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OBJECTIVE To evaluate the relative importance of increased lactate production as opposed to decreased utilization in hyperlactatemic patients, as well as their relation to glucose metabolism. DESIGN Prospective observational study. SETTING Surgical intensive care unit of a university hospital. PATIENTS Seven patients with severe sepsis or septic shock, seven patients with cardiogenic shock, and seven healthy volunteers. INTERVENTIONS C-labeled sodium lactate was infused at 10 micromol/kg/min and then at 20 micromol/kg/min over 120 mins each. H-labeled glucose was infused throughout. MEASUREMENTS AND MAIN RESULTS Baseline arterial lactate was higher in septic (3.2 +/- 2.6) and cardiogenic shock patients (2.8 +/- 0.4) than in healthy volunteers (0.9 +/- 0.20 mmol/L, p < .05). Lactate clearance, computed using pharmacokinetic calculations, was similar in septic, cardiogenic shock, and controls, respectively: 10.8 +/- 5.4, 9.6 +/- 2.1, and 12.0 +/- 2.6 mL/kg/min. Endogenous lactate production was determined as the initial lactate concentration multiplied by lactate clearance. It was markedly enhanced in the patients (septic 26.2 +/- 10.5; cardiogenic shock 26.6 +/- 5.1) compared with controls (11.2 +/- 2.7 micromol/kg/min, p < .01). C-lactate oxidation (septic 54 +/- 25; cardiogenic shock 43 +/- 16; controls 65 +/- 15% of a lactate load of 10 micromol/kg/min) and transformation of C-lactate into C-glucose were not different (respectively, 15 +/- 15, 9 +/- 18, and 10 +/- 7%). Endogenous glucose production was markedly increased in the patients (septic 14.8 +/- 1.8; cardiogenic shock 15.0 +/- 1.5) compared with controls (7.2 +/- 1.1 micromol/kg/min, p < .01) and was not influenced by lactate infusion. CONCLUSIONS In patients suffering from septic or cardiogenic shock, hyperlactatemia was mainly related to increased production, whereas lactate clearance was similar to healthy subjects. Increased lactate production was concomitant to hyperglycemia and increased glucose turnover, suggesting that the latter substantially influences lactate metabolism during critical illness.

Background and purpose: Approximately 20-25% of the patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation (AF) during the clinical course of the disease, a percentage significantly larger than that of the general population. The purpose of the present study was to report on the procedural results of patients with AF and either primary or secondary left ventricular hypertrophy (LVH). Methods and subjects: Twenty-two consecutive HCM patients (55% male, mean age 57 ± 8 years) with symptomatic AF, having undergone AF ablation procedures between September 2009 and July 2012 were compared with respect to procedural outcome and follow-up characteristics with 22 matched controls with secondary cardiac hypertrophy (64% male, 63 ± 10 years) from our prospective AF catheter ablation registry. Results and conclusion: Radiofrequency catheter ablation (RFCA) was successful in restoring long-term sinus rhythm in patients with LVH due to HCM and due to secondary etiology. However, patients with HCM needed more RFCA procedures and frequently additional antiarrhythmic drug therapy in order to maintain sinus rhythm. © 2014 Japanese College of Cardiology.

Objective. Gaining postpyloric access in ventilated, sedated ICU patients usually requires time-consuming procedures such as endoscopy. Recently, a feeding tube has been introduced that migrates spontaneously into the jejunum in surgical patients. The study aimed at assessing the rate of migration of this tube in critically ill patients. Design. Prospective descriptive trial. Setting. Surgical ICU in a tertiary University Hospital. Patients. One hundred and five consecutive surgical ICU patients requiring enteral feeding were enrolled, resulting in 128 feeding-tube placement attempts. Methods. A self-propelled tube was used and followed up for 3 days: progression was assessed by daily contrast-injected X-ray. Severity of illness was assessed with SAPS II and organ failure assessed with SOFA score. Results. The patients were aged 55±19 years (mean±SD) with SAPS II score of 45±18. Of the 128 tube placement attempts, 12 could not be placed in the stomach; eight were accidentally pulled out while in gastric position due to the necessity to avoid fixation during the progression phase. Among organ failures, respiratory failure predominated, followed by cardiovascular. By day 3, the postpyloric progression rate was 63/128 tubes (49%). There was no association between migration and age, or SAPS II score, but the progression rate was significantly poorer in patients with hemodynamic failure. Use of norepinephrine and morphine were negatively associated with tube progression (P

