Overcoming barriers and stigma: new frontiers in solid organ transplantation for people with HIV

There is a growing need for solid organ transplantation (SOT) for people living with human immunodeficiency virus (HIV). With the advent of antiretroviral therapy, people living with HIV are experiencing increased life expectancies and are, therefore, developing more comorbidities, including end-stage organ disease. In cases of advanced organ failure, SOT is often the best therapeutic option to improve quality of life and overall survival. As organ shortages persist, transplantation of organs from donors with HIV to recipients with HIV has become a potential therapeutic option. This article first reviews the current state of organ transplantation from donors without HIV to recipients with HIV (HIV D-/R+) by organ and discusses key lessons learned from these transplant trials, including those about drug-drug interactions, rejection, and opportunistic infections. It then explores transplantation from donors with HIV to recipients with HIV (HIV D+/R+), a new frontier. Finally, it investigates challenges of implementation, including public awareness and regulatory requirements, and explores future directions for SOT in people living with HIV.

InGaN Platelets: Synthesis and Applications toward Green and Red Light-Emitting Diodes

In this work, we present a method to synthesize arrays of hexagonal InGaN submicrometer platelets with a top c-plane area having an extension of a few hundred nanometers by selective area metal-organic vapor-phase epitaxy. The InGaN platelets were made by in situ annealing of InGaN pyramids, whereby InGaN from the pyramid apex was thermally etched away, leaving a c-plane surface, while the inclined {101̅1} planes of the pyramids were intact. The as-formed c-planes, which are rough with islands of a few tens of nanometers, can be flattened with InGaN regrowth, showing single bilayer steps and high-quality optical properties (full width at half-maximum of photoluminescence at room temperature: 107 meV for In_0.09Ga_0.91N and 151 meV for In_0.18Ga_0.82N). Such platelets offer surfaces having relaxed lattice constants, thus enabling shifting the quantum well emission from blue (as when grown on GaN) to green and red. For single InGaN quantum wells grown on the c-plane of such InGaN platelets, a sharp interface between the quantum well and the barriers was observed. The emission energy from the quantum well, grown under the same conditions, was shifted from 2.17 eV on In_0.09Ga_0.91N platelets to 1.95 eV on In_0.18Ga_0.82N platelets as a result of a thicker quantum well and a reduced indium pulling effect on In_0.18Ga_0.82N platelets. On the basis of this method, prototype light-emitting diodes were demonstrated with green emission on In_0.09Ga_0.91N platelets and red emission on In_0.18Ga_0.82N platelets.

Optimization of Current Injection in AlGaInP Core-Shell Nanowire Light-Emitting Diodes

Core-shell nanowires offer great potential to enhance the efficiency of light-emitting diodes (LEDs) and expand the attainable wavelength range of LEDs over the whole visible spectrum. Additionally, nanowire (NW) LEDs can offer both improved light extraction and emission enhancement if the diameter of the wires is not larger than half the emission wavelength (λ/2). However, AlGaInP nanowire LEDs have so far failed to match the high efficiencies of traditional planar technologies, and the parameters limiting the efficiency remain unidentified. In this work, we show by experimental and theoretical studies that the small nanowire dimensions required for efficient light extraction and emission enhancement facilitate significant loss currents, which result in a low efficiency in radial NW LEDs in particular. To this end, we fabricate AlGaInP core-shell nanowire LEDs where the nanowire diameter is roughly equal to λ/2, and we find that both a large loss current and a large contact resistance are present in the samples. To investigate the significant loss current observed in the experiments in more detail, we carry out device simulations accounting for the full 3D nanowire geometry. According to the simulations, the low efficiency of radial AlGaInP nanowire LEDs can be explained by a substantial hole leakage to the outer barrier layer due to the small layer thicknesses and the close proximity of the shell contact. Using further simulations, we propose modifications to the epitaxial structure to eliminate such leakage currents and to increase the efficiency to near unity without sacrificing the λ/2 upper limit of the nanowire diameter. To gain a better insight of the device physics, we introduce an optical output measurement technique to estimate an ideality factor that is only dependent on the quasi-Fermi level separation in the LED. The results show ideality factors in the range of 1-2 around the maximum LED efficiency even in the presence of a very large voltage loss, indicating that the technique is especially attractive for measuring nanowire LEDs at an early stage of development before electrical contacts have been optimized. The presented results and characterization techniques form a basis of how to simultaneously optimize the electrical and optical efficiency of core-shell nanowire LEDs, paving the way to nanowire light emitters that make true use of larger-than-unity Purcell factors and the consequently enhanced spontaneous emission.

Simplifying Nanowire Hall Effect Characterization by Using a Three-Probe Device Design

Electrical characterization of nanowires is a time-consuming and challenging task due to the complexity of single nanowire device fabrication and the difficulty in interpreting the measurements. We present a method to measure Hall effect in nanowires using a three-probe device that is simpler to fabricate than previous four-probe nanowire Hall devices and allows characterization of nanowires with smaller diameter. Extraction of charge carrier concentration from the three-probe measurements using an analytical model is discussed and compared to simulations. The validity of the method is experimentally verified by a comparison between results obtained with the three-probe method and results obtained using four-probe nanowire Hall measurements. In addition, a nanowire with a diameter of only 65 nm is characterized to demonstrate the capabilities of the method. The three-probe Hall effect method offers a relatively fast and simple, yet accurate way to quantify the charge carrier concentration in nanowires and has the potential to become a standard characterization technique for nanowires.

Doping evaluation of InP nanowires for tandem junction solar cells

In order to push the development of nanowire-based solar cells further using optimized nanowire diameter and pitch, a doping evaluation of the nanowire geometry is necessary. We report on a doping evaluation of n-type InP nanowires with diameters optimized for light absorption, grown by the use of metal-organic vapor phase epitaxy in particle-assisted growth mode using tetraethyltin (TESn) as the dopant precursor. The charge carrier concentration was evaluated using four-probe resistivity measurements and spatially resolved Hall measurements. In order to reach the highest possible nanowire doping level, we set the TESn molar fraction at a high constant value throughout growth and varied the trimethylindium (TMIn) molar fraction for different runs. Analysis shows that the charge carrier concentration in nanowires grown with the highest TMIn molar fraction (not leading to kinking nanowires) results in a low carrier concentration of approximately 10(16) cm(-3). By decreasing the molar fraction of TMIn, effectively increasing the IV/III ratio, the carrier concentration increases up to a level of about 10(19) cm(-3), where it seems to saturate. Axial carrier concentration gradients along the nanowires are found, which can be correlated to a combination of changes in the nanowire growth rate, measured in situ by optical reflectometry, and polytypism of the nanowires observed in transmission electron microscopy.

