Robotic partial nephrectomy for complex renal tumors: surgical technique.

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Rogers, Craig G; Singh, Amar; Blatt, Adam M; Linehan, W Marston; Pinto, Peter A

2008-03-01

Laparoscopic partial nephrectomy requires advanced training to accomplish tumor resection and renal reconstruction while minimizing warm ischemia times. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery. We describe our technique, illustrated with video, of robotic partial nephrectomy for complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance was used to resect 14 tumors in eight patients (mean age: 50.3 yr; range: 30-68 yr). Three patients had hereditary kidney cancer. All patients had complex tumor features, including hilar tumors (n=5), endophytic tumors (n=4), and/or multiple tumors (n=3). Robotic partial nephrectomy procedures were performed successfully without complications. Hilar clamping was used with a mean warm ischemia time of 31 min (range: 24-45 min). Mean blood loss was 230 ml (range: 100-450 ml). Histopathology confirmed clear-cell renal cell carcinoma (n=3), hybrid oncocytic tumor (n=2), chromophobe renal cell carcinoma (n=2), and oncocytoma (n=1). All patients had negative surgical margins. Mean index tumor size was 3.6 cm (range: 2.6-6.4 cm). Mean hospital stay was 2.6 d. At 3-mo follow-up, no patients experienced a statistically significant change in serum creatinine or estimated glomerular filtration rate and there was no evidence of tumor recurrence. Robotic partial nephrectomy is safe and feasible for select patients with complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance may facilitate a minimally invasive, nephron-sparing approach for select patients with complex renal tumors who might otherwise require open surgery or total nephrectomy.

Delayed Partial Nephrectomy for Hydronephrosis After Renal Trauma.

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Setia, Shaan; Jackson, Jessica Nicole; Herndon, C D Anthony; Corbett, Sean T

2017-03-01

Delayed sequelae following conservative management of renal trauma in the pediatric population are uncommon. Reports of delayed operations to manage these sequelae are even less common. Here we present the case of a 16-year-old male patient who had delayed development of upper urinary tract obstruction with recurrent infections following high-grade renal trauma managed conservatively. Ultimately, he required a robotic-assisted partial nephrectomy 2 years after initial nonoperative management. This is unique as no prior studies to our knowledge have described delayed hydronephrosis and delayed partial nephrectomy over a year following renal trauma. Copyright © 2016 Elsevier Inc. All rights reserved.

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

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Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G; Russo, Paul; Thompson, R Houston; Uzzo, Robert G; Wood, Christopher G; Gill, Inderbir S

2015-12-01

A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). A literature review was conducted. Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

Generation of Chimeric “ABS Nanohemostat” Complex and Comparing Its Histomorphological In Vivo Effects to the Traditional Ankaferd Hemostat in Controlled Experimental Partial Nephrectomy Model

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Emre Huri

2013-01-01

Full Text Available Purpose. Using the classical Ankaferd Blood Stopper (ABS solution to create active hemostasis during partial nephrectomy (PN may not be so effective due to insufficient contact surface between the ABS hemostatic liquid agent and the bleeding area. In order to broaden the contact surface, we generated a chimeric hemostatic agent, ABS nanohemostat, via combining a self-assembling peptide amphiphile molecule with the traditional Ankaferd hemostat. Materials and Methods. In order to generate ABS nanohemostat, a positively charged Peptide Amphiphile (PA molecule was synthesized by using solid phase peptide synthesis. For animal experiments, 24 Wistar rats were divided into the following 4 groups: Group 1: control; Group 2: conventional PN with only 0.5 ml Ankaferd hemostat; Group 3: conventional PN with ABS + peptide gel; Group 4: conventional PN with only 0.5 ml peptide solution. Results. Mean warm ischemia times (WITs were 232.8 ± 56.3, 65.6±11.4, 75.5± 17.2, and 58.1±17.6 seconds in Group 1 to Group 4, respectively. Fibrosis was not different among the groups, while inflammation was detected to be significantly different in G3 and G4. Conclusions. ABS nanohemostat has comparable hemostatic efficacy to the traditional Ankaferd hemostat in the partial nephrectomy experimental model. Elucidation of the cellular and tissue effects of this chimeric compound may establish a catalytic spark and open new avenues for novel experimental and clinical studies in the battlefield of hemostasis.

Review of laparoscopic partial nephrectomy in the treatment of renal tumors, T1 stadium in adults

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Zamora Montes de Oca, Maria Jose

2012-01-01

The T1 renal cancer in adults is made known; incidence, characteristics and management. Renal cell carcinoma has been the most common malignancy of the kidney, percentage is close to three percent of solid tumors of adults. The treatments for this tumor are analyzed: open radical nephrectomy, laparoscopic radical nephrectomy, open partial nephrectomy and laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy has represented an alternative option acceptable, safely and with good oncological and surgical outcomes for patients, as it is used to conserve nephrons and simultaneously to resect the tumor of a complete form promoting in the future the patient present a good renal function. Additionally, a adequate oncological control has reduced the risk of submit postoperative renal failure. An evolution of laparoscopic partial nephrectomy is presented determining the procedure for renal tumors in state T1 in the adults [es

Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

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Carlo Camargo Passerotti

2012-02-01

Full Text Available CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with

Do fibrin sealants impact negative outcomes after robot-assisted partial nephrectomy?

