Bright, balanced white‐light electroluminescence has been achieved from a single active oligothiophene compound. White light is created by the superposition of a broad blue–green‐light emission ...originating from the single molecule and a red‐shifted narrow peak due to dimer formation. These results open the way to the fabrication of novel, low‐cost white‐light‐emitting devices with a single molecular material as the active compound.
Purpose We describe the presentation, endovascular management and functional outcomes of 15 patients with renal arterial pseudoaneurysm following open and laparoscopic partial nephrectomy. Materials ...and Methods An institutional review board approved, Health Insurance Portability and Accountability Act compliant retrospective review of a prospectively maintained database revealed that 7 of 1,160 patients who underwent open partial nephrectomy and 8 of 301 treated with laparoscopic partial nephrectomy were diagnosed with a pseudoaneurysm of a renal artery branch between 2003 and 2010. Some cases were associated with arteriovenous fistula. Results Diagnosis of pseudoaneurysm was made a median of 14 days after surgery. Gross hematuria was the most frequent symptom. Median estimated glomerular filtration rate measurements at the preoperative evaluation, postoperatively, on the day the vascular lesion was diagnosed, after embolization and at the last followup were 62, 55, 55, 56 and 58 ml/minute/1.73 m2 , respectively. Median followup was 7.8 months. All patients underwent angiography and superselective coil embolization of 1 or more pseudoaneurysms with or without arteriovenous fistula. Eleven patients had immediate cessation of symptoms while 4 had persistent gross hematuria after the procedure. Of these 4 patients 2 were treated with bedside care, 1 required repeat embolization with thrombin, which was successful, and the remaining patient had coagulopathy and underwent radical nephrectomy for persistent bleeding. Conclusions Pseudoaneurysms and arteriovenous fistulas of the renal artery are rare complications of partial nephrectomy. Presentation is often delayed. Superselective coil embolization is a safe, minimally invasive treatment option that usually solves the clinical problem and preserves renal function.
A new organic multifunctional material, a rigid core thiophene oligomer, has been designed and synthesized. In both solution‐processed and vacuum‐sublimed films, the delicate balance of forces needed ...to obtain a supramolecular organization that imparts good charge transport and electroluminescence has been achieved, with the films being successfully employed as active layers in organic light‐emitting (field‐effect) transistors (see Figure).
Light‐induced generation of charges into an electron acceptor–donor phase‐segregated blend is studied. The blend is made of highly ordered nanoscopic crystals of ...3″‐methyl‐4″‐hexyl‐2,2′:5′,2″:5″,2‴:5‴,2″″‐quinquethiophene‐1″,1″‐dioxide embedded into a regioregular poly(3‐hexylthiophene) matrix, acting as acceptor and donor materials, respectively. Kelvin probe force microscopy investigations reveal a tendency for the acceptor nanocrystals to capture the generated electrons whereas the donor matrix becomes more positively charged. The presence of particular positively charged defects, i.e., nanocrystals, is also observed within the film. The charging and discharging of both materials is studied in real time, as well as the effect of different acceptor–donor ratios. Upon prolonged thermal annealing at high temperatures the chemical structure of the blend is altered, leading to the disappearance of charge separation upon light irradiation. The obtained results allow a better understanding of the correlation between the nanoscopic structure of the photoactive material and solar‐cell performance.
A thiophene oligomer self‐organizes into ordered nanocrystals, embedded in an amorphous polythiophene matrix. Under light, charge generation is observed with electrons accumulating in the nanocrystals and holes accumulating in the matrix, as monitored in real‐time by Kelvin probe force microscopy (see figure).
Upper tract urothelial carcinoma (UTUC) is a rare and aggressive disease that is associated with high rates of recurrence and death. Radical nephroureterectomy (RNU) with excision of the bladder cuff ...is considered the standard of care for high-risk UTUC, whereas kidney-sparing techniques can be indicated for select patients with low-risk disease. There is a significant lack of clinical and pathological prognostic factors for stratifying patients with regard to making treatment decisions. Incorporation of tissue-based molecular markers into prognostic tools could help accurately stratify patients for clinical decision-making in this heterogeneous disease. Although the number of studies on tissue-based markers in UTUC has risen dramatically in the past several years—many of which are based on single centers and small cohorts, with a low level of evidence—many discrepancies remain between their results. Nevertheless, certain biomarkers are promising tools, necessitating prospective multi-institution studies to validate their function.