The mainstream planar technology is marked by physical and technological limitations, which have a severe impact on the system characteristics. The performance, the multifunctionality and the reliability of microelectronic systems will be mainly limited by the wiring between the IC's and subsystems. The "onchip" wiring also leads to a critical performance bottleneck for future IC generations which can be solved only temporarily by the introduction of additional metallization layers and innovative materials (copper, low-/spl epsiv/-dielectrics). 3D IC fabrication creates a basis to overcome these drawbacks and to pave the way for system approaches of an entirely new quality. We realized a three dimensional metallization for Vertically integrated Circuits (VIC) using a newly developed technology that allows stacking and vertical interchip wiring of completely processed and electrically tested wafers using available microelectronic processes. wafers are stacked by an aligned bonding process. Vertical electrical connections are formed between the uppermost metal levels of the bonded wafers by fabrication and metal refill of high aspect ratio interchip vias. This interchip via (ICV) concept allows the formation of multiple wafer stacks using CMOS compatible materials and process steps and avoids backside processes. The potential of the ICV technology is the realization of some 100 000 vertical interconnects per cm/sup -2/ with 1-4 /spl mu/m/sup 2/ interchip vias, arbitrarily selectable.

For the use as metallization in CMOS device fabrication, we established a single wafer CVD copper deposition process with CupraSelect(R) (Schumacher) as precursor. Deposition was performed with a Delta 201 from Electrotech. We used a direct liquid injection system with an HPLC pump. The dependance of film properties upon pressure is described. In a certain pressure range, the CVD process is suitable for conformal filling of 18 /spl mu/m deep via holes with an aspect ratio of 10. The measured film resistivity is 1.95 u/spl Omega/cm as deposited and is reduced to 1.86 /spl mu//spl Omega/m after an annealing step.

Shallow junctions have been fabricatd using an excimer and a CO 2 laser as heating source. The diffusion was made out of a silicate glass layer. The produced diodes were electrically characterized. The concentration profiles measured by SIMS agree with simulations by ICECREM and have a depth of about 100 nm.

A new method of measuring the temperature of a silicon wafer in an RTP-Reaktor is described. It is based on the thermal expansion of the bulk silicon that is measured by a laser-interferometer. Thus it avoids the usual problems of a pyrometer like changing optical properties of the wafer surface. The method is especially suitable for processes below 600 degree C.

The ventricular response (VR) during atrial fibrillation (AF) presents particular characteristics which may play a relevant role in the selection of the most appropriate treatment. Preferential AV nodal conductions are visible when RR intervals Poincare plots during AF are constructed. The main objective of this work is the evaluation of the relationship between the position of more probable RR intervals and the atrial rate (AA). Holter monitoring was used to demonstrate that in patients with one, two or even three clusters of RR intervals, these clusters track nth multiples of the atrial rate (i.e. 2ldrAA, 3ldrAA, etc.). A possible classification of AF patients according to the ventricular response mechanism could help to improve the rate control treatments results.

A CO2 high-power laser was used for laser-driven boron and phosphorus diffusion in solid phase from silicate glass layers into silicon. This technique allows the formation of shallow (

Numerical simulations of crystal growth of Si film and heat transport in 3D structure were made for optimization of physical and geometrical parameters used during laser recrystallization. Based on simulations we introduced a new concept called micro-absorber to modulate the temperature profile so that Si films free of grain boundaries of up to 100 μm × 50 μm have been obtained.

With the further shrink of IC dimensions, metallization becomes the most crucial layer because conductivity and contact resistivity determine the RC constants and thus the speed of the circuits. With our Q-switched Nd:YAG laser we have evaporated different materials (Al, Ti, W, Pt, Au), alloys (Ta-Si) and dielectrics (ZrO 2 , Al 2 O 3 ). We also produced sandwich layers (Al-Au, Ti-Al). The layers were investigated with regard to deposition rate, homogeneity, adhesion, step coverage and surface roughness. Deposition rates in the order of 60 nm/min were achieved. At a power of 10 W and a repetition rate of about 5 kHz we could form ohmic contacts to silicon with a good step coverage in the contact.

Prostate cancer is the most common malignant tumor in men. Recently, a slightly decreased frequency of margin positivity following neoadjuvant bicalutamide treatment due to tumor shrinkage was reported. Trials investigating other anti-androgens in the past also reported lower frequencies of surgical margin positivity, but patients outcome has not improved. In this case, local recurrence was confirmed by needle biopsy in a patient five years following radical prostatectomy for prostate adenocarcinoma. After therapy with 50 mg bicalutamide for a month, the tumour was resected. Despite of detailed histological work-up and immunohistochemistry cancer suspicious lesions were not found. We think that bicalutamide may be capable of masking prostate cancer cells.

