Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis

BACKGROUND

Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, in this study, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry.

METHODS

Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (1-2) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm [2]; C2, ≥ 10 and < 15 cm [2]; and C3: ≥ 15 cm [2]. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model.

RESULTS

Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160-8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor.

CONCLUSIONS

The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.

Luminescent Lanthanide Complexes for Effective Oxygen-Sensing and Singlet Oxygen Generation

Invited for this month's cover is the collaborating groups of Yuichi Kitagawa, Yasuchika Hasegawa, and co-workers at the Hokkaido University. The cover picture shows triplet-oxygen sensing and singlet-oxygen generation using lanthanide complexes. Organic ligands play crucial roles in lanthanide complexes as light-harvesting antennas for lanthanide luminescence and singlet-oxygen generation. More information can be found in the Review by Y. Kitagawa, Y. Hasegawa, and co-workers.

Synthesis of Bicyclo[1.1.1]pentane (BCP)-Based Straight-Shaped Diphosphine Ligands

[1.1.1]Propellane, which is structurally simple and compact, exhibits promising potential for the synthesis of disubstituted straight-shaped bicyclo[1.1.1]pentane (BCP) compounds by manipulation of its highly reactive internal C-C bond. BCPs are considered to be isosteres of 1,4-disubstituted benzenes, which have found broad applications in the areas of functional molecules and drug discovery. The internal C-C single bond of [1.1.1]propellane is regarded as a charge-shift bond, which can be readily cleaved by radical means to construct BCPs. We herein report a novel synthetic method for (un)symmetric diphosphines based on the BCP motif, which can be interpreted as isosteres of 1,4-bis(diphenylphosphino)benzenes. The obtained BCP-diphosphine derivatives were used to generate a straight-shaped Au complex and an Eu-based coordination polymer.

Luminescent Lanthanide Complexes for Effective Oxygen-Sensing and Singlet Oxygen Generation

Oxygen quantification using luminescence has attracted considerable attention in various fields, including environmental monitoring and clinical analysis. Among the reported luminophores, trivalent lanthanide complexes have displayed characteristic narrow emission bands with high brightness. This bright emission is based on photo-sensitized energy transfer via organic triplet states. The organic triplet states in lanthanide complexes effectively react with the triplet oxygen, enabling oxygen quantification by lanthanide luminescence. Some Tb^III and Eu^III complexes with slow deactivation processes have also formed the excited state equilibrium, thus resulting in the emission-lifetime based oxygen sensing property. The combination of Tb^III /Eu^III emission, Eu^III /Sm^III emission, Eu^III /ligand phosphorescence, and ligand fluorescence/ligand phosphorescence provide the ratiometric oxygen-sensing properties. Moreover, the reaction generates singlet oxygen species which exhibit numerous applications in the photo-medical field. The ligands with large π-conjugated aromatic systems, such as porphyrin, phthalocyanine, and polyaromatic compounds, induces highly efficient oxygen generation. The combination of effective luminescence with singlet-oxygen generation by the lanthanide complexes render them suitable for photo-driven theranostics. This review summarizes the research progress of lanthanide complexes with efficient oxygen-sensing and singlet-oxygen generation properties.

Enhanced circularly polarized luminescence of chiral Eu(III) coordination polymers with structural strain

Three types of Eu(III) coordination polymers with different distorted chiral ligands, [Eu(+tfc)₃(p-dpeb)]_n, [Eu(+pfc)₃(p-dpeb)]_n, and [Eu(+hfc)₃(p-dpeb)]_n (+tfc: (+)-3-(trifluoroacetyl)camphorate, +pfc: (+)-3-(pentafluoropropionyl)camphorate, +hfc: (+)-3-(heptafluorobutyryl)camphorate, p-dpeb: 1,4-bis(diphenylphosphorylethynyl)benzene), were prepared for elucidating the relationship between their structural distortions, ligand-to-metal charge transfer (LMCT), and circularly polarized luminescence (CPL) properties. Their strain factors in the ligands were evaluated using crystallographic data obtained by single-crystal X-ray structural analyses. The characteristics of the LMCT excited states were estimated from theoretical calculations. The introduction of a bulky substituent into the chiral ligand afforded a distorted structure of β-diketonates and changed the direction of the transition electric dipole moments, which are related to the magnitude of the CPL intensity. The CPL dissymmetry factor (g_CPL) of [Eu(+hfc)₃(p-dpeb)]_n, with a large distorted structure, was -0.22, while those of [Eu(+tfc)₃(p-dpeb)]_n and [Eu(+pfc)₃(p-dpeb)]_n, with small distorted structures, were -0.05 and -0.10, respectively. The controlled steric hindrance of the chiral ligands in Eu(III) coordination polymers is one of the strain factors enhancing their CPL properties.