Study Type – Therapy (case series)
Level of Evidence 4
What’s known on the subject? and What does the study add?
Usually malignant disease involving the kidneys is characterized by bilateral and ...multiple lesions in association with widespread dissemination of the primary tumour. Metastasis to the kidney as a solitary, isolated renal mass is an extremely rare event and little is known about its characteristics and outcomes.
Our study shows that kidney involvement by other tumours can occur as isolated solitary lesions and the kidney can be the first and only site of metastatic involvement. Of the 14 patients included in the study, 8 were alive at the last follow‐up and 4 without evidence of disease after nephrectomy. In this highly selected group of patients nephrectomy can be offered as a therapeutic option.
OBJECTIVE
• To analyse the clinical characteristics and outcomes of patients who underwent nephrectomy for solitary, isolated metastatic disease to the kidney.
PATIENTS AND METHODS
• From July 1989 to July 2009, we identified 13 patients who underwent nephrectomy for solitary metastasis to the kidney. Patients’ demographics, intra‐operative variables and outcomes are reported.
RESULTS
• The median age at nephrectomy was 52 years (range 33–79). Eleven patients (85%) had an incidentally discovered renal mass, whereas two patients (15%) presented with gross haematuria.
• Median time from initial surgery at the primary site to development of metastatic disease to the kidney was 63 months (range 9–136). No patient had evidence of disease at other sites at the time of nephrectomy. In seven patients (54%), the kidney was the first site of recurrence.
• The most common primary site was the lung in five patients (38%), followed by the colon in two (15%), chest wall in two (15%) and bone, brain, breast and salivary gland in one patient each (8%).
• Of the 14 procedures performed, eight (57%) were partial nephrectomy (PN) and six (43%) were radical nephrectomy (RN).
• Four patients died after progression from the primary tumour, all within 2 years of nephrectomy. One patient with a primary chondrosarcoma had no evidence of disease at last follow‐up and died from other causes 50 months after nephrectomy. The median follow‐up for the eight patients who were alive at last follow‐up was 30 months after nephrectomy. Four of these patients had no evidence of disease and four patients were alive with metastatic disease.
CONCLUSION
• Kidney involvement by metastatic disease can occur as isolated solitary lesions. Some patients will also have the kidney as the first and only site of metastatic involvement. The presence of an isolated renal metastasis should not be considered an end‐stage disease, and nephrectomy can be offered for highly selected patients as a therapeutic option.
Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b
What’s known on the subject? and What does the study add?
Improved patient selection for conservative management, neoadjuvant ...chemotherapy, and/or extended lymphadenectomy is urgently needed. We developed a highly accurate preoperative model to predict muscle‐invasive and non‐organ‐confined upper tract urothelial carcinoma based on standard imaging and ureteroscopy features.
OBJECTIVE
• To create a preoperative multivariable model to identify patients at risk of muscle‐invasive (pT2+) upper tract urothelial carcinoma (UTUC) and/or non‐organ confined (pT3+ or N+) UTUC (NOC‐UTUC) who potentially could benefit from radical nephroureterectomy (RNU), neoadjuvant chemotherapy and/or an extended lymph node dissection.
PATIENTS AND METHODS
• We retrospectively analysed data from 324 consecutive patients treated with RNU between 1995 and 2008 at a tertiary cancer centre.
• Patients with muscle‐invasive bladder cancer were excluded, resulting in 274 patients for analysis.
• Logistic regression models were used to predict pT2+ and NOC‐UTUC. Pre‐specified predictors included local invasion (i.e. parenchymal, renal sinus fat, or periureteric) on imaging, hydronephrosis on imaging, high‐grade tumours on ureteroscopy, and tumour location on ureteroscopy.
• Predictive accuracy was measured by the area under the curve (AUC).
RESULTS
• The median follow‐up for patients without disease recurrence or death was 4.2 years.