Designed Quasi-1D Potential Structures Realized in Compositionally Graded InAs1-xPx Nanowires

III-V semiconductor heterostructures are important components of many solid-state optoelectronic devices, but the ability to control and tune the electrical and optical properties of these structures in conventional device geometries is fundamentally limited by the bulk dimensionality and the inability to accommodate lattice-mismatched material combinations. Here we demonstrate how semiconductor nanowires may enable the creation of arbitrarily shaped one-dimensional potential structures for new types of designed device functionality. We describe the controlled growth of stepwise compositionally graded InAs1-xPx heterostructures defined along the axes of InAs nanowires, and we show that nanowires with sawtooth-shaped composition profiles behave as near-ideal unipolar diodes with ratchet-like rectification of the electron transport through the nanowires, in excellent agreement with simulations. This new type of designed quasi-1D potential structure represents a significant advance in band gap engineering and may enable fundamental studies of low-dimensional hot-carrier dynamics, in addition to constituting a platform for implementing novel electronic and optoelectronic device concepts.

Comparing Hall Effect and Field Effect Measurements on the Same Single Nanowire

We compare and discuss the two most commonly used electrical characterization techniques for nanowires (NWs). In a novel single-NW device, we combine Hall effect and back-gated and top-gated field effect measurements and quantify the carrier concentrations in a series of sulfur-doped InP NWs. The carrier concentrations from Hall effect and field effect measurements are found to correlate well when using the analysis methods described in this work. This shows that NWs can be accurately characterized with available electrical methods, an important result toward better understanding of semiconductor NW doping.

Radial Nanowire Light-Emitting Diodes in the (AlxGa1-x)yIn1-yP Material System

Nanowires have the potential to play an important role for next-generation light-emitting diodes. In this work, we present a growth scheme for radial nanowire quantum-well structures in the AlGaInP material system using a GaInP nanowire core as a template for radial growth with GaInP as the active layer for emission and AlGaInP as charge carrier barriers. The different layers were analyzed by X-ray diffraction to ensure lattice-matched radial structures. Furthermore, we evaluated the material composition and heterojunction interface sharpness by scanning transmission electron microscopy energy dispersive X-ray spectroscopy. The electro-optical properties were investigated by injection luminescence measurements. The presented results can be a valuable track toward radial nanowire light-emitting diodes in the AlGaInP material system in the red/orange/yellow color spectrum.

InAs Nanowire Transistors with Multiple, Independent Wrap-Gate Segments

We report a method for making horizontal wrap-gate nanowire transistors with up to four independently controllable wrap-gated segments. While the step up to two independent wrap-gates requires a major change in fabrication methodology, a key advantage to this new approach, and the horizontal orientation more generally, is that achieving more than two wrap-gate segments then requires no extra fabrication steps. This is in contrast to the vertical orientation, where a significant subset of the fabrication steps needs to be repeated for each additional gate. We show that cross-talk between adjacent wrap-gate segments is negligible despite separations less than 200 nm. We also demonstrate the ability to make multiple wrap-gate transistors on a single nanowire using the exact same process. The excellent scalability potential of horizontal wrap-gate nanowire transistors makes them highly favorable for the development of advanced nanowire devices and possible integration with vertical wrap-gate nanowire transistors in 3D nanowire network architectures.

A comparative study of absorption in vertically and laterally oriented InP core-shell nanowire photovoltaic devices

We have compared the absorption in InP core-shell nanowire p-i-n junctions in lateral and vertical orientation. Arrays of vertical core-shell nanowires with 400 nm pitch and 280 nm diameter, as well as corresponding lateral single core-shell nanowires, were configured as photovoltaic devices. The photovoltaic characteristics of the samples, measured under 1 sun illumination, showed a higher absorption in lateral single nanowires compared to that in individual vertical nanowires, arranged in arrays with 400 nm pitch. Electromagnetic modeling of the structures confirmed the experimental observations and showed that the absorption in a vertical nanowire in an array depends strongly on the array pitch. The modeling demonstrated that, depending on the array pitch, absorption in a vertical nanowire can be lower or higher than that in a lateral nanowire with equal absorption predicted at a pitch of 510 nm for our nanowire geometry. The technology described in this Letter facilitates quantitative comparison of absorption in laterally and vertically oriented core-shell nanowire p-i-n junctions and can aid in the design, optimization, and performance evaluation of nanowire-based core-shell photovoltaic devices.

Study of carrier concentration in single InP nanowires by luminescence and Hall measurements

The free electron carrier concentrations in single InP core-shell nanowires are determined by micro-photoluminescence, cathodoluminescence (CL) and Hall effect measurements. The results from luminescence measurements were obtained by solving the Fermi-Dirac integral, as well as by analyzing the peak full width at half maximum (FWHM). Furthermore, the platform used for Hall effect measurements, combined with spot mode CL spectroscopy, is used to determine the carrier concentrations at specific positions along single nanowires. The results obtained via luminescence measurements provide an accurate and rapid feedback technique for the epitaxial development of doping incorporation in nanowires. The technique has been employed on several series of samples in which growth parameters, such as V/III-ratio, temperature and dopant flows, were investigated in an optimization procedure. The correlation between the Hall effect and luminescence measurements for extracting the carrier concentration of different samples were in excellent agreement.

Formation of nanogaps in InAs nanowires by selectively etching embedded InP segments

We present a method to fabricate nanometer scale gaps within InAs nanowires by selectively etching InAs/InP heterostructure nanowires. We used vapor-liquid-solid grown InAs nanowires with embedded InP segments of 10-60 nm length and developed an etching recipe to selectively remove the InP segment. A photo-assisted wet etching process in a mixture of acetic acid and hydrobromic acid gave high selectivity, with accurate removal of InP segments down to 20 nm, leaving the InAs wire largely unattacked, as verified using scanning electron and transmission electron microscopy. The obtained nanogaps in InAs wires have potential as semiconducting electrodes to investigate electronic transport in nanoscale objects. We demonstrate this functionality by dielectrophoretically trapping 30 nm diameter gold nanoparticles into the gap.

