signaling complexes with type II receptors and ligands. We found that ablation of BmpRII and ActRIIa abrogated BMP ligand-mediated and caALK2-mediated signaling and transcription in cells and disrupted caALK2-induced heterotopic ossification in mice. Signaling via GS domain ALK2 mutants could be restored by the expression of either BMP type II receptor. The contribution of BMP type II receptors was independent of their ligand-binding or kinase function but was dependent upon an intact cytoplasmic domain. These data demonstrate that GS domain ALK2 mutants act independently of upstream signaling but may require a nonenzymatic scaffolding function provided by type II receptors to form functional, apparently ligand-independent signaling complexes. These findings define the minimal requirements for signaling of GS domain ALK2 mutants, with implications for the therapeutic targeting of their activity in disease.

Quantum confinement in silver selenide semiconductor nanocrystals.

We prepare Ag(2)Se nanocrystals with average diameters between 2.7 and 10.4 nm that exhibit narrow optical absorption features in the near to mid infrared. We demonstrate that these features are broadly tunable due to quantum confinement. They provide the longest wavelength absorption peaks (6.5 µm) yet reported for colloidal nanocrystals.

Electronic impurity doping in CdSe nanocrystals.

We dope CdSe nanocrystals with Ag impurities and investigate their optical and electrical properties. Doping leads not only to dramatic changes but surprising complexity. The addition of just a few Ag atoms per nanocrystal causes a large enhancement in the fluorescence, reaching efficiencies comparable to core-shell nanocrystals. While Ag was expected to be a substitutional acceptor, nonmonotonic trends in the fluorescence and Fermi level suggest that Ag changes from an interstitial (n-type) to a substitutional (p-type) impurity with increased doping.

Combined method of bladder neck closure and concomitant augmentation cystoplasty in the setting of refractory urinary incontinence.

OBJECTIVE: To describe the technique of concomitant bladder neck closure and augmentation cystoplasty in a 22-year-old woman with a history of bladder exstrophy and refractory urinary incontinence. This patient had prior augmentation cystoplasty and circumferential fascial urethral sling placement with continued incontinence. During closure of the bladder neck, the bladder neck was incorporated into the augmentation cystoplasty to help prevent failure of bladder neck closure. MATERIAL AND METHODS: The patient had previously undergone augmentation cystoplasty, circumferential fascial urethral sling placement, and antegrade collagen injection of the bladder neck. Despite these interventions, she continued to have refractory urinary incontinence. Her bladder neck was closed by incorporating the bladder neck into the cystotomy and using the bladder neck as an edge of anastomosis during augmentation cystoplasty. RESULTS: The patient tolerated the procedure well. She catheterizes easily through her appendicovesicostomy and has remained continent. She has no leakage from her closed bladder neck 30 months after closure. CONCLUSION: Incorporating the bladder neck into the cystotomy during a planned augmentation cystoplasty and bladder neck closure should be considered as an alternative to separate bladder neck closure, which can fail and can result in continued urinary incontinence.

Facile synthesis of silver chalcogenide (Ag2E; E=Se, S, Te) semiconductor nanocrystals.

A general, one-pot, single-step method for producing colloidal silver chalcogenide (Ag(2)E; E = Se, S, Te) nanocrystals is presented, with an emphasis on Ag(2)Se. The method avoids exotic chemicals, high temperatures, and high pressures and requires only a few minutes of reaction time. While Ag(2)S and Ag(2)Te are formed in their low-temperature monoclinic phases, Ag(2)Se is obtained in a metastable tetragonal phase not observed in the bulk.

HIV status is an independent risk factor for reporting lower urinary tract symptoms.

PURPOSE: HIV/AIDS is a worldwide epidemic. Limited evidence suggests that men infected with HIV/AIDS are at increased risk for lower urinary tract symptoms. We determined whether HIV/AIDS status is an independent risk factor for self-reported bothersome lower urinary tract symptoms in a large contemporary cohort. MATERIALS AND METHODS: We performed a cross-sectional, Internet based survey of urinary quality of life outcomes in adult HIV infected and HIV uninfected men who have sex with men. The main outcome measure was International Prostate Symptom Score. RESULTS: Of respondents with complete data 1,507 were HIV uninfected (median age 42 years, mean 43) and 323 HIV infected (median age 45 years, mean 45.1). Of the HIV infected respondents 148 were nonAIDS defining HIV infected and 175 were AIDS defining HIV infected. After adjusting for age and other comorbid conditions, nonAIDS defining HIV infected and AIDS defining HIV infected status increased the odds of severe lower urinary tract symptoms by 2.07 (95% CI 1.04-3.79) and 2.49 (95% CI 1.43-4.33), respectively. HIV infected men had a worse total International Prostate Symptom Score for all domains including quality of life compared to HIV uninfected men. Within the population of men with HIV, those with AIDS had worse mean total International Prostate Symptom Score and all individual International Prostate Symptom Score components relative to nonAIDS defining HIV infected men. CONCLUSIONS: HIV status is an independent risk factor for bothersome lower urinary tract symptoms. The odds of severe lower urinary tract symptoms are greater in HIV infected men with a history of AIDS.

