A 46-year-old woman complained of a 10-year history of headache, nausea, a precordial oppressive feeling and shortness of breath on miction. She had noted a marked elevation in her blood pressure after miction using home blood pressure measurement. Her catecholamine levels were less than twice the value of the normal upper limit. Several imaging modalities detected a urinary bladder tumor, and 123I-metaiodobenzylguanidine scintigraphy showed positive accumulation. The diagnosis of urinary bladder paraganglioma was confirmed by partial cystectomy. We must keep in mind that paroxysms and hypertension associated with miction are important diagnostic clues of pheochromocytoma/paraganglioma. Home blood pressure measurement was very useful for detecting hypertension in this case.

OBJECTIVES This study sought to investigate the relationship between multiple plaque ruptures, C-reactive protein (CRP), and clinical prognosis in acute myocardial infarction (AMI). BACKGROUND Several studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients. Recent studies have reported that a ruptured plaque at the culprit lesion is associated with elevated CRP, which indicates a poor prognosis in patients with ACS. METHODS We performed intravascular ultrasound in 45 infarct-related arteries and another 84 major coronary arteries in 45 first AMI patients. RESULTS Plaque rupture was observed in 21 patients (47%) at the culprit site. Intravascular ultrasound revealed 17 additional plaque ruptures at remote sites in 11 patients (24%). Patients with multiple risk factors were more frequently found in our multiple-plaque rupture patients compared with single-plaque rupture or nonrupture patients (82% vs. 40% vs. 29%, p 0.01). High-sensitive CRP levels had a positive correlation with the number of plaque ruptures (p 0.01). All culprit lesions were successfully treated by percutaneous coronary intervention. Patients with multiple plaque rupture showed significantly poor prognosis compared with others (p 0.01). CONCLUSIONS Multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Our results suggest that AMI treatment should focus not only on stabilization of the culprit site but also a systemic approach to systemic stabilization of the arteries. (J Am Coll Cardiol 2005;45:1594–9) ublished by Elsevier Inc. doi:10.1016/j.jacc.2005.01.053

The change in temperature coefficient of the threshold voltage (=dVth/dT) for poly-Si/TiN/high-k gate insulator metal–oxide–semiconductor field-effect transistors (MOSFETs) was systematically investigated with respect to various TiN thicknesses for both n- and p-channel MOSFETs. With increasing TiN thickness, dVth/dT shifts towards negative values for both n- and p-MOSFETs. A mechanism that changes dVth/dT, depending on TiN thickness is proposed. The main origins are the work function of TiN (ΦTiN) and its temperature coefficient (dΦTiN/dT). These are revealed to change when decreasing the thickness of the TiN layer, because the crystallinity of the TiN layer is degraded for thinner films, which was confirmed by ultraviolet photoelectron spectroscopy (UPS), transmission electron microscopy (TEM) and X-ray diffraction (XRD).

We show the systematical investigation results of the effects of the implanted ion dose of P or As under various solid-phase epitaxy (SPE) conditions on the local stress in channel regions in metal-oxide-semiconductor field-effect transistor (MOSFET) structures, and on sheet resistance and strain in carbon-doped source/drain (Si:C-S/D) layers. P or As substitution is in conflict with C substitution in Si: C layers during SPE. Furthermore, the amount of P incorporated instead of C into the Si lattice site is larger than that of As incorporated instead of C. Therefore, low-resistivity Si: C layers with low stress in the case of using P and high-resistivity Si:C layers with high stress in the case of using As are formed by single-step C7Hx implantation with rapid thermal annealing and nonmelt laser annealing, respectively. As a countermeasure, we demonstrate that cascade C7Hx implantation to control the C profiles in Si: C layers is effective for achieving high-strain channels and low-resistivity Si: C-S/D layers. Control of C profiles is a key technology for state-of-the-art complementary MOS devices with Si:C-S/D. (C) 2015 The Japan Society of Applied Physics

Introduction: Idiopathic premature ventricular contractions (PVCs) mainly have an outflow tract origin. The PVC originating from posteroseptum (PS) is very uncommon. Results: We describe the case of a 64-year-old woman with a 6-month history of palpitation and dizziness with premature ventricular contraction (PVC) was refractory to treatment with beta-blockers and calcium channel blockers drugs. Transthoracic echocardiography showed mild left ventricular hypertrophy. The PVC beat had morphology of left bundle branch block with superior axis. The duration of the QRS complex PVC was 120 msec. The QRS complex had QS pattern in lead V1, R pattern in lead I and aVL, and an early precordial R/S transition between V1 and V2. Mapping at the site between tricuspid annulus (TV) and coronary sinus ostium (CSo) showed an early local activation at −22 msec and a QS pattern on unipolar lead. Pace mapping at this site showed perfect pace mapping. Radiofrequency (RF) catheter ablation was performed at this site during sinus rhythm. RF energy was delivered with maximum power of 30 W and maximum temperature of 55 degrees. PVC disappeared by a single RF application for a few seconds. PVC was not inducible with ventricular burst pacing and isoproterenol infusion. During 10-month follow-up, PVC was not documented. Conclusions: We report a case with PVC arising from PS and were successfully treated with RF.