Crystal phase-dependent nanophotonic resonances in InAs nanowire arrays

Nanostructures have many material, electronic, and optical properties that are not found in bulk systems and that are relevant for technological applications. For example, nanowires realized from III-V semiconductors can be grown into a wurtzite crystal structure. This crystal structure does not naturally exist in bulk where these materials form the zinc-blende counterpart. Being able to concomitantly grow these nanowires in the zinc-blende and/or wurtzite crystal structure provides an important degree of control for the design and optimization of optoelectronic applications based on these semiconductor nanostructures. However, the refractive indices of this new crystallographic phase have so far not been elucidated. This shortcoming makes it impossible to predict and utilize the full potential of these new nanostructured materials for optoelectronics applications: a careful design and optimization of optical resonances by tuning the nanostructure geometry is needed to achieve optimal performance. Here, we report and analyze striking differences in the optical response of nanophotonic resonances in wurtzite and zinc-blende InAs nanowire arrays. Specifically, through reflectance measurements we find that the resonance can be tuned down to λ ≈ 380 nm in wurtzite nanowires by decreasing the nanowire diameter. In stark contrast, a similar tuning to below λ ≈ 500 nm is not possible in the zinc-blende nanowires. Furthermore, we find that the wurtzite nanowires can absorb twice as strongly as the zinc-blende nanowires. We attribute these strikingly large differences in resonant behavior to large differences between the refractive indices of the two crystallographic phases realized in these nanostructures. We anticipate our findings to be relevant for other III-V materials as well as for all material systems that manifest polytypism. Taken together, our results demonstrate crystal phase engineering as a potentially new design dimension for optoelectronics applications.

Synthesis of doped InP core-shell nanowires evaluated using hall effect measurements

InP core-shell nanowire pn-junctions doped with Zn and Sn have been investigated in terms of growth morphology and shell carrier concentration. The carrier concentrations were evaluated using spatially resolved Hall effect measurements and show improved homogeneity compared to previous investigations, attributed to the use of Sn as the n-type dopant. Anisotropies in the growth rate of different facets are found for different doping levels that in turn affects the migration of Sn and In on the nanowire surface. A route for increasing the In migration length to obtain a more homogeneous shell thickness is presented.

Electron-beam patterning of polymer electrolyte films to make multiple nanoscale gates for nanowire transistors

We report an electron-beam based method for the nanoscale patterning of the poly(ethylene oxide)/LiClO4 polymer electrolyte. We use the patterned polymer electrolyte as a high capacitance gate dielectric in single nanowire transistors and obtain subthreshold swings comparable to conventional metal/oxide wrap-gated nanowire transistors. Patterning eliminates gate/contact overlap, which reduces parasitic effects and enables multiple, independently controllable gates. The method's simplicity broadens the scope for using polymer electrolyte gating in studies of nanowires and other nanoscale devices.

Conductance enhancement of InAs/InP heterostructure nanowires by surface functionalization with oligo(phenylene vinylene)s

We have investigated the electronic transport through 3 μm long, 45 nm diameter InAs nanowires comprising a 5 nm long InP segment as electronic barrier. After assembly of 12 nm long oligo(phenylene vinylene) derivative molecules onto these InAs/InP nanowires, we observed a pronounced, nonlinear I-V characteristic with significantly increased currents of up to 1 μA at 1 V bias, for a back-gate voltage of 3 V. As supported by our model calculations based on a nonequilibrium Green Function approach, we attribute this effect to charge transport through those surface-bound molecules, which electrically bridge both InAs regions across the embedded InP barrier.

Spatially resolved Hall effect measurement in a single semiconductor nanowire

Efficient light-emitting diodes and photovoltaic energy-harvesting devices are expected to play an important role in the continued efforts towards sustainable global power consumption. Semiconductor nanowires are promising candidates as the active components of both light-emitting diodes and photovoltaic cells, primarily due to the added freedom in device design offered by the nanowire geometry. However, for nanowire-based components to move past the proof-of-concept stage and be implemented in production-grade devices, it is necessary to precisely quantify and control fundamental material properties such as doping and carrier mobility. Unfortunately, the nanoscale geometry that makes nanowires interesting for applications also makes them inherently difficult to characterize. Here, we report a method to carry out Hall measurements on single core-shell nanowires. Our technique allows spatially resolved and quantitative determination of the carrier concentration and mobility of the nanowire shell. As Hall measurements have previously been completely unavailable for nanowires, the experimental platform presented here should facilitate the implementation of nanowires in advanced practical devices.

A cathodoluminescence study of the influence of the seed particle preparation method on the optical properties of GaAs nanowires

Cathodoluminescence at 8 K is used to compare the optical properties of AlGaAs-capped GaAs nanowires, grown by metal-organic vapour phase epitaxy and seeded by gold particles prepared by different methods. Six different methods were used to fabricate and deposit gold seed particles onto GaAs substrates: colloid particles, aerosol particles and particles defined by electron beam lithography. The nanowires were grown with and without an in situ annealing step prior to the nanowire growth. The morphology showed no significant differences between the nanowires. The emissions from ensembles of nanowires have the same peak position, irrespective of seed particle type. Without the in situ annealing step prior to the nanowire growth, there are significant differences in the emission intensity and emission patterns from nanowires grown from different seed particles. When an in situ annealing step is included, all the resulting nanowires show identical optical emission intensity and emission patterns. This shows the importance of using an in situ annealing step prior to growth. This study demonstrates that different preparation methods for gold seed particles can be used to produce GaAs nanowires with highly similar optical properties. The choice of particle preparation method to be used can therefore be based on availability and cost.