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Cohen, Jason; Jayram, Gautam; Mullins, Jeffrey K; Ball, Mark W; Allaf, Mohamad E

2013-10-01

Contemporary rates of postoperative hemorrhage after partial nephrectomy (PN) are low. Commercially available hemostatic agents are commonly used during this surgery to reduce this risk despite a paucity of data supporting the practice. We assessed the impact of fibrin sealant hemostatic agents, a costly addition to surgeries, during robot-assisted partial nephrectomy (RAPN). Between 2007 and 2011, 114 consecutive patients underwent RAPN by a single surgeon (MEA). Evicel fibrin sealant was used in the first 74 patients during renorraphy. The last 40 patients had renorraphy performed without the use of any hemostatic agents. Clinicopathologic, operative, and complication data were compared between groups. Multivariate and univariate logistic regression analysis was performed to test the association between the use of fibrin sealants and operative outcomes. Patient demographic data and clinical tumor characteristics were similar between groups. The use of fibrin sealant did not increase operative time (166.3 vs 176.1 minutes, P=0.28), warm ischemia time (WIT) (14.4 vs 16.1 minutes, P=0.18), or length of hospital stay (2.6 vs 2.4 days, P=0.35). The omission of these agents did not increase estimated blood loss (116.6 vs 176.1 mL, P=0.8) or postoperative blood transfusion (0% vs 2.5%, P=0.17). Univariate analysis demonstrated no association between use of fibrin sealants and increased complications (P>0.05). Multivariable logistic regression showed no statistically significant predictive value of omission of hemostatic agents for perioperative outcomes (P>0.05). Perioperative hemorrhage and other major complications after contemporary RAPN are rare in experienced hands. In our study, the use of fibrin sealants during RAPN does not decrease the rate of complications, blood loss, or hospital stay. Furthermore, no impact is seen on operative time, WIT, or other negative outcomes. Omitting these agents during RAPN could be a safe, effective, cost-saving measure.

Robotic-assisted partial Nephrectomy: initial experience in South America

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Gustavo C. Lemos

2011-08-01

Full Text Available OBJECTIVE:To report the initial outcomes of robotic-assisted partial nephrectomy in a tertiary center in South America. MATERIAL AND METHODS: From 11/2008 to 12/2009, a total of 16 transperitoneal robotic-assisted partial nephrectomies were performed in 15 patients to treat 18 kidney tumors. One patient with bilateral tumor had two procedures, while two patients with two synchronous unilateral tumors had a single operation to remove them. Eleven (73% patients were male and the right kidney was affected in 7 (46% patients. The median patient age and tumor size were 57 years old and 30 mm, respectively. Five (28% tumors were hilar and/or centrally located. RESULTS: The median operative time, warm ischemia time and estimated blood loss was 140 min, 27 min and 120 mL, respectively. Blood transfusion was required in one patient with bilateral tumor, and one additional pyelolithotomy was performed due to a 15mm stone located in the renal pelvis. The histopathology analysis showed 15 (83% malignant tumors, which 10 (67% were clear cell carcinoma. The median hospital stay was 72 hrs and no major complication was observed. CONCLUSION: Robotic-assisted partial nephrectomy is safe and represents a valuable option to perform minimally invasive nephron-sparing surgery.

Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

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Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

2017-07-01

To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and

Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy.

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Ng, Casey K; Gill, Inderbir S; Patil, Mukul B; Hung, Andrew J; Berger, Andre K; de Castro Abreu, Andre Luis; Nakamoto, Masahiko; Eisenberg, Manuel S; Ukimura, Osamu; Thangathurai, Duraiyah; Aron, Monish; Desai, Mihir M

2012-01-01

Robot-assisted and laparoscopic partial nephrectomies (PNs) for medial tumors are technically challenging even with the hilum clamped and, until now, were impossible to perform with the hilum unclamped. Evaluate whether targeted vascular microdissection (VMD) of renal artery branches allows zero-ischemia PN to be performed even for challenging medial tumors. A prospective cohort evaluation of 44 patients with renal masses who underwent robot-assisted or laparoscopic zero-ischemia PN either with anatomic VMD (group 1; n=22) or without anatomic VMD (group 2; n=22) performed by a single surgeon from April 2010 to January 2011. Zero-ischemia PN with VMD incorporates four maneuvers: (1) preoperative computed tomographic reconstruction of renal arterial branch anatomy, (2) anatomic dissection of targeted, tumor-specific tertiary or higher-order renal arterial branches, (3) neurosurgical aneurysm microsurgical bulldog clamp(s) for superselective tumor devascularization, and (4) transient, controlled reduction of blood pressure, if necessary. Baseline, perioperative, and postoperative data were collected prospectively. Group 1 tumors were larger (4.3 vs 2.6 cm; p=0.011), were more often hilar (41% vs 9%; p=0.09), were medial (59% and 23%; p=0.017), were closer to the hilum (1.46 vs 3.26 cm; p=0.0002), and had a lower C index score (2.1 vs 3.9; p=0.004) and higher RENAL nephrometry scores (7.7 vs 6.2; p=0.013). Despite greater complexity, no group 1 tumor required hilar clamping, and perioperative outcomes were similar to those of group 2: operating room time (4.7 and 4.1h), median blood loss (200 and 100ml), surgical margins for cancer (all negative), major complications (0% and 9%), and minor complications (18% and 14%). The median serum creatinine level was similar 2 mo postoperatively (1.2 and 1.3mg/dl). The study was limited by the relatively small sample size. Anatomic targeted dissection and superselective control of tumor-specific renal arterial branches facilitate

Different methods of hilar clamping during partial nephrectomy: Impact on renal function.