• Overall, 49% of the patients had pT2+, and 30% had NOC‐UTUC at the time of RNU.
• In the multivariable analysis, only local invasion on imaging and ureteroscopy high grade were significantly associated with pathological stage.
• AUC to predict pT2+ and NOC‐UTUC were 0.71 and 0.70, respectively.
CONCLUSIONS
• We designed a preoperative prediction model for pT2+ and NOC‐UTUC, based on readily available imaging and ureteroscopic grade.
• Further research is needed to determine whether use of this prediction model to select patients for conservative management vs RNU, neoadjuvant chemotherapy, and/or extended lymphadenectomy will improve patient outcomes.
Abstract Background The prognostic impact of primary tumor location on outcomes for patients with upper-tract urothelial carcinoma (UTUC) is still contentious. Objective To test the association ...between tumor location and disease recurrence and cancer-specific survival (CSS) in patients treated with radical nephroureterectomy (RNU) for UTUC. Design, setting, and participants Prospectively collected data were retrospectively reviewed from 324 consecutive patients treated with RNU between 1995 and 2008 at a single tertiary referral center. Patients who had previous radical cystectomy, preoperative chemotherapy, previous contralateral UTUC, or metastatic disease at presentation were excluded. This left 253 patients for analysis. Tumor location was categorized as renal pelvis or ureter based on the location of the dominant tumor. Recurrences in the bladder only, in nonbladder sites, and in any site were analyzed. Intervention All patients were treated with RNU. Measurements Recurrence-free survival and CSS probabilities were estimated using Kaplan-Meier and Cox regression analyses. Results and limitations Median follow-up for survivors was 48 mo. The 5-yr recurrence-free probability (including bladder recurrence) and CSS estimates were 32% and 78%, respectively. On multivariable analysis, pathologic stage was the only predictor for disease recurrence ( p = 0.01). Tumor location was not an independent predictor for recurrence (hazard ratio: 1.19; p = 0.3), and there was no difference in the probability of disease recurrence between ureteral and renal pelvic tumors ( p = 0.18). On survival analysis, we also found no differences between ureteral and renal pelvic tumors on probability of CSS ( p = 0.2). On multivariate analysis, pathologic stage ( p < 0.0001) and nodal status ( p = 0.01) were associated with worse CSS. This study is limited by its retrospective nature. Conclusions Our study did not show any differences in recurrence and CSS rates between patients with ureteral and renal pelvic tumors treated with RNU.
Abstract Background Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as ...a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. Objective Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. Design, setting, and participants We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN ( n = 109) or LRN ( n = 53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. Intervention All patients underwent RN. Measurements Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. Results and limitations Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p = 0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio HR: 0.88 for LRN vs ORN; 95% confidence interval CI, 0.57–1.38; p = 0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46–1.34; p = 0.4) or disease-specific mortality ( p = 0.9). This study is limited by its retrospective nature. Conclusions Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.
The synthesis via the Stille coupling of a new family of oligomers derived from benzobthiophene is reported. Owing to their branched molecular structure lacking any symmetry element, these compounds ...display a low tendency to crystallization and better film‐forming properties than their linear counterparts. Spin‐coated films show photoluminescence efficiencies up to 50 %. Light‐emitting diodes with spin‐coated films as the active layers display markedly improved performance with respect to similar devices based on linear oligothiophenes, with luminance values up to more than 10 000 cd m–2. Semiempirical PM3 and ZINDO/S calculations provide insight into the molecular geometries and electron distribution of the frontier orbitals of the new compounds. Cyclic voltammetry data indicates that the transformation of the thienyl sulfur of benzobthiophene to the corresponding thienyl‐S,S‐dioxide leads an increase in electron affinity by 0.5–0.7 V, analogous to that of the corresponding linear oligomers.
The synthesis via the Stille coupling of new branched oligothiophenes (e.g., see the calculated geometry and electron density of the highest occupied molecular orbital model in Figure) with excellent film‐forming properties is reported. Light‐emitting diodes with spin‐coated films as the active layers display markedly improved performance with respect to similar devices based on linear oligothiophenes.
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