The temperature coefficient of V th (=d V th/d T), which is commonly utilized for circuit design, was systematically obtained against various TiN and capping layer thicknesses in high-k/metal gate field-effect transistors (FETs). It is known that the magnitude of |d V th/d T| for such FETs is larger than that of polycrystalline silicon (poly-Si) gate FETs. The origins of the d V th/d T difference among high-k/metal gate FETs were attributed to differences in the temperature coefficient of flat band voltage (=d V FB/d T) and the equivalent gate oxide thickness (EOT). Thicker TiN layers reduced d V FB/d T, which enlarged the magnitude of |d V th/d T|. The EOT increased as the TiN metal layer or Al2O3 capping layer increased in thickness. The large EOT led to an increase in |d V th/d T|, since d V th/d T is a function of the inverse of gate capacitance. In contrast, La2O3 capping hardly affected d V th/d T. This is because La2O3 capping did not affect EOT differently from Al2O3 capping. The relationship between d V th/d T and EOT implies that EOT scaling relieves the issue of large |d V th/d T| for high-k/metal gate FETs.

Background: The aim of this study was to evaluate the diagnostic potential of coronary flow velocity reserve (CFR) measurement by transthoracic Doppler echocardiography (TTDE) to detect restenosis in the 3 major coronary arteries: the left anterior descending coronary artery, right coronary artery, and left circumflex coronary artery.Methods: The lesions of 175 patients who were scheduled for follow-up coronary angiography and TTDE 6 months after undergoing stents implantation were studied. CFR was assessed by TTDE in the targeted arteries into which stents had been implanted.Results: Coronary stents were implanted in a total of 238 angiographic lesions in 175 patients. Doppler recordings of coronary flow in the 3 major arterial lesions were obtained in 211 of the 238 angiographic lesions (89% feasibility). CFR was significantly lower in lesions with restenosis than those without restenosis (1.70 +/- 0.32 vs 2.65 +/- 0.66, P < .01). A CFR value < 2.0 was 89% sensitive and 91% specific for detecting restenosis in the 3 major coronary arteries. Sensitivity and specificity were 86% and 91%, respectively, in the left anterior descending coronary artery (95% feasibility); 92% and 92%, respectively, in the right coronary artery (85% feasibility); and 91% and 92%, respectively, in the left circumflex coronary artery (81% feasibility).Conclusion: CFR assessment by TTDE is an accurate method for monitoring restenosis, not only in the left anterior descending but also in the right and left circumflex coronary arteries in patients previously subjected to percutaneous coronary intervention. (J Am Soc Echocardiogr 2010; 23: 553-559.)

Left ventricular (LV) ejection fraction (EF) was known as a conventional predictor of heart failure (HF). However, early transmitral flow velocity (E)/early diastolic velocity of mitral annulus (E') correlated well with LV end-diastolic pressure, and E/E' ratio > 15 was an excellent predictor of adverse outcomes in patients with HF. This study was designed to determine the prognostic value of a new combined index, E/E' ratio and LVEF, in patients with HF. One hundred twenty-six consecutive patients hospitalized with HF underwent comprehensive echocardiographic-Doppler study when ready for discharge. Patients were divided into the 4 groups of group I (LVEF >40% and E/E' ratio < 15), group 11 (EF >40% and E/E' ratio >= 15), group III (EF <= 40% and E/E' ratio < 15), and group IV (EF >= 40% and E/E' ratio >= 15). The ability of this index to determine the primary end point (rehospitalization for HF or cardiac death) was assessed. Patients with significant valvular disease were excluded. Of 126 patients, 110 met the inclusion criteria. Follow-up was complete for 108 of 110 patients at 351 +/- 252 days after discharge. There were 27, 30, 21, and 30 patients in groups I, II, III, and IV, respectively. There were 52 patients with the primary end point. On univariate analysis, E/E' ratio, group IV, E', and age were significant predictors. In multivariable analysis, the most powerful independent prognostic indicator of events was group IV (hazard ratio 12.6, 95% confidence interval 2.2 to 74.2, p = 0.005). In conclusion, a new index, a combination of LVEF and E/E' ratio, allowed the identification of patients at higher risk of readmission and cardiac death in patients with HF. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;103:1275-1279)

We have investigated the characteristics of silicon oxide films deposited by plasma-enhanced atomic layer deposition (PEALD) and plasma-enhanced chemical vapor deposition (PECVD) as offset spacer films of high- k /metal gate stacks. From the results of bonding structure analysis, the silicon oxide film deposited by PEALD has been found to be composed of a Si–O bond network of the stoichiometric silicon oxide film. On the other hand, the silicon oxide film deposited by PECVD is considered to contain suboxide bond structures. From the results of physical and mechanical evaluations, the silicon oxide film deposited by PEALD exhibits a lower wet etch rate, a higher film density, a lower dielectric constant, a smaller amount of water in the film, and a higher elastic modulus than that deposited by PECVD. PEALD showed excellent thickness controllability. From these results, the silicon oxide film deposited by PEALD has higher quality and is more suitable for use as an offset spacer than that deposited by PECVD. X-ray photoelectron spectroscopy showed that the surface oxidation of a titanium nitride film, which is used as a metal gate electrode, during PEALD can be suppressed by using a lower PEALD temperature. Finally, we have demonstrated that the drain current of a high- k /metal gate transistor with a silicon oxide offset spacer deposited by PEALD is markedly increased, compared with that with a high-temperature-deposited silicon oxide offset spacer.