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Lee, Jeong Woo; Kim, Hwanik; Choo, Minsoo; Park, Yong Hyun; Ku, Ja Hyeon; Kim, Hyeon Hoe; Kwak, Cheol

2014-03-01

To evaluate the impact of different hilar clamping methods on changes in renal function after partial nephrectomy. We analyzed the clinical data of 369 patients who underwent partial nephrectomy for a single renal tumor of size ≤4.0 cm and a normal contralateral kidney. Patients were separated into three groups depending on hilar clamping method: non-clamping, cold ischemia and warm ischemia. Estimated glomerular filtration rate was examined at preoperative, nadir and 1 year postoperatively. Percent change in estimated glomerular filtration rate was used as the parameter to assess the renal functional outcome. Percent change in nadir estimated glomerular filtration rate in the non-clamping group was significantly less compared with the cold ischemia and warm ischemia groups (P hilar clamping (both warm ischemia and cold ischemia) were significantly associated with percent change in nadir estimated glomerular filtration rate, but not in 1-year estimated glomerular filtration rate. Non-clamping partial nephrectomy results in a lower percent change in nadir estimated glomerular filtration rate, whereas it carries an estimated glomerular filtration rate change at 1 year that is similar to partial nephrectomy with cold ischemia and warm ischemia. Cold ischemia and warm ischemia provide a similar effect on renal function. Therefore, when hilar clamping is required, minimization of ischemia time is necessary. © 2013 The Japanese Urological Association.

Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy With the Novel Da Vinci Single-Site Platform: Initial Experience

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Komninos, Christos; Tuliao, Patrick; Kim, Dae Keun; Choi, Young Deuk; Chung, Byung Ha

2014-01-01

Purpose To report our initial clinical cases of robotic laparoendoscopic single-site (R-LESS) partial nephrectomy (PN) performed with the use of the novel Da Vinci R-LESS platform. Materials and Methods Three patients underwent R-LESS PN from November 2013 through February 2014. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted. Results Operative time and estimated blood loss volume ranged between 100 and 110 minutes and between 50 and 500 mL, respectively. None of the patients was transfused. All cases were completed with the off-clamp technique, whereas one case required conversion to the conventional (multiport) approach because of difficulty in creating the appropriate scope for safe tumor resection. No major postoperative complications occurred, and all tumors were resected in safe margins. Length of hospital stay ranged between 3 and 7 days. The lack of EndoWrist movements, the external collisions, and the bed assistant's limited working space were noticed to be the main drawbacks of this surgical method. Conclusions Our initial experience with R-LESS PN with the novel Da Vinci platform shows that even though the procedure is feasible, it should be applied in only appropriately selected patients. However, further improvement is needed to overcome the existing limitations. PMID:24955221

Temporary targeted renal blood flow interruption using a reverse thermosensitive polymer to facilitate bloodless partial nephrectomy: a swine survival study.

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Harty, Niall J; Laskey, Daniel H; Moinzadeh, Alireza; Flacke, Sebastian; Benn, James A; Villani, Rosanna; Kalra, Aarti; Libertino, John A; Madras, Peter N

2012-09-01

What's known on the subject? and What does the study add? Lumagel™ is a reverse thermosensitive polymer (RTP) that has previously been described in the literature as providing temporary vascular occlusion to allow for bloodless partial nephrectomy (PN) while maintaining blood flow to the untargeted portion of the kidney. At body temperature, Lumagel™ has the consistency of a viscous gel but upon cooling rapidly converts to a liquid state and does not reconstitute thereafter. This property has allowed for it to be used in situations requiring temporary vascular occlusion. Previous experience with similar RTPs in coronary arteries proved successful, with no detectable adverse events. We have previously described our technique for temporary vascular occlusion of the main renal artery, as well as segmental and sub-segmental renal branches, to allow for bloodless PN in either an open or minimally invasive approach. These experiments were performed in the acute setting. This study is a two-armed survival trial to assess whether this RTP is as safe as hilar clamping for bloodless PN. Surviving animals showed normal growth after using the RTP, absence of toxicity, no organ dysfunction, and no pathological changes attributable to the RTP. We conclude that Lumagel™ is as safe as conventional PN with hilar clamping, while adding the advantage of uninterrupted perfusion during renal resection. To examine whether randomly selected regions of the kidney could undergo temporary flow interruption with a reverse thermosensitive polymer (RTP), Lumagel™ (Pluromed, Inc., Woburn, MA, USA), followed by partial nephrectomy (PN), without adding risks beyond those encountered in the same procedure with the use of hilar clamping. A two-armed (RTP vs hilar clamp), 6-week swine survival study was performed. Four swine underwent PN using hilar clamps, while six underwent PN with flow interruption using the RTP. The RTP, administered angiographically, was used for intraluminal occlusion

Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging. A single institute experience with 290 consecutive patients

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Lee, Seung-Hwan; Park, Sang-Un; Rha, Koon-Ho; Choi, Young-Deuk; Hong, Sung-Joon; Yang, Seung-Choul; Mah, Sang-Yol; Chung, Byung-Ha [Health System, Yonsei Univ., Seoul (Korea, Republic of)

2010-06-15

The aim of this study was to determine trends in the incidence of benign lesions in patients undergoing surgery for suspicious renal masses on preoperative computed tomography scan. The records of 1065 patients who underwent open consecutive partial nephrectomy (PN) or radical nephrectomy (RN) between January 2001 and December 2008 were reviewed. Patients who underwent PN during the periods 2001-2002, 2003-2004, 2005-2006, and 2007-2008 were assigned to groups 1, 2, 3 and 4, respectively. The frequencies of benign and malignant lesions in these groups were assessed according to size and histology subtypes. The ratio of PN to RN was 12.4%, 18.3%, 24.3% and 37.2% in groups 1, 2, 3 and 4, respectively (P<0.05). The mean size of resected lesions was 2.6 cm (range 0.8-6.2 cm). Of the 290 cases, histopathology revealed benign findings in 52 (17.9%). Benign pathology was found in three of 18 cases (16.7%) in group 1, seven of 36 cases (19.4%) in group 2, 12 of 63 cases (19.0%) in group 3 and 30 of 173 cases (17.3%) in group 4. There was no significant difference in the frequency of benign histology among groups. PN, as opposed to RN, has shown a rising tendency over time. The frequency of benign pathology findings after PN for suspicious renal masses on preoperative computed tomography imaging has not decreased. Proper management should favor nephron-sparing surgery for renal lesions if such lesions can be removed satisfactorily with PN. (author)

Multicenter Experience with Nonischemic Multiport Laparoscopic and Laparoendoscopic Single-Site Partial Nephrectomy Utilizing Bipolar Radiofrequency Ablation Coagulator

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Wassim M. Bazzi

2011-01-01

Full Text Available Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS nonischemic laparoscopic partial nephrectomy (NI-LPN utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3% successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL was 1.02/1.07 (=.471. All had negative margins. 12 (20% patients developed complications. 3 (5% developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy.

