Gating a single-molecule transistor with individual atoms

Transistors, regardless of their size, rely on electrical gates to control the conductance between source and drain contacts. In atomic-scale transistors, this conductance is sensitive to single electrons hopping via individual orbitals1, 2. Single-electron transport in molecular transistors has been previously studied using top-down approaches to gating, such as lithography and break junctions1, 3, 4, 5, 6, 7, 8, 9, 10, 11. But atomically precise control of the gate—which is crucial to transistor action at the smallest size scales—is not possible with these approaches. Here, we used individual charged atoms, manipulated by a scanning tunnelling microscope12, to create the electrical gates for a single-molecule transistor. This degree of control allowed us to tune the molecule into the regime of sequential single-electron tunnelling, albeit with a conductance gap more than one order of magnitude larger than observed previously8, 11, 13, 14. This unexpected behaviour arises from the existence of two different orientational conformations of the molecule, depending on its charge state. Our results show that strong coupling between these charge and conformational degrees of freedom leads to new behaviour beyond the established picture of single-electron transport in atomic-scale transistors

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Service of General Interest in the Rhenish Coal-Mining Area in Context of Structural Change

Territorial cohesion is of main interest in the EU and its member state Germany. It should lead to a reduction of disparities between different stats of development and is closely related to the accessibility to Service of General (SGI) in different areas. The investigated area in this article is characterized by the end of coal fired power generation by the Coal-Phase-out act. In this article the accessibility to SGI is discussed. Additionally, the accessibility to specific SGI is investigated with a special view to the southern rural parts of the Rhenish coal-mining area. It is outlined that the provision to SGIs is high near to agglomerations and decreases in rural parts. This can also be observed for broadband expansion, while the access to internet allows a higher accessibility to SGIs for different analysed indicators. This research is used to establish a regional development strategy to maintain equal living conditions for the entire region

Examination of the geometry-dependent anisotropic material behavior in additive layer manufacturing for the calculation of mesoscopic lightweight structures: Presentation held at the Direct Digital Manufacturing Conference, March 14 - 15, 2012, Berlin; DDMC 2012

Due to the producible geometric complexity, additive layer manufacturing (ALM) processes show a high potential for the production of lightweight components. Especially mesoscopic approaches, like honeycombs or lattice structures, exhibit very advantageous mechanical properties like stiffness or strength combined with low masses. To achieve an optimum structure, a regular buildup out of equal elementary cells is not ideal. Rather, an adjustment of the course of the structure and its material filling degree has to be done. Therefore, detailed knowledge about the material behavior of additive manufactured components is necessary. Especially for lightweight structures, these properties are affected by anisotropy and geometry dependent influences. These effects have a severe influence on the basic elements of mesoscopic patterns, like struts in case of lattice structures or the single walls of honeycombs. In case of anisotropy this means that the material behaviour – and even the success of the build-up process – of the basic elements depend on the angle, under which the strut or honeycomb is built in relation to the building direction. In case of geometry dependency, this means that the material behavior is influenced by several geometric attributes. For lattice structures, this can be the lengths or the cross section of the struts. In the field of honeycombs, the height and broadness as well as the thickness of the walls can be mentioned. While there are already numerous analyses concerning the orientation dependent anisotropy, the influences of the geometric properties have not been researched, yet. To achieve best possible mesoscopic structures in lightweight components, these influences have to be taken into account. Therefore, a material model for struts in lattice structures, including the corresponding experimental results, will be introduced in this paper. This model takes anisotropic and geometry-dependent aspects into account and therefore provides a basis for a successful calculation and optimization of lattice structures

Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery

AIM: To assess long-term efficacy of initially successful endo-sponge assisted therapy