Characteristic stacked structures and luminescent properties of dinuclear lanthanide complexes with pyrene units

A novel design strategy of stacked organic fluorophores using dinuclear lanthanide (Ln(III)) complexes is demonstrated for the formation of excimer. The dinuclear Ln(III) complexes are composed of two Ln(III) (Eu(III) or Gd(III)) ions, six hexafluoroacetylacetonate (hfa), and two pyrene-based phosphine oxide ligands. Single-crystal analysis revealed a rigid pyrene-stacked structure via CH-F (pyrene/hfa) intramolecular interactions. The rigid aggregation structures of the two-typed organic ligands around Ln(III) resulted in high thermal stability (decomposition temperature: 340°C). The aggregated ligands exhibited excimer-type green emission from the stacked pyrene-center. The change in the Ln(III) ion promotes effective shifts of excimer emissions (Gd(III):500 nm, Eu(III):490 nm). The organic aggregation system using red-luminescent Eu(III) also provides temperature-sensitive ratiometric emission composed of π-π* and 4f-4f transitions by energy migration between aggregated ligands and Eu(III).

Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer

The present study aimed to analyze the effect of predisposing clinical factors for severe erectile dysfunction (ED) in patients treated with focal therapy using high-intensity focused ultrasound (HIFU) for localized prostate cancer (PC). Patients without severe ED (International Index of Erectile Function-5 [IIEF-5] score ≥ 8) before focal HIFU therapy were included. A total of 92 of the 240 patients met the inclusion criteria and were included. The rate of severe ED (IIEF-5 ≤ 7) was 36% 12 months after treatment. Multivariable logistic regression analysis showed that the pre-procedural lower IIEF-5 score (odds ratio [OR] 0.812, p = 0.005), the pre-procedural lower score of the sexual domain of the Expanded Prostate Cancer Index Composite (OR 0.960, p = 0.038), and the treatment of the edge of the peripheral zone (PZ) in proximity to the neurovascular bundle (NVB) [treated vs. untreated, OR 8.048, p = 0.028] were significant risk factors for severe ED at 12 months after treatment. In conclusion, pre-procedural lower erectile function and treatment of the part in proximity to the NVB were significant risk factors for severe ED after focal therapy.

Plant growth acceleration using a transparent Eu3+-painted UV-to-red conversion film

The stimulation of photosynthesis is a strategy for achieving sustainable plant production. Red light is useful for plant growth because it is absorbed by chlorophyll pigments, which initiate natural photosynthetic processes. Ultraviolet (UV)-to-red wavelength-converting materials are promising candidates for eco-friendly plant cultures that do not require electric power. In this study, transparent films equipped with a UV-to-red wavelength-converting luminophore, the Eu3+ complex, were prepared on commercially available plastic films for plant growth experiments. The present Eu3+-based films absorb UV light and exhibit strong red luminescence under sunlight. Eu3+-painted films provide significant growth acceleration with size increment and biomass production for vegetal crops and trees in a northern region. The plants cultured with Eu3+-painted films had a 1.2-fold height and 1.4-fold total body biomass than those cultures without the Eu3+ luminophores. The present film can promote the plant production in fields of agriculture and forestry.

Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society

BACKGROUND

Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa.

METHODS

A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold.

RESULTS

Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority.

CONCLUSIONS

The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.

Effective Photosensitization in Excited-State Equilibrium: Brilliant Luminescence of TbIII Coordination Polymers Through Ancillary Ligand Modifications

Invited for this month's cover are the collaborating groups of Yuichi Kitagawa, Yasuchika Hasegawa, Tetsuya Taketsugu, and co-workers at Hokkaido University. The cover picture shows a photosensitizer that has a long excited-state lifetime and provides strong emissions for TbIII coordination polymers. The photosensitization ability can be considerably altered by changing the ancillary ligands in the TbIII coordination polymers. The results provide new insights on the design of photosensitizers for improving the properties of photo-functional materials. More information can be found in the Research Article by Y. Kitagawa, Y. Hasegawa, and co-workers.

Comparing the toxicity and disease control rate of radiotherapy for prostate cancer between salvage settings after high-intensity focused ultrasound therapy and initial settings

The purpose of this retrospective study was to compare the toxicity and disease control rate of radiotherapy for prostate cancer in salvage settings after high-intensity focused ultrasound (HIFU) therapy (HIFU cohort) with those in radical settings (non-HIFU cohort). From 2012 to 2020, 215 patients were identified for this study and 17 were treated in the salvage settings after HIFU. The median follow-up time was 34.5 months (range: 7-102 months, inter-quartile range [IQR]: 16-64 months). Genitourinary (GU) and gastrointestinal (GI) adverse events were evaluated in acute and late periods with Common Terminology Criteria for Adverse Events version 5, and the rates of biochemical-clinical failure free survival (BCFS) and overall survival (OS) were estimated. The cumulative incidence of late GU Grade 2 or greater toxicity after five years was significantly different between the non-HIFU and HIFU cohorts with rates of 7.3% and 26.2%, respectively (P = 0.03). Regarding GI Grade 2 or greater toxicity, there was no significant difference between the two cohorts. The 5y-BCFS was 84.2% in the non-HIFU cohort and 69.5% in the HIFU cohort with no significant difference (P = 0.10) and the 5y-OS was 95.9% and 92.3%, respectively (P = 0.47). We concluded that the possibility of increased late GU Grade 2 or greater should be considered when applying salvage radiotherapy for local recurrence after HIFU.