Variability of inter-observer agreement on feasibility of partial nephrectomy before and after neoadjuvant axitinib for locally advanced renal cell carcinoma (RCC): independent analysis from a phase II trial.

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Karam, Jose A; Devine, Catherine E; Fellman, Bryan M; Urbauer, Diana L; Abel, E Jason; Allaf, Mohamad E; Bex, Axel; Lane, Brian R; Thompson, R Houston; Wood, Christopher G

2016-04-01

To evaluate how many patients could have undergone partial nephrectomy (PN) rather than radical nephrectomy (RN) before and after neoadjuvant axitinib therapy, as assessed by five independent urological oncologists, and to study the variability of inter-observer agreement. Pre- and post-systemic treatment computed tomography scans from 22 patients with clear cell renal cell carcinoma in a phase II neoadjuvant axitinib trial were reviewed by five independent urological oncologists. R.E.N.A.L. nephrometry score and κ statistics were calculated. The median R.E.N.A.L. nephrometry score changed from 11 before treatment to 10 after treatment (P = 0.002). Five tumours with moderate complexity before axitinib treatment remained moderate complexity after treatment. Of 17 tumours with high complexity before axitinib treatment, three became moderate complexity after treatment. The overall κ statistic was 0.611. Moderate-complexity κ was 0.611 vs a high-complexity κ of 0.428. Before axitinib treatment the κ was 0.550 vs 0.609 after treatment. After treatment with axitinib, all five reviewers agreed that only five patients required RN (instead of eight before treatment) and that 10 patients could now undergo PN (instead of three before treatment). The odds of PN feasibility were 22.8-times higher after treatment with axitinib. There is considerable variability in inter-observer agreement on the feasibility of PN in patients treated with neoadjuvant targeted therapy. Although more patients were candidates for PN after neoadjuvant axitinib therapy, it remains difficult to identify these patients a priori. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Bilateral adrenal hemorrhage due to heparin-induced thrombocytopenia following partial nephrectomy – a case report [v1; ref status: indexed, http://f1000r.es/2pn

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Ashley G. Winter

2014-01-01

Full Text Available Heparin-induced thrombocytopenia (HIT can cause severe life-threatening events such as bilateral adrenal hemorrhage (BAH. A 48-year-old female developed a pulmonary embolus (PE following partial nephrectomy. The anticoagulation treatment for her PE was complicated by HIT and subsequent BAH. To the author’s knowledge, this is the first reported case of HIT-associated BAH following renal surgery.

Efficiency and Reliability of Laparoscopic Partial Nephrectomy for Renal Tumors Larger than 4 cm

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Faruk Özgör

2015-03-01

Full Text Available Aim: To evaluate safety and efficiency of laparoscopic partial nephrectomy for renal tumors larger than 4 cm. Methods: We retrospectivelly evaluated the medical records of 65 patients who underwent laparascopic partial nephrectomy between May 2009 and June 2013 in our clinic. The patients were divided into two groups according to tumor size. Patients with a tumor 4 cm were included in group 1 (n=45 and group 2 (n=20, respectively. Demographic, perioperative and postoperative parameters were compared between the groups. Histopathological examination and surgical margin status were also evaluated. Results: The mean age of the patients was 59.2±10.9 (range: 26- 81 years. The mean tumor size and the mean RENAL nephrometry score were significantly higher in group 2 than in group 1. The mean operation time and warm ischemia time were similar between groups but estimated blood loss and transfusion requirement were significantly higher in group 2. Convertion to open surgery was seen two patients in group 2 and one patient in group 1. Only one patient underwent radical nephrectomy for uncontrolled bleeding in group 2. There was no difference in preoperative and 3-month postoperative serum creatinine levels between the groups. The incidence of positive surgical margin was 0% and 5% in group 1 and group 2, respectively. Conclusion: Laparoscopic partial nephrectomy for renal tumors is an effective and feasible procedure with acceptable oncologic results. However, tranfusion rate and requiremet of pelvicaliceal system repair were more common in patients with tumor >4 cm. (The Medical Bulletin of Haseki 2015; 53:30-5

The Piezo Actuator-Driven Pulsed Water Jet System for Minimizing Renal Damage after Off-Clamp Laparoscopic Partial Nephrectomy.