Inhibition of bone morphogenetic protein signaling attenuates anemia associated with inflammation.

Anemia of inflammation develops in settings of chronic inflammatory, infectious, or neoplastic disease. In this highly prevalent form of anemia, inflammatory cytokines, including IL-6, stimulate hepatic expression of hepcidin, which negatively regulates iron bioavailability by inactivating ferroportin. Hepcidin is transcriptionally regulated by IL-6 and bone morphogenetic protein (BMP) signaling. We hypothesized that inhibiting BMP signaling can reduce hepcidin expression and ameliorate hypoferremia and anemia associated with inflammation. In human hepatoma cells, IL-6-induced hepcidin expression, an effect that was inhibited by treatment with a BMP type I receptor inhibitor, LDN-193189, or BMP ligand antagonists noggin and ALK3-Fc. In zebrafish, the induction of hepcidin expression by transgenic expression of IL-6 was also reduced by LDN-193189. In mice, treatment with IL-6 or turpentine increased hepcidin expression and reduced serum iron, effects that were inhibited by LDN-193189 or ALK3-Fc. Chronic turpentine treatment led to microcytic anemia, which was prevented by concurrent administration of LDN-193189 or attenuated when LDN-193189 was administered after anemia was established. Our studies support the concept that BMP and IL-6 act together to regulate iron homeostasis and suggest that inhibition of BMP signaling may be an effective strategy for the treatment of anemia of inflammation.

Urinary incontinence in women.

Urinary incontinence is a common and vexing problem that affects millions of adults. The main types of incontinence in women are stress, urge, and mixed. It is important to delineate the different types to target the treatment options better. Treatments include conservative or behavioral modifications, pharmacotherapy, and surgical interventions.

Molecular mechanisms related to parturition-induced stress urinary incontinence.

BACKGROUND: The molecular mechanisms underlying stress urinary incontinence (SUI) at the tissue level are poorly understood. OBJECTIVE: To study genetic and molecular alterations in the urethras of animals with experimentally induced SUI. DESIGN, SETTING, AND PARTICIPANTS: Cohort analysis of primiparous 2-month-old female Sprague-Dawley rats with experimentally induced SUI versus those who did not develop SUI in a university research laboratory setting. INTERVENTION: Rats underwent intravaginal balloon dilation within 24 hours of parturition followed by bilateral ovariectomy one week later. Transvesical cystometry was performed 12 weeks after parturition. Rats were classified as continent (C) or incontinent (I) according to the results of cystometry. MEASUREMENTS: The expression of over 22,000 genes in urethral tissue from the two groups was assessed with the use of an oligo microarray. The expression of relevant genes was confirmed by real-time polymerase chain reaction. Protein expression of small mothers against decapentaplegic 2 (Smad2), one of the differentially expressed genes, was extensively studied by immunohistochemistry and Western blot analysis. Regulation of Smad2 activity by transforming growth factor-beta (TGF-beta) was assessed in cultured urethral smooth muscle cells (USMCs). RESULTS AND LIMITATIONS: After intervention, 14 (58.3%) rats remained continent and 10 (41.7%) became incontinent. There were significant differences in the expression of 42 urethral genes between continent and incontinent rats. The expression of genes involved in the TGF cellular signaling pathway (Smad2), collagen breakdown (matrix metalloproteinase 13 [Mmp13]), and smooth muscle inhibition (regulator of G-protein signaling 2 [Rgs2]) was significantly increased in the incontinent group. SMAD2 protein expression was significantly upregulated in the incontinent rats. In cultured USMCs, SMAD2 phosphorylation and nuclear translocation increased after Tgf-beta treatment. CONCLUSIONS: Genes important in inflammation, collagen breakdown, and smooth muscle inhibition are upregulated in the urethras of female rats with parturition-associated incontinence.