Electrical and optical properties of InP nanowire ensemble p⁺-i-n⁺ photodetectors

We report on a comprehensive study of electrical and optical properties of efficient near-infrared p⁺-i-n⁺ photodetectors based on large ensembles of self-assembled, vertically aligned i-n⁺ InP nanowires monolithically grown on a common p⁺ InP substrate without any buffer layer. The nanowires have a polytype modulated crystal structure of wurtzite and zinc blende. The electrical data display excellent rectifying behavior with an ideality factor of about 2.5 at 300 K. The ideality factor scales with 1/T, which possibly reflects deviations from classical transport models due to the mixed crystal phase of the nanowires. The observed dark leakage current is of the order of merely ∼100 fA/nanowire at 1 V reverse bias. The detectors display a linear increase of the photocurrent with reverse bias up to about 10 pA/nanowire at 5 V. From spectrally resolved measurements, we conclude that the photocurrent is primarily generated by funneling photogenerated carriers from the substrate into the NWs. Contributions from direct excitation of the NWs become increasingly important at low temperatures. The photocurrent decreases with temperature with an activation energy of about 50 meV, which we discuss in terms of a temperature-dependent diffusion length in the substrate and perturbed transport through the mixed-phase nanowires.

Evaluation of RAD51C as cancer susceptibility gene in a large breast-ovarian cancer patient population referred for genetic testing

Despite extensive analysis of the BRCA1 and BRCA2 genes, germline mutations are detected in <20% of families with a presumed genetic predisposition for breast and ovarian cancer. Recent literature reported RAD51C as a new breast cancer susceptibility gene. In this study, we report the analysis of 410 patients from 351 unrelated pedigrees. All were referred for genetic testing and we selected families with at least one reported case of ovarian cancer in which BRCA1&2 mutations were previously ruled out. We analyzed the coding exons, intron-exons boundaries, and UTRs of RAD51C. Our mutation analysis did not reveal any unequivocal deleterious mutation. In total 12 unique sequence variations were identified of which two were novel. Our study and others suggest a low prevalence of RAD51C mutations with an exception for some founder populations. This observation is in favor of the rare allele hypothesis in the debate over the nature of the genetic contribution to individual susceptibility to breast and ovarian cancer and further genome-wide studies in high risk families are warranted.

Realizing lateral wrap-gated nanowire FETs: controlling gate length with chemistry rather than lithography

An important consideration in miniaturizing transistors is maximizing the coupling between the gate and the semiconductor channel. A nanowire with a coaxial metal gate provides optimal gate-channel coupling but has only been realized for vertically oriented nanowire transistors. We report a method for producing laterally oriented wrap-gated nanowire field-effect transistors that provides exquisite control over the gate length via a single wet etch step, eliminating the need for additional lithography beyond that required to define the source/drain contacts and gate lead. It allows the contacts and nanowire segments extending beyond the wrap-gate to be controlled independently by biasing the doped substrate, significantly improving the subthreshold electrical characteristics. Our devices provide stronger, more symmetric gating of the nanowire, operate at temperatures between 300 and 4 K, and offer new opportunities in applications ranging from studies of one-dimensional quantum transport through to chemical and biological sensing.

Distal myopathy with upper limb predominance caused by filamin C haploinsufficiency

OBJECTIVE

In this study, we investigated the detailed clinical findings and underlying genetic defect in 3 presumably related Bulgarian families displaying dominantly transmitted adult onset distal myopathy with upper limb predominance.

METHODS

We performed neurologic, electrophysiologic, radiologic, and histopathologic analyses of 13 patients and 13 at-risk but asymptomatic individuals from 3 generations. Genome-wide parametric linkage analysis was followed by bidirectional sequencing of the filamin C (FLNC) gene. We characterized the identified nonsense mutation at cDNA and protein level.

RESULTS

Based on clinical findings, no known myopathy subtype was implicated in our distal myopathy patients. Light microscopic analysis of affected muscle tissue showed no specific hallmarks; however, the electron microscopy revealed changes compatible with myofibrillar myopathy. Linkage studies delineated a 9.76 Mb region on chromosome 7q22.1-q35 containing filamin C (FLNC), a gene previously associated with myofibrillar myopathy. Mutation analysis revealed a novel c.5160delC frameshift deletion in all patients of the 3 families. The mutation results in a premature stop codon (p.Phe1720LeufsX63) that triggers nonsense-mediated mRNA decay. FLNC transcript levels were reduced in muscle and lymphoblast cells from affected subjects and partial loss of FLNC in muscle tissue was confirmed by protein analysis.

CONCLUSIONS

The FLNC mutation that we identified is distinct in terms of the associated phenotype, muscle morphology, and underlying molecular mechanism, thus extending the currently recognized clinical and genetic spectrum of filaminopathies. We conclude that filamin C is a dosage-sensitive gene and that FLNC haploinsufficiency can cause a specific type of myopathy in humans.

Analysis of FOXG1 Is Highly Recommended in Male and Female Patients with Rett Syndrome

We screened a cohort of 5 male and 20 female patients with a Rett spectrum disorder for mutations in the coding region of FOXG1, previously shown to cause the congenital variant of Rett syndrome. Two de novo mutations were identified. The first was a novel missense mutation, p.Ala193Thr (c.577G>A), in a male patient with congenital Rett syndrome, and the second was the p.Glu154GlyfsX301 (c.460dupG) truncating mutation in a female with classical Rett syndrome, a mutation that was previously reported in an independent patient. The overall rate of FOXG1 mutations in our cohort is 8%. Our findings stress the importance of FOXG1 analysis in male patients with Rett syndrome and in female patients when mutations in the MECP2 and CDKL5 genes have been excluded.

Scanning gate imaging of quantum dots in 1D ultra-thin InAs/InP nanowires

We use a scanning gate microscope (SGM) to characterize one-dimensional ultra-thin (diameter ≈ 30 nm) InAs/InP heterostructure nanowires containing a nominally 300 nm long InAs quantum dot defined by two InP tunnel barriers. Measurements of Coulomb blockade conductance versus backgate voltage with no tip present are difficult to decipher. Using the SGM tip as a charged movable gate, we are able to identify three quantum dots along the nanowire: the grown-in quantum dot and an additional quantum dot near each metal lead. The SGM conductance images are used to disentangle information about individual quantum dots and then to characterize each quantum dot using spatially resolved energy-level spectroscopy.