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Kamiyama, Yoshihiro; Yamashita, Shinichi; Nakagawa, Atsuhiro; Fujii, Shinji; Mitsuzuka, Koji; Kaiho, Yasuhiro; Ito, Akihiro; Abe, Takaaki; Tominaga, Teiji; Arai, Yoichi

2017-09-01

In the setting of partial nephrectomy (PN) for renal cell carcinoma, postoperative renal dysfunction might be caused by surgical procedure. The aim of this study was to clarify the technical safety and renal damage after off-clamp laparoscopic PN (LPN) with a piezo actuator-driven pulsed water jet (ADPJ) system. Eight swine underwent off-clamp LPN with this surgical device, while off-clamp open PN was also performed with radio knife or soft coagulation. The length of the removed kidney was 40 mm, and the renal parenchyma was dissected until the renal calyx became clearly visible. The degree of renal degeneration from the resection surface was compared by Hematoxylin-Eosin staining and immunostaining for 1-methyladenosine, a sensitive marker for the ischemic tissue damage. The mRNA levels of neutrophil gelatinase-associated lipocalin (Ngal), a biomarker for acute kidney injury, were measured by quantitative real-time PCR. Off-clamp LPN with ADPJ system was successfully performed while preserving fine blood vessels and the renal calix with little bleeding. In contrast to other devices, the resection surface obtained with the ADPJ system showed only marginal degree of ischemic changes. Indeed, the expression level of Ngal mRNA was lower in the resection surface obtained with the ADPJ system than that with soft coagulation (p = 0.02). Furthermore, using the excised specimens of renal cell carcinoma, we measured the breaking strength at each site of the human kidney, suggesting the applicability of this ADPJ to clinical trials. In conclusion, off-clamp LPN with the ADPJ system could be safely performed with attenuated renal damage.

Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: Retrospective analysis.

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Weingarten, Toby N; Del Mundo, Serena B; Yeoh, Tze Yeng; Scavonetto, Federica; Leibovich, Bradley C; Sprung, Juraj

2014-10-01

The aim of this retrospective study is to test the hypothesis that the use of spinal analgesia shortens the length of hospital stay after partial nephrectomy. We reviewed all patients undergoing partial nephrectomy for malignancy through flank incision between January 1, 2008, and June 30, 2011. We excluded patients who underwent tumor thrombectomy, used sustained-release opioids, or had general anesthesia supplemented by epidural analgesia. Patients were grouped into "spinal" (intrathecal opioid injection for postoperative analgesia) versus "general anesthetic" group, and "early" discharge group (within 3 postoperative days) versus "late" group. Association between demographics, patient physical status, anesthetic techniques, and surgical complexity and hospital stay were analyzed using multivariable logistic regression analysis. Of 380 patients, 158 (41.6%) were discharged "early" and 151 (39.7%) were "spinal" cases. Both spinal and early discharge groups had better postoperative pain control and used less postoperative systemic opioids. Spinal analgesia was associated with early hospital discharge, odds ratio 1.52, (95% confidence interval 1.00-2.30), P = 0.05, but in adjusted analysis was no longer associated with early discharge, 1.16 (0.73-1.86), P = 0.52. Early discharge was associated with calendar year, with more recent years being associated with early discharge. Spinal analgesia combined with general anesthesia was associated with improved postoperative pain control during the 1(st) postoperative day, but not with shorter hospital stay following partial nephrectomy. Therefore, unaccounted practice changes that occurred during more recent times affected hospital stay.

Hilar location is an independent prognostic factor for recurrence in T1 renal cell carcinoma after nephrectomy.

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Shim, Myungsun; Song, Cheryn; Park, Sejun; Kim, Aram; Choi, Seung-Kwon; Kim, Choung-Soo; Ahn, Hanjong

2015-01-01

We investigated the prognostic significance of tumor location at the renal hilum near the sinus structure on the recurrence in T1 renal cell carcinoma (RCC). A total of 1,818 T1 RCC patients who underwent radical (RN) or partial nephrectomy (PN) from 1997 to 2011 were retrospectively reviewed. A hilar tumor was defined as a tumor abutting the main renal artery and/or vein or its segmental branches, without invasion. We compared the recurrence-free survival (RFS) rates between hilar and nonhilar T1 RCC and analyzed predictors of RFS after nephrectomy. Patients with hilar tumors showed a poorer 5-year RFS compared with nonhilar tumors both in T1a (89.7 vs. 98.5 %, p hilar tumors were associated with lower 5-year RFS (87.6 vs. 97.2 % for RN, 78.1 vs. 98.2 % for PN, both p hilar tumor, PN was associated with poorer 5-year RFS than RN (79.5 vs. 93.0 %, p hilar location remained as an independent predictor of recurrence in both T1a and T1b tumors (both p = 0.001). Hilar tumors show a higher recurrence rate than nonhilar counterparts in T1 RCC. In T1a hilar tumors, PN demonstrated poorer RFS than RN. Potential intrinsic renal anatomical or lymphovascular structural differences as well as differences in cancer characteristics need further investigations.

External Validation of Contact Surface Area as a Predictor of Postoperative Renal Function in Patients Undergoing Partial Nephrectomy.

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Haifler, Miki; Ristau, Benjamin T; Higgins, Andrew M; Smaldone, Marc C; Kutikov, Alexander; Zisman, Amnon; Uzzo, Robert G

2017-09-20

We sought to externally validate a mathematical formula for tumor contact surface area as a predictor of postoperative renal function in patients undergoing partial nephrectomy for renal cell carcinoma. We queried a prospectively maintained kidney cancer database for patients who underwent partial nephrectomy between 2014 and 2016. Contact surface area was calculated using data obtained from preoperative cross-sectional imaging. The correlation between contact surface area and perioperative variables was examined. The correlation between postoperative renal functional outcomes, contact surface area and the R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touches main renal artery or vein) nephrometry score was also assessed. A total of 257 patients who underwent partial nephrectomy had sufficient data to enter the study. Median contact surface area was 14.5 cm 2 (IQR 6.2-36) and the median nephrometry score was 9 (IQR 7-10). Spearman correlation analysis showed that contact surface area correlated with estimated blood loss (r s = 0.42, p contact surface area and nephrometry score were independent predictors of the absolute change in the estimated glomerular filtration rate (each p contact surface area was a better predictor of a greater than 20% postoperative decline in the estimated glomerular filtration rate compared with the nephrometry score (AUC 0.94 vs 0.80). Contact surface area correlated with the change in postoperative renal function after partial nephrectomy. It can be used in conjunction with the nephrometry score to counsel patients about the risk of renal functional decline after partial nephrectomy. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program?