The selective retina therapy (SRT) is a new laser treatment at the fundus of the eye for diseases originating from an altered metabolism in the retinal pigment epithelium (RPE). The objective of the project is the realization of a compact longitudinally diode pumped Yb:YAG laser system for this new therapy. Therefore the laser system has to emit /spl mu/s-pulses with a repetition rate of 100 Hz in the spectral range of 500-520 nm with pulse energies of 1-2 mJ.

Summary Background and aims Critically ill patients with complicated evolution are frequently hypermetabolic, catabolic, and at risk of underfeeding. The study aimed at assessing the relationship between energy balance and outcome in critically ill patients. Methods Prospective observational study conducted in consecutive patients staying⩾5 days in the surgical ICU of a University hospital. Demographic data, time to feeding, route, energy delivery, and outcome were recorded. Energy balance was calculated as energy delivery minus target. Data in means±SD, linear regressions between energy balance and outcome variables. Results Forty eight patients aged 57±16 years were investigated; complete data are available in 669 days. Mechanical ventilation lasted 11±8 days, ICU stay 15±9 was days, and 30-days mortality was 38%. Time to feeding was 3.1±2.2 days. Enteral nutrition was the most frequent route with 433 days. Mean daily energy delivery was 1090±930kcal. Combining enteral and parenteral nutrition achieved highest energy delivery. Cumulated energy balance was between −12,600±10,520kcal, and correlated with complications \( P 0.001 \) , already after 1 week. Conclusion Negative energy balances were correlated with increasing number of complications, particularly infections. Energy debt appears as a promising tool for nutritional follow-up, which should be further tested. Delaying initiation of nutritional support exposes the patients to energy deficits that cannot be compensated later on.

The EBIC/TCM (electron beam induced current/tunneling current microscopy) method was applied to gate oxide structures. Oxide defects could be localized exactly for further analyses by scanning or transmission electron microscopy. Passivated structures and trench capacitors were investigated. Semiautomatic measurements were carried out in order to obtain statistical results. In the case of degraded gate oxide before destructive breakdown, TCM was used. The best results were achieved in the depletion range. A lateral solution of about 200 nm and a step-resolution of 2 nm were attained. To avoid further radiation damage by the electron beam, laser-activated TCM was used. Both methods yielded comparable results. >

The fabrication technology and electrical behavior of extremely thin integrated circuits are investigated and discussed. Wafers with implemented test chips are stuck to a handling substrate with an organic glue and then thinned by different methods. The mechanical properties of these extremely thin silicon chips have been studied and preliminary electrical results of chip foils laminated to another substrate are reported.

Fibrin sealing has proved a successful procedure for a variety of indications in operative gynecologic laparoscopy. Ovaries can be reshaped after cystectomy, serosa and peritoneal defects as well as perforations of the uterus can be sealed with fibrin adhesive. At present, application for salpingotomy, fimbrial eversion and tubal anastomosis is being investigated in clinical studies. Yet larger collectives and a longer follow-up are necessary for a final evaluation of the method. No complications were observed in 75 laparoscopic fibrin sealing performed at our department for established indications. Fibrin adhesive can replace time-consuming, complicated endoscopic sutures. It is an atraumatic tissue-sealing and hemostatic technique, easy in handling, thus leading to a considerable reduction in operation times. The excellent hemostyptic and wound healing characteristics of fibrin adhesive are also an advantage.Fibrin sealing has proven successful in a variety of situations in operative gynecologic laparoscopy. Ovaries can be reshaped after cystectomy, serosa and peritoneal defects as well as uterine perforations can be sealed with fibrin adhesive. At the present time, application for salpingostomy, fimbrial eversion, and tubal anastomosis are being investigated in clinical studies. Larger samples and longer follow-up periods are necessary for a final evaluation of the method. No complications were observed in 75 laparoscopic fibrin sealings performed at the authors' department. Fibrin adhesive can replace time-consuming, complicated endoscopic sutures. It is an atraumatic tissue sealing and hemostatic technique, easy in handling, and thus leading to a considerable reduction in operation times. The excellent hemostyptic and wound healing characteristics of fibrin adhesive are also an advantage. (author's modified)