Gate-induced fermi level tuning in InP nanowires at efficiency close to the thermal limit

As downscaling of semiconductor devices continues, one or a few randomly placed dopants may dominate the characteristics. Furthermore, due to the large surface-to-volume ratio of one-dimensional devices, the position of the Fermi level is often determined primarily by surface pinning, regardless of doping level. In this work, we investigate the possibility of tuning the Fermi level dynamically with wrap-around gates, instead of statically setting it using the impurity concentration. This is done using Ω-gated metal-oxide-semiconductor field-effect transistors with HfO(2)-capped InP nanowires as channel material. It is found that induced n-type devices exhibit an optimal inverse subthreshold slope of 68 mV/decade. By adjusting the growth and process parameters, it is possible to produce ambipolar devices, in which the Fermi level can be tuned across the entire band gap, making it possible to induce both n-type and p-type conduction.

Sensitivity and specificity of a whole-blood RNA transcript-based diagnostic test for the diagnosis of prostate cancer (CaP) compared with prostate-specific antigen (PSA) alone

5052

Background: Screening for CaP with PSA testing is limited by a high number of false postives, particularly in the setting of benign prostatic hypertrophy (BPH). The goal of this study was to develop whole blood RNA transcript-based diagnostic tests that improve the diagnosis of CaP over PSA alone. Methods: From August 2006 to October 2008, three prospective cohorts of men consented to the collection of whole blood in PAXgene Blood RNA tubes for gene expression analysis: men with newly diagnosed, localized, untreated CaP, otherwise healthy men without CaP, and otherwise healthy men with BPH. 168 inflammation and CaP-related genes (Source MDx Precision Profiles) were assayed using optimized Q-PCR technology. Logistic regression methods were used to develop models to optimize prostate cancer diagnosis. Results: 182 men underwent expression analysis (n = 76, 76 and 30 for CaP, normal, and BPH cohorts, respectively). The CaP and normal cohorts were age matched (median age 60 yrs); the BPH cohort median age was 70. Considering only the CaP and normal cohorts, PSA alone (using a cut-off of 4 ng/ml) had a specificity of 94.7%, but sensitivity of only 71.1% for diagnosis of CaP, or 90.8% and 77.6%, respectively, when using age-adjusted PSA criteria. A model consisting of the expression analysis of 6 genes and PSA had a higher specificity (96.1%) and a much improved sensitivity (97.4%) for CaP diagnosis. When the BPH cohort was added, the improvement of the 6-gene model remained (sensitivity and specificity of 97.4% and 92.0% vs 77.6% and 88.1% using the age-adjusted PSA criteria). Further model development using the CaP and BPH cohorts yielded a 5-gene model which, integrated with PSA and age, correctly predicted 96.1% of the CaP pts and 93.3% of BPH pts. Conclusions: These results suggest that specific whole blood RNA transcript levels can assess abnormal gene expression associated with CaP. Such a molecular CaP biomarker would be a powerful tool to reduce unnecessary biopsies in patients without CaP and detect CaP in patients with PSA values below the current cutoff. Validation of these results is ongoing and will be available at the time of the meeting.

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An optimized DHPLC protocol for molecular testing of the EXT1 and EXT2 genes in hereditary multiple osteochondromas

Hereditary multiple osteochondromas (MO) is an autosomal dominant bone disorder characterized by the presence of bony outgrowths (osteochondromas or exostoses) on the long bones. MO is caused by mutations in the EXT1 or EXT2 genes, which encode glycosyltransferases implicated in heparan sulfate biosynthesis. Standard mutation analysis performed by sequencing analysis of all coding exons of the EXT1 and EXT2 genes reveals a mutation in approximately 80% of the MO patients. We have now optimized and validated a denaturing high-performance liquid chromatography (DHPLC)-based protocol for screening of all EXT1- and EXT2-coding exons in a set of 49 MO patients with an EXT1 or EXT2 mutation. Under the optimized DHPLC conditions, all mutations were detected. These include 20 previously described mutations and 29 new mutations - 20 new EXT1 and nine new EXT2 mutations. The protocol described here, therefore, provides a sensitive and cost-sparing alternative for direct sequencing analysis of the MO-causing genes.

Multiplex ligation-dependent probe amplification to detect subtelomeric rearrangements in routine diagnostics

Subtelomeric rearrangements are believed to be responsible for 5-7% of idiopathic mental retardation cases. Due to the relative complexity and high cost of the screening methods used till now, only preselected patient populations including mostly the more severely affected cases have been screened. Recently, multiplex ligation-dependent probe amplification (MLPA) has been adapted for use in subtelomeric screening, and we have incorporated this technique into routine diagnostics of our laboratory. Since the evaluation of MLPA as a screening method, we tested 275 unselected patients with idiopathic mental retardation and detected 12 possible subtelomeric aberrations: a der(11)t(11;20)(qter;qter), a 19pter duplication, a der(18)t(18;10)(qter; pter), a 15qter deletion, a 8pter deletion, a 6qter deletion, a der(X)t(X;1)(pter;qter), a der(X)t(X;3)(pter;pter), a 5qter duplication, a 3pter deletion, and two 3qter duplications. The patients can be subdivided into two groups: the first containing de novo rearrangements that are likely related to the clinical presentation of the patient and the second including aberrations also present in one of the parents that may or may not be causative of the mental retardation. In our patient cohort, five (1.8%) subtelomeric rearrangements were de novo, three (1.1%) rearrangements were familial and suggestively disease causing, and four (1.5%) were possible polymorphisms. This high frequency of subtelomeric abnormalities detected in an unselected population warrants further investigation about the feasibility of routine screening for subtelomeric aberrations in mentally retarded patients.

Absence of constitutional Y chromosome AZF deletions in patients with testicular germ cell tumors

OBJECTIVES

To investigate the frequency of azoospermia factor (AZF) deletions in Dutch patients with testicular germ cell tumors (TGCTs). Reduced fertility is associated with TGCTs and reduced fertility and TGCTs might share genetic risk factors according to the testicular dysgenesis hypothesis. Up to 8% of infertility and reduced fertility in the general male population can be explained by the presence of constitutional deletions of part of the long arm of the Y chromosome (Yq11), referred to as the AZF region.