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Brandao, Luis Felipe; Zargar, Homayoun; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Ko, Oliver; Samarasekera, Dinesh; Li, Jianbo; Rabets, John; Krishnan, Jayram; Haber, Georges-Pascal; Kaouk, Jihad; Stein, Robert J

2014-09-01

After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates. We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy. From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher. Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[A new technique for ensuring negative surgical margins during partial nephrectomy: the ex vivo ultrasound control].

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Desmonts, A; Tillou, X; Le Gal, S; Secco, M; Orczyk, C; Bensadoun, H; Doerfler, A

2013-10-01

To evaluate the feasibility and the efficiency of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by urologist. Patients undergoing partial nephrectomy from July 2010 to November 2012 for T1-T2 renal tumors were included in analysis. Tumor margin status was immediately determined by ex vivo ultrasound done by the surgeon himself. Results were compared with margin status on definitive pathological evaluation. A total of 26 men and 15 women with a median age of 61 (30-82) years old were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 38 cases and positive margins in two. Final pathological results revealed negative margins in all except one case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Mean ultrasound duration was 1minute±1. Mean tumor and margin sizes were 3.4±1.8cm and 2.38±1.76mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by a urologist seemed to be feasible, efficient and easy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Non-neoplastic parenchymal changes in kidney cancer and post-partial nephrectomy recovery of renal function.

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Bazzi, Wassim M; Chen, Ling Y; Cordon, Billy H; Mashni, Joseph; Sjoberg, Daniel D; Bernstein, Melanie; Russo, Paul

2015-09-01

To explore the association of non-neoplastic parenchymal changes (nNPC) with patients' health and renal function recovery after partial nephrectomy (PN). This retrospective review identified 800 pT1a patients who underwent PN at Memorial Sloan Kettering Cancer Center from 2007 to 2012. Pathology reports were reviewed for nNPC graded as mild or severe: vascular sclerosis (VS), glomerulosclerosis (GS), and fibrosis/scarring. Correlations between nNPC and known preoperative predictors of renal function [age, sex, African-American race, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, body mass index, coronary artery disease, and hypertension (HTN)] were assessed using Spearman's rank correlation (ρ). Multivariable linear regression, adjusted for the described known preoperative risk predictors, was performed to evaluate whether the parenchymal features were able to predict 6-month postoperative eGFR. In this study, 46 % of tumors had benign surrounding parenchyma. We noted statistically significant yet weak associations of VS with age (ρ = 0.19; p < 0.001), ASA (ρ = 0.09; p < 0.001), preoperative eGFR (ρ = -0.14; p < 0.001), and HTN (ρ = 0.14; p < 0.001). GS also significantly correlated with HTN, but the correlation was again small (ρ = 0.12; p < 0.001). After adjusting for known risk predictors, only GS was a significant predictor of 6-month postoperative eGFR. When compared with no GS, mild and severe GS were negatively associated with a decrease of 4.9 and 10.8 mL/min/1.73 m(2) in 6-month postoperative eGFR, respectively. Presence of VS and GS correlated with patients' baseline health, and presence of GS predicted postoperative renal function recovery.

Renal pelvic anatomy is associated with incidence, grade, and need for intervention for urine leak following partial nephrectomy.

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Tomaszewski, Jeffrey J; Cung, Bic; Smaldone, Marc C; Mehrazin, Reza; Kutikov, Alexander; Viterbo, Rosalia; Chen, David Y T; Greenberg, Richard E; Uzzo, Robert G

2014-11-01

Although the effect of tumor complexity on perioperative outcome measures is well established, the impact of renal pelvic anatomy on perioperative outcomes remains poorly defined. To evaluate renal pelvic anatomy as an independent predictor of urine leak in moderate- and high-complexity tumors undergoing nephron-sparing surgery. Patients undergoing open partial nephrectomy (PN) for localized RCC were stratified into intermediate- and high-complexity groups using a nephrometry score (7-9 and 10-12, respectively). A renal pelvic score (RPS) was defined by the percentage of renal pelvis contained inside the volume of the renal parenchyma. On this basis, patients were categorized as having an intraparenchymal (>50%) or extraparenchymal (renal pelvis. Characteristics of patients with and without an intraparenchymal renal pelvic anatomy were compared. Inclusion criteria were met by 255 patients undergoing PN for intermediate (73.6%) and complex (26.4%) localized renal tumors (mean size: 4.6±2.9cm). Twenty-four (9.6%) renal pelves were classified as completely intraparenchymal. Following stratification by RPS, groups differed with respect to Charlson comorbidity index, body mass index, and largest tumor size, while no differences were observed between hospital length of stay, nephrometry score, estimated blood loss, operative time, and age. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (75% vs 6.5%; p=0.001), secondary intervention (37.5% vs 3.9%; prenal pelvic anatomy is an uncommon anatomic variant associated with an increased rate of urine leak following PN. Elevated pressures within a small intraparenchymal renal pelvis might explain the increased risk. Preoperative imaging characteristics suggestive of increased risk for urine leak should be considered in perioperative management algorithms. Copyright © 2013. Published by Elsevier B.V.

Robotic partial nephrectomy for renal cell carcinomas with venous tumor thrombus.