Effective Photosensitization in Excited-State Equilibrium: Brilliant Luminescence of TbIII Coordination Polymers Through Ancillary Ligand Modifications

Molecular photosensitizers provide efficient light-absorbing abilities for photo-functional materials. Herein, effective photosensitization in excited-state equilibrium is demonstrated using five Tb^III coordination polymers. The coordination polymers are composed of Tb^III ions (emission center), hexafluoroacetylacetonato (photosensitizer ligands), and phosphine oxide-based bridges (ancillary ligands). The two types of ligand combinations induces a rigid coordination structure via intermolecular interactions, resulting in high thermal stability (with decomposition temperatures above 300 °C). Excited-triplet-state lifetimes of photosensitizer ligands (τ=120-1320 μs) are strongly dependent on the structure of the ancillary ligands. The photosensitizer with a long excited-triplet-state lifetime (τ≥1120 μs) controls the excited state equilibrium between the photosensitizer and Tb^III , allowing the construction of Tb^III coordination polymer with high Tb^III emission quantum yield (≥70 %).

Impact of stone volume on treatment outcomes of percutaneous nephrolithotripsy

PURPOSE

We aimed to evaluate the impact of stone volume on the surgical outcomes of patients who underwent percutaneous nephrolithotripsy, which is the preferred treatment for renal and upper ureteral stones.

MATERIALS AND METHODS

This retrospective study included 37 patients who underwent percutaneous lithotripsy between 2013 and 2019. Preoperative and postoperative stone volumes were quantified using computed tomography scan data.

RESULTS

The mean preoperative and postoperative stone volumes were 10.7 cm³ (1.1-50.2 cm³ ) and 2.1 cm³ (0-18.2 cm³ ), respectively. The correlation coefficient between the stone volume and maximum stone length was 0.62 (P < .01). A residual stone volume of >5 mm was observed in 17 cases (45.9%). Thirteen cases underwent secondary treatment (35.1%) who had a preoperative stone volume of >15 cm³ or a postoperative stone volume of <2 cm³ . The areas under the curve for the stone volume for treatment success and the requirement for secondary treatment were 0.701 and 0.739, respectively, and were higher than those of stone length (0.638 and 0.558) and shape (0.644 and 0.641).

CONCLUSIONS

Measurement of stone volume using three-dimensional imaging is simple and greatly impacted the course of stone treatment. Information on stone volume may predict an increased likelihood of secondary treatment in patients with a preoperative stone volume of >15 cm³ .

Asymmetric Lumino-Transformer: Circularly Polarized Luminescence of Chiral Eu(III) Coordination Polymer with Phase-Transition Behavior

A chiral Eu(III) coordination polymer with phase-transition behavior, [Eu(+tfc)₃(m-dpeb)]_n, (+tfc: (+)-3-trifluoroacetylcamphorato, m-dpeb: 1,3-bis(diphenylphosphorylethynyl)benzene) was reported for understanding the effect of polymer chain arrangement (orientation effect) on the circularly polarized luminescence (CPL) in a solid system. The phase-transition behavior of the transformable Eu(III) coordination polymer was characterized using differential scanning calorimetry and powder X-ray diffraction. The Eu(III) coordination polymer exhibited phase transition at approximately 180 °C. The magnitude of the CPL intensity was drastically changed because of the phase transition, without coordination geometrical change around the Eu(III) ion. In this study, the orientation effect of a chiral Eu(III) coordination polymer on the CPL properties in crystalline solid is demonstrated.

Preoperative factors affecting the operative outcomes of laparoscopic nephrectomy

OBJECTIVES

Laparoscopic radical nephrectomy is the standard surgery for localized renal cell carcinoma. Both tumor and patient factors affect the difficulty of laparoscopic radical nephrectomy. Obesity is a major factor influencing technical difficulty in surgical procedures. This study examined preoperative tumor and patient factors affecting the operating time.

METHODS

The data of 123 patients who underwent laparoscopic radical nephrectomy at our institution between January 2014 and December 2018 were retrospectively analyzed. The operating time was determined based on the median pneumoperitoneum time. Surgical procedures with a pneumoperitoneum time of ≥130 min were defined as having prolonged pneumoperitoneum time. Multiple logistic regression analyses were performed to identify the preoperative factors affecting the prolonged pneumoperitoneum time, and risk stratification was performed based on these factors.

RESULTS

Multiple logistic regression analyses revealed that a total number of renal pedicle blood vessels ≥3 and a visceral fat volume ≥3000 cm³ were associated with prolonged pneumoperitoneum time of laparoscopic radical nephrectomy. Based on the multivariate analysis results, these factors were considered individually, and the cohort was stratified into three risk groups: low (0 point), intermediate (1 point), and high (2 points) risk groups. The pneumoperitoneum time was significantly prolonged as the number of risk factors increased.

CONCLUSIONS

We developed a risk stratification model using preoperative factors to predict the prolonged pneumoperitoneum time of laparoscopic radical nephrectomy, which can help select suitable cases that are appropriate for each surgeon's skill level.