METHODS

In 112 patients with TGCT, screening for constitutional deletions in the AZF region was performed by multiplex polymerase chain reaction analysis in DNA extracted from peripheral blood lymphocytes. A set of 24 primer pairs, of which 20 primer pairs are homologous to previously identified and mapped sequenced tag sites within the AZF region were used.

RESULTS

No deletions in the Yq11 region were detected in any of the 112 patients.

CONCLUSIONS

Large Y chromosome microdeletions in the AZF region are not a major contributor to the development of TGCT and TGCT-associated reduced fertility.

A Psychometric Analysis of the Maslach Burnout Inventory-General Survey in the South African Police Service

The objectives of this study, which was undertaken by two members of the WorkWell Research Unit, were to validate the Maslach Burnout Inventory-General Survey (MBI-GS) for the South African Police Service and to determine the construct equivalence of this Inventory and bias for different race groups. A cross-sectional survey design was used. Stratified random samples ( N=2396) were taken of police members from nine provinces in South Africa. The study was based on the MBI-GS and a biographical questionnaire. Structural equation modelling confirmed a 3-factor model of burnout, consisting of Exhaustion, Cynicism and Professional Efficacy. All three factors showed acceptable internal consistencies. An exploratory factor analysis with target rotations confirmed the construct equivalence of the three factors for different race groups in the SAPS. No evidence was found for uniform or non-uniform bias of the items of the MBI-GS for different race groups.

A psychometric analysis of the Utrecht Work Engagement Scale in the South African police service

The objectives of this research were to validate the Utrecht Work Engagement Scale (UWES) for the South African Police Service (SAPS) and to determine its construct equivalence and bias in different race groups. A cross-sectional survey design was used. Stratified random samples (N = 2396) were taken of police members of nine provinces in South Africa. The UWES and a biographical questionnaire were administered. Structural equation modelling confirmed a 3-factor model of work engagement, consisting of Vigour, Dedication and Absorption. These three factors have acceptable internal consistencies. Exploratory factor analysis with target rotations showed equivalence of the three factors for different race groups in the SAPS. No evidence was found for uniform or non-uniform bias of the items of the UWES for different race groups. Opsomming Die doelstellings van hierdie navorsing was om die Utrecht- werksbegeesteringskaal (UWES) te valideer vir die Suid- Afrikaanse Polisiediens (SAPD) en die konstrukekwivalensie daarvan vir verskillende rassegroepe te bepaal. ’n Dwarssnee opname-ontwerp is gebruik. Gestratifiseerde ewekansige steekproewe (N = 2396) is van polisielede uit nege provinsies geneem. Die UWES en ’n biografiese vraelys is afgeneem. Strukturele vergelykingsmodellering het ’n 3-faktormodel, bestaande uit Energie, Toewyding en Absorpsie, aangetoon. Hierdie drie faktore het aanvaarbare interne konsekwentheid getoon. Eksploratiewe faktoranalise met teikenrotasies het konstrukekwivalensie vir die drie faktore vir verskillende rassegroepe in die SAPD getoon. Bewyse is nie gevind vir uniforme of nie-uniforme sydigheid van die items van die UWES vir verskillende rassegroepe nie.

Coping, stress and burnout in the South African police service in Kwazulu-natal

The objective of this research was to determine the relationship between coping, stress and burnout in the South African Police Service. A survey design was used. The study population (N = 257) consisted of police personnel in Kwazulu-Natal. The COPE, Police Stress Inventory and Maslach Burnout Inventory – General Survey (MBI-GS), were used as measuring instruments. Structural equation analysis showed that job demands (as stressors) are associated with exhaustion. Passive coping strategies contributed to exhaustion and cynicism, while seeking emotional support led to lower exhaustion. Exhaustion contributed to cynicism. Stress because of a lack of resources, active coping strategies and not coping passively seem to impact on professional efficacy. Opsomming Die doelstelling van hierdie navorsing was om die verband tussen coping, stres en uitbranding binne die Suid-Afrikaanse Polisiediens te ondersoek. ’n Opname-ontwerp is gebruik. Die studiepopulasie (N = 257) het bestaan uit polisiepersoneel in Kwazulu-Natal. Die COPE, die Polisiestres-Opname en die Maslach-uitbrandingsvraelys – Algemene Opname (MBI-GS) is as meetinstrumente gebruik. Strukturele vergelykingsmodellering het aangetoon dat werkseise (as stressore) geassosieer word met uitputting. Passiewe coping- strategieë het bygedra tot uitputting en sinisme, terwyl die soeke na emosionele ondersteuning tot laer uitputting gelei het. Uitputting het tot sinisme bygedra. Stres a.g.v. ’n tekort aan hulpbronne (invers), aktiewe coping-strategieë en passiewe coping-strategieë (invers) blyk ’n uitwerking op professionele doeltreffendheid te hê.

The relationship between burnout, personality traits and coping strategies in a corporate pharmaceutical group

The objective of this research was to determine the relationship between burnout, personality traits and coping strategies. A survey design was used. The study population consisted of 131 employees in a corporate pharmaceutical group. The Maslach Burnout Inventory, NEO Personality Inventory Revised and COPE were administered. Active coping strategies were associated with Emotional Stability, Extraversion, Openness to Experience and Conscientiousness, while passive coping strategies were associated with Neuroticism, low Agreeableness and low Conscientiousness. Emotional Stability, Extraversion, Openness to Experience, Agreeableness and Conscientiousness were associated with lower emotional exhaustion and depersonalisation and higher personal accomplishment. Constructive coping strategies were associated with personal accomplishment. Opsomming Die doelstelling van hierdie navorsing was om te bepaal of daar ’n verband tussen uitbranding, persoonlikheidstrekke en coping-strategieë bestaan. ’n Opnameontwerp is gebruik. Die ondersoekgroep het bestaan uit 131 werknemers van ’n korporatiewe apteekgroep. Drie vraelyste is gebruik, naamlik die Maslach-Uitbrandingsvraelys, die NEO Personality Inventory Revised en die COPE. Aktiewe coping-strategieë is geassosieer met Emosionele Stabiliteit, Ekstroversie, Openheid vir Ervaring en Konsensieusheid, terwyl passiewe coping-strategieë geassosieer is met Neurotisisme, lae Inskiklikheid en lae Konsensieusheid. Emosionele Stabiliteit, Ekstroversie, Openheid vir Ervaring, Inskiklikheid en Konsensieusheid is geassosieer met lae emosionele uitputting, lae depersonalisasie en hoë persoonlike bereiking. Konstruktiewe coping-strategieë is geassosieer met persoonlike bereiking.