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Abaza, Ronney; Angell, Jordan

2013-06-01

To describe the first report of robotic partial nephrectomies (RPNs) for renal cell carcinoma (RCC) with venous tumor thrombus (VTT). Partial nephrectomy for RCC extending into the renal vein has been described in limited fashion, but such a complex procedure has not previously been reported in minimally-invasive fashion. We demonstrate the feasibility of robotic nephron-sparing surgery despite vein thrombi and the results of the initial four highly-selected patients to have undergone this novel procedure. Two patients underwent RPN for RCC with VTT involving intraparenchymal vein branches, and 2 others had VTT involving the main renal vein. Mean patient age was 65 years (range 50-74 years). Mean tumor size was 7.75 cm (range 4.3-12.8 cm) with mean RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score of 9.75 (range 8-12). Mean warm ischemia time was 24.2 minutes (range 19-27 minutes) and mean estimated blood loss was 168.8 mL (range 100-300 mL). No patients required transfusion, and there were no intraoperative complications. No patients required conversion to open or standard laparoscopic surgery. All 4 patients were discharged home on the first postoperative day. A single postoperative complication occurred in 1 patient who was readmitted with an ileus that resolved spontaneously. All patients had negative surgical margins. Two patients developed metastatic disease on surveillance imaging. RPN in patients with VTT is safe and feasible in selected patients. Given the risk of metastatic disease in patients with pathologic stage T3a RCC, the role of nephron sparing requires further evaluation such that radical nephrectomy remains the standard of care. Copyright © 2013 Elsevier Inc. All rights reserved.

Selective Arterial Clamping Versus Hilar Clamping for Minimally Invasive Partial Nephrectomy.

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Yezdani, Mona; Yu, Sue-Jean; Lee, David I

2016-05-01

Partial nephrectomy has become an accepted treatment of cT1 renal masses as it provides improved long-term renal function compared to radical nephrectomy (Campbell et al. J Urol. 182:1271-9, 2009). Hilar clamping is utilized to help reduce bleeding and improve visibility during tumor resection. However, concern over risk of kidney injury with hilar clamping has led to new techniques to reduce length of warm ischemia time (WIT) during partial nephrectomy. These techniques have progressed over the years starting with early hilar unclamping, controlled hypotension during tumor resection, selective arterial clamping, minimal margin techniques, and off-clamp procedures. Selective arterial clamping has progressed significantly over the years. The main question is what are the exact short- and long-term renal effects from increasing clamp time. Moreover, does it make sense to perform these more time-consuming or more complex procedures if there is no long-term preservation of kidney function? More recent studies have shown no difference in renal function 6 months from surgery when selective arterial clamping or even hilar clamping is employed, although there is short-term improved decline in estimated glomerular filtration rate (eGFR) with selective clamping and off-clamp techniques (Komninos et al. BJU Int. 115:921-8, 2015; Shah et al. 117:293-9, 2015; Kallingal et al. BJU Int. doi: 10.1111/bju.13192, 2015). This paper reviews the progression of total hilar clamping to selective arterial clamping (SAC) and the possible difference its use makes on long-term renal function. SAC may be attempted based on surgeon's decision-making, but may be best used for more complex, larger, more central or hilar tumors and in patients who have renal insufficiency at baseline or a solitary kidney.

Hybrid laparoscopic and robotic ultrasound-guided radiofrequency ablation-assisted clampless partial nephrectomy.

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Nadler, Robert B; Perry, Kent T; Smith, Norm D

2009-07-01

To describe a clampless approach made possible by creating an avascular plane of tissue with radiofrequency ablation. Laparoscopic partial nephrectomy is slowly gaining acceptance as a method to treat small (generator. Typically, we used a power setting of 50 W but have found settings as low as 25 W necessary to provide hemostasis for larger vessels. The tumor was then sharply excised with a negative margin using robotic scissors and electrocautery to facilitate tissue cutting. Retrograde injection of methylthioninium chloride and saline through an externalized ureteral catheter allowed for precise sutured closure of the collecting system. FloSeal and BioGlue were then applied, making surgical bolsters or parenchymal sutures unnecessary. Intraoperative histologic evaluation of the surgical margin and repeat resection of the tumor bed was possible because the renal hilum was not clamped, and no warm ischemia was used. This technique, which combines the improving technologies of robotic surgery, intraoperative laparoscopic ultrasonography, and radiofrequency ablation, might make more surgeons comfortable with the intricacies of laparoscopic suturing and eliminate prolonged warm ischemia times. Overall, this method should result in more patients being able to undergo minimally invasive laparoscopic partial nephrectomy.

Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety.

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Rha, Koon H; Abdel Raheem, Ali; Park, Sung Y; Kim, Kwang H; Kim, Hyung J; Koo, Kyo C; Choi, Young D; Jung, Byung H; Lee, Sang K; Lee, Won K; Krishnan, Jayram; Shin, Tae Y; Cho, Jin-Seon

2017-11-01

To assess the correlation of the resected and ischaemic volume (RAIV), which is a preoperatively calculated volume of nephron loss, with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset. We identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robot-assisted PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were used to identify the associations between various time points of PRF and the RAIV, as a continuous variable. The mean (sd) RAIV was 24.2 (29.2) cm 3 . The mean preoperative estimated glomerular filtration rate (eGFR) and the eGFRs at postoperative day 1, 6 and 36 months after PN were 91.0 and 76.8, 80.2 and 87.7 mL/min/1.73 m 2 , respectively. In multivariable linear regression analysis, the amount of decline in PRF at follow-up was significantly correlated with the RAIV (β 0.261, 0.165, 0.260 at postoperative day 1, 6 and 36 months after PN, respectively). This study has the limitation of its retrospective nature. Preoperatively calculated RAIV significantly correlates with the amount of decline in PRF during long-term follow-up. The RAIV could lead our research to the level of prediction of the amount of PRF decline after PN and thus would be appropriate for assessing the technical advantages of emerging techniques. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Safety and Efficacy of transarterial nephrectomy as an alternative to surgical nephrectomy

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Cho, Jooae; Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jin Hyoung; Sung, Kyu Bo

2014-01-01

To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Safety and Efficacy of transarterial nephrectomy as an alternative to surgical nephrectomy

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Cho, Jooae; Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jin Hyoung; Sung, Kyu Bo [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2014-08-15

To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Better recovery of kidney function in patients with de novo chronic kidney disease after partial nephrectomy compared with those with pre-existing chronic kidney disease.