New materials often force modification in a metal–oxide–semiconductor field-effect transistor (MOSFET) fabrication process and a device structure. In our investigation, a high-stress silicon nitride (SiN) contact etch stopper layer (CESL), which improves device performance by straining the Si lattice, was used as the modified structure. A portion of its gate surround was cut to fabricate a fully silicided (FUSI) metal gate. FET characteristics of a polycrystalline silicon (poly-Si) gate and a Ni-FUSI gate MOSFET with a discontinuous CESL were compared with those of a poly-Si gate MOSFET with an ordinary continuous CESL for several SiN-stress conditions. It was found that the removal of a gate-top CESL diminishes mobility modulation effects of a high-stress CESL. It was also demonstrated that stress due to a FUSI gate compensates the effect of gate-top CESL removal. Mobility enhancement utilizing a high-stress SiN film was still effective for a FUSI gate process.

AIMS:In this study, we investigated the relationship between longitudinal morphology reconstructed from pre-intervention intravascular ultrasound (IVUS) images and thrombolysis in myocardial infarction (TIMI) flow grade at initial angiograms in the acute phase of acute coronary syndrome (ACS).METHODS AND RESULTS:Our patient population comprised 72 ACS patients in whom we obtained successful reconstructed longitudinal images. On the basis of the site of the maximum aperture of rupture in the longitudinally reconstructed IVUS images, patients were divided into three groups: plaques with rupture in the proximal shoulder (proximal type; n = 28), mid-portion (mid-type; n = 18), and distal shoulder (distal type; n = 26) of the plaque. There were no differences in terms of coronary risk factors or the angiographic findings. The proximal-type group more frequently showed TIMI 0 on initial angiogram (proximal type, 86%; mid-type, 50%; and distal type, 31%; P = 0.002). A multivariable logistic regression model revealed that the presence of a proximal-type rupture correlated with the presentation of ST-elevation myocardial infarction (P = 0.019; odds ratio, 8.12; 95% CI, 1.404-49.996).CONCLUSIONS:Longitudinal morphological features in a ruptured plaque may affect the formation of obstructive thrombus in ACS. Our results suggest that longitudinal morphology may be an important determinant of coronary artery occlusion.

The significance of controlling threshold voltage using nitrogen molecule ion (N-2(+)) implantation into a silicon substrate was demonstrated for an n-channel MOS with a nickel fully silicided gate electrode and a high-k gate dielectric. We have clarified the idea that a small part of the implanted nitrogen was activated and acted as a counter dope for a channel by secondary ion mass spectrometry analysis, spreading resistance analysis, and inverse modeling analysis of MOS capacitance-voltage characteristics. It was found that N-2(+) implantation had an advantage over N+ implantation for forming a shallow counter-dope layer because the nitrogen-nitrogen pair has large diffusion coefficient, which resulted in a steep profile of nitrogen in a substrate.

Control of threshold voltage (Vth) is a common and serious problem for realizing scalable LSIs with either nitrogen rich SiON, high-k gate dielectrics, or metal gates. In this paper, we demonstrate the improvement of HfSiON pMISFETs characteristics with the F incorporation technique, which may prove to be a powerful tool for lowering |Vth| in pMISFET with both poly-Si and metal gates. Using F implantation in the channel region prior to HfSiON formation, |Vth| lowering up to ~200mV is obtained without mobility degradation. In the same manner as the F incorporation technique, N incorporation is useful for reducing Vth value in nMISFETs. Furthermore, the impact of F incorporation in HfSiON is investigated in terms of reliability. From a comparison of the F incorporation effect on SiON and HfSiON gate dielectrics, we have proposed a model for the F passivation of defects in both HfSiON and the HfSiON/Si interface.

We demonstrated the use of an in situ metal/high-k fabrication method for improving the performance of metal-insulator-semiconductor field-effect transistors (MISFETs). Gate-first pMISFETs with polycrystalline silicon (poly-Si)/TiN/HfSiON stacks were fabricated by techniques based on low-damage physical vapor deposition, in which high-quality HfSiON dielectrics were formed by the interface reaction between an ultrathin metal-Hf layer (0.5 nm thick) and a SiO2 underlayer, and TiN electrodes were continuously deposited on the gate dielectrics without exposure to air. Gate-first pMISFETs with high carrier mobility and a low threshold voltage (V-th) were realized by reducing the carbon impurity in the gate stacks and improving the V-th stability against thermal treatment. As a result, we obtained superior current drivability (I-on = 350 mu A/mu m at I-off = 200pA/mu m), which corresponds to a 13% improvement over that of conventional chemical vapor deposition-based metal/high-k devices.