The M34T allele variant of connexin 26

GJB2 encodes the protein Connexin 26, one of the building blocks of gap junctions. Each Connexin 26 molecule can oligomerize with five other connexins to form a connexon; two connexons, in turn, can form a gap junction. Because mutations in GJB2 are the most common cause of congenital severe-to-profound autosomal recessive nonsyndromic hearing loss, the effect of the Connexin 26 allele variants on this dynamic 'construction' process and the function of any gap junctions that do form is particularly germane. One of the more controversial allele variants, M34T, has been hypothesized to cause autosomal dominant nonsyndromic hearing loss. In this paper, we present clinical and genotypic data that refutes this hypothesis and suggests that the effect of the M34T allele variant may be dependent on the mutations segregating in the opposing allele.

The clinical pharmacokinetics of a new pharmacokinetically enhanced formulation of amoxicillin/clavulanate

BACKGROUND

A new oral pharmacokinetically enhanced formulation of the broad-spectrum antibiotic amoxicillin/clavulanate has been developed to provide more effective therapy against resistant pathogens than is provided by currently available formulations by maintaining therapeutically useful plasma amoxicillin concentrations for a longer period after dosing.

OBJECTIVE

This study explored the pharmacokinetics of the new oral formulation of amoxicillin/clavulanate in healthy male and female subjects.

METHODS

A single oral dose of pharmacokinetically enhanced amoxicillin/clavulanate (2000/125 mg; 16:1 ratio) was administered to subjects at the start of a meal. After dosing, blood samples were collected at frequent intervals up to 12 hours, and plasma was assayed for amoxicillin and clavulanate concentrations using validated procedures. The new formulation consisted of 1 layer of immediate-release amoxicillin and clavulanate and another of sustained-release amoxicillin in a proportion such that for an amoxicillin minimum inhibitory concentration (MIC) of 4 microg/mL, the time above the MIC (T >MIC) would be approximately > or = 40% over a 12-hour dosing interval.

RESULTS

The study enrolled 24 and 31 healthy male and female subjects, respectively. Their mean age was 35 years (range, 18-58 years) and mean body weight was 69 kg (range, 51-86 kg). After the expected sharp peak in plasma amoxicillin concentration, there appeared to be a slower decline with the pharmacokinetically enhanced formulation than is usually seen with conventional formulations, and there was evidence of a second amoxicillin absorption phase. The mean T >MIC for an amoxicillin MIC of 4 microg/mL was 49.4% of a 12-hour dosing interval, a value that cannot be achieved with existing approved doses and formulations of amoxicillin/clavulanate. By 12 hours, plasma amoxicillin concentrations were very low (approximately 0.05 microg/mL), suggesting no expectation of notable dose-to-dose accumulation on repeat dosing with a BID regimen. The terminal half-lives of amoxicillin (1.27 hours) and clavulanate (1.03 hours) with the new formulation were similar to those of existing formulations of amoxicillin/clavulanate. No deaths or serious adverse events were reported.

CONCLUSIONS

The enhanced pharmacokinetic profile of amoxicillin/clavulanate seen in this study suggests that this formulation is likely to be highly effective for the oral treatment of infections caused by bacteria--including beta-lactamase-producing organisms--and strains with amoxicillin MICs < or = 4 microg/mL.

Determination of the carrier frequency of the common GJB2 (connexin-26) 35delG mutation in the Belgian population using an easy and reliable screening method

Mutations in the gene GJB2, encoding the gap-junction protein connexin-26, have been shown to be a major cause of nonsyndromic recessive deafness (NSRD). A single mutation in the GJB2 gene accounts for the majority of NSRD in many different populations. This mutation represents a deletion of a guanine within a stretch of six Gs between nucleotide positions +30 and +35 of the GJB2 cDNA (35delG). Molecular detection of the 35delG mutation is usually performed by direct sequencing analysis of PCR products, or by allele-specific PCR analysis. To screen for this mutation, we developed an easier and more reliable method, based on the principle of PCR-mediated site-directed mutagenesis (PSDM), followed by a BsiYI digestion. We tested 360 unrelated unaffected Belgian individuals for heterozygosity of the 35delG mutation and found a carrier frequency of 1 in 40 (95% CI, 1 in 30 to 1 in 60). As our new screening method is simple and reliable in use, and detects a mutation responsible for a significant part of NSRD, it may find widespread use in DNA diagnostics.

CAG repeat contraction in the androgen receptor gene in three brothers with mental retardation

We report on three brothers with mental retardation and a contracted CAG repeat in the androgen receptor (AR) gene. It is known that expansion of the CAG repeat in this gene leads to spinal and bulbar muscular atrophy (SBMA or Kennedy disease); however, contracted repeats have not yet been implicated in disease. As the range of the length of CAG repeats in the AR gene, like those of other genes associated with dynamic mutations, follows a normal distribution, the theoretical possibility of disease at both ends of the distribution should be considered.

Classical Friedreich's ataxia and its genotype

Fourteen patients with classical features of Friedreich's ataxia (FRDA) were examined. The clinical diagnosis of FRDA was afterwards confirmed in all patients by the appropriate DNA investigation which showed markedly increased amounts of GAA repeats on both alleles of the frataxin gene. None of our patients presented with atypical features such as late-onset FRDA, FRDA with retained deep tendon reflexes or with a very slow course. Five of them are not yet confined to a wheelchair. But for 1 patient who died at age 36 years and had the largest number of GAA repeats on both alleles, there was no significant correlation between number of repeats in the shortest allele, age at onset, age at wheelchair dependence, duration of the disease and main clinical signs. All patients but 3 had between 500 and 1,050 GAA repeats. The 3 patients with, respectively, 400, 450 and 500 repeats on the shortest allele had a clinical course comparable to the other patients. Even in the case of variations in the number of repeats in the same sibship, there were only modest differences between the siblings concerning age at onset of the disease, symptoms and signs and age at wheelchair dependence. There were no qualitative differences in the main clinical features and laboratory investigations in the full-blown phase of the disorder. Molecular biology has become a major element in the diagnosis of FRDA. DNA testing for FRDA should be applied to every case of idiopathic autosomal recessive or sporadic ataxia. However, the clinical features of FRDA remain fully characteristic in many patients and keep their diagnostic value.