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Takagi, Toshio; Kondo, Tsunenori; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Hashimoto, Yasunobu; Yoshida, Kazuhiko; Tanabe, Kazunari

2014-06-01

We compared kidney functional recovery between patients with pre-existing chronic kidney disease, those with de novo chronic kidney disease and those with normal kidney function, after partial nephrectomy. A total of 311 patients who underwent partial nephrectomy at Tokyo Women's Medical University Hospital, Tokyo, Japan, between January 2004 and July 2011 with sufficient kidney functional data participated in the study. Patients with pre-existing chronic kidney disease (group1: 78 patients) were defined as those with estimated glomerular filtration rate under 60 mL/min/m(2) before partial nephrectomy. Patients with de novo chronic kidney disease (group 2: 49) were defined as those with estimated glomerular filtration rate over 60 mL/min/m(2) before surgery and who developed estimated glomerular filtration rate under 60 mL/min/m(2) 3 months after partial nephrectomy. Normal patients (group 3: 184) were defined as those with estimated glomerular filtration rate over 60 mL/min/m(2) both before and after partial nephrectomy. Group 1 was associated with older age and higher comorbidity, including hypertension and diabetes mellitus, compared with other groups. R.E.N.A.L. score was not significantly different between the groups. Although the percent change of estimated glomerular filtration rate between the preoperative period and 3 months after partial nephrectomy in group 2 was significantly decreased compared with that in other groups (group 1: -6.8%, group 2: -18%, group 3: -7.3%), the renal functional recovery between 3 and 12 months after partial nephrectomy in group 2 was better than that in other groups (group 1: -0.5%, group 2: 5.6%, group 3: -0.4%). Patients with de novo chronic kidney disease had better kidney functional recovery than the other two groups, which might suggest that they were surgically assaulted and developed chronic kidney disease in the early postoperative period, and were essentially different from those with pre-existing chronic kidney

Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes

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A. Porreca

Full Text Available ABSTRACT Objectives The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy. Materials and methods From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right. Average size was 3cm (1-9. Average PADUA score 7.1 (5-10. Average surgical time (overall and only robot time, ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. Results All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340. Operative time was 145 minutes (80-300, overall blood loss was 142cc (60-310cc. In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7. None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a. Hospital stay was 3 days (2-7. Conclusions The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.

Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours

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Abdulmuttalip Simsek

2017-06-01

Full Text Available Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN compared to robotic partial nephrectomy (RPN for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20 or RPN (n = 22 by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI, American Society of Anaesthesiologists (ASA score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001. Warm ischemia time was similar in both groups (p = 0.58. Estimated blood loss (EBL was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

Anatomic features involved in technical complexity of partial nephrectomy.

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Hou, Weibin; Yan, Weigang; Ji, Zhigang

2015-01-01

Nephrometry score systems, including RENAL nephrometry, preoperative aspects and dimensions used for an anatomical classification system, C-index, diameter-axial-polar nephrometry, contact surface area score, calculating resected and ischemized volume, renal tumor invasion index, surgical approach renal ranking score, zonal NePhRO score, and renal pelvic score, have been reviewed. Moreover, salient anatomic features like the perinephric fat and vascular variants also have been discussed. We then extract 7 anatomic characteristics, namely tumor size, spatial location, adjacency, exophytic/endophytic extension, vascular variants, pelvic anatomy, and perinephric fat as important features for partial nephrectomy. For novice surgeons, comprehensive and adequate anatomic consideration may help them in their early clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Mini-flank supra-12th rib incision for open partial nephrectomy for renal tumor with RENAL nephrometry score ≥10: an innovation of traditional open surgery.

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Wang, Hang; Sun, Li-an; Wang, Yiwei; Xiang, Zhuoyi; Zhou, Lin; Guo, Jianming; Wang, Guomin

2015-04-01

The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5-8.1). Mean warm ischemia time was 28.1 minutes (range: 21-39), mean operative time was 105 minutes (range: 70-150) and mean estimated blood loss was 68 mL (range: 10-400). Mean postoperative hospital stay was 6.5 days (range: 5-12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47-132) and 87.1 μmol/L (range: 61-189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8-50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open

A Mathematical Method to Calculate Tumor Contact Surface Area: An Effective Parameter to Predict Renal Function after Partial Nephrectomy.

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Hsieh, Po-Fan; Wang, Yu-De; Huang, Chi-Ping; Wu, Hsi-Chin; Yang, Che-Rei; Chen, Guang-Heng; Chang, Chao-Hsiang

2016-07-01

We proposed a mathematical formula to calculate contact surface area between a tumor and renal parenchyma. We examined the applicability of using contact surface area to predict renal function after partial nephrectomy. We performed this retrospective study in patients who underwent partial nephrectomy between January 2012 and December 2014. Based on abdominopelvic computerized tomography or magnetic resonance imaging, we calculated the contact surface area using the formula (2*π*radius*depth) developed by integral calculus. We then evaluated the correlation between contact surface area and perioperative parameters, and compared contact surface area and R.E.N.A.L. (Radius/Exophytic/endophytic/Nearness to collecting system/Anterior/Location) score in predicting a reduction in renal function. Overall 35, 26 