Incomplete EcoRI digestion may lead to false diagnosis of fragile X syndrome

Molecular diagnosis of fragile X syndrome is usually performed using Southern blot analysis of DNA digested with EcoRI. In the course of diagnostic studies, we observed that a specific EcoRI restriction site in the fragile X gene (FMR1) is sometimes refractory to digestion, generating additional fragments on a Southern blot suggestive of a full mutation in FMR1. This may lead to a false-positive diagnosis of fragile X syndrome. Such additional bands are avoided by the use of HindIII instead of EcoRI. Therefore, we recommend the use of HindIII for the molecular diagnosis of fragile X syndrome.

Copper treatment increases recombinant baculovirus production and polyhedrin and p10 expression

Treatment with 2 mM CuSO4 was used to induce a Drosophila melanogaster metallothionein (Mtn) promoter that had been cloned into a recombinant baculovirus. Careful study revealed that the Mtn promoter functioned as an inducible, if somewhat "leaky" promoter within the context of baculovirus-infected cells. In the process of generating a recombinant-baculovirus, it was discovered that post-transfection treatment with copper resulted in a 10-fold increase in the production of recombinant virus. This effect on virus production was specific to transfection, as treatment of infected cells with copper did not increase the production of virus. Treatment of infected cells with copper did, however, extend the period of expression of the polyhedrin and p10 proteins by at least 12 h. These findings have practical applications for the production of recombinant baculoviruses and the subsequent expression of foreign proteins using baculovirus expression vectors.

Mildly impaired water maze performance in male Fmr1 knockout mice

Fmr1 knockout mice constitute a putative model of fragile X syndrome, the most common form of heritable mental disability in humans. We have compared the performance of transgenic mice with an Fmr1 knockout with that of normal littermates in hidden- and visible-platform water maze learning, and showed that knockouts exhibit subnormal spatial learning abilities and marginal motor performance deficits. During 12 training trials of the hidden-platform task, escape latency and path length decreased significantly in knockouts and control littermates, and no effect of genotype was found. During four ensuing reversal trials, however, significant differences were found between knockouts and control littermates both in escape latency and path length. During the visible-platform condition, the reversal trials also revealed a difference between knockouts and normal littermates in escape latency, but not in path length. Possibly due to marginal motor incapacity, knockouts swam significantly slower than controls during these latter trials. During both probe trials of the hidden-platform task, knockouts as well as normal littermates spent more time in the target quadrant than in the other quadrants, and percent of time spent in the target quadrant was the same in both groups; swimming velocity was not significantly different between knockouts and normal littermates during these trials. Entries in the target area during the probe trials did show a significant effect of genotype on number of entries. The present results largely confirm and extend our previous findings. Impaired spatial abilities in Fmr1 knockouts might have been due to relatively low response flexibility or high memory interference in Fmr1 knockouts. It remains unclear, however, which brain region or neurochemical system might be involved in these disabilities. We conclude that Fmr1 knockout mice might be a valid model of fragile X mental retardation.

Overexpression of actin in AcMNPV-infected cells interferes with polyhedrin synthesis and polyhedra formation

Autographa californica M nuclear polyhedrosis virus (AcMNPV) terminates host protein synthesis during the late stage of infection, at approximately 14 hr postinfection (hpi). If infection takes place in the presence of cytochalasin D (CD), however, host actin synthesis is transiently stimulated and continues to be synthesized until approximately 30 hpi, and the hyperexpression of polyhedrin is delayed from about 20 hpi until about 36 hpi (S. N. Talhouk and L. E. Volkman, Virology 182, 626-634, 1991; N. Wei and L. E. Volkman, Virology 191, 42-48, 1992). To investigate whether these events are causally related, i.e., whether actin synthesis negatively affects polyhedrin synthesis, we constructed recombinant viruses that expressed actin at various levels during infection. We found that the expression of actin by a strong promoter interfered with polyhedrin synthesis at a posttranscriptional level. It also interfered with polyhedra formation, which may suggest a mechanism for the observed paucity of polyhedra in infected midgut columnar epithelial cells in vivo.

Transgenic mouse model for the fragile X syndrome

Transgenic fragile X knockout mice have been constructed to provide an animal model to study the physiologic function of the fragile X gene (FMR1) and to gain more insight into the clinical phenotype caused by the absence of the fragile X protein. Initial experiments suggested that the knockout mice show macroorchidism and cognitive and behavioral deficits, abnormalities comparable to those of human fragile X patients. In the present study, we have extended our experiments, and conclude that the Fmr1 knockout mouse is a reliable transgenic model to study the fragile X syndrome.

Severe mental retardation and macroorchidism without mutation in the FMR1 gene

Only one missense mutation, an Ile304Asn, has been reported in the fragile X gene (FMR1). This mutation is located in the second KH domain of FMR1, and has led to the discovery of the function of the FMR1 gene product as an RNA-binding protein. The patient carrying this mutation has profound mental retardation, macroorchidism, and an "acromegalic" face with prominent supraorbital ridges, enlarged jaw, heavy brow ridges, thick lips, and a broad nose. We have studied the possible involvement of FMR1 in two maternal half-brothers with a phenotype similar to that of the patient with the Ile304Asn mutation. Both brothers had an identical number of CGG repeats in the normal size-range, and shared the same maternal Xq27 haplotype. Southern blot analysis with two overlapping FMR1 cDNA clones, spanning the total FMR1 open reading frame, showed no major deletions, insertions, or gross rearrangements. Single-strand conformation pattern (SSCP) analysis of the KH domains showed no aberrant patterns. The total open reading frame of the FMR1 gene was cloned and sequenced, but no mutation was found. Northern blot analysis showed mRNA in the normal size-range, and immunocytochemistry on individual lymphocytes indicated that FMRP, the protein product of FMR1, was present. In conclusion, it is unlikely that FMR1 plays a role in the phenotype of this patient. Other genes may be responsible for the combination of mental retardation and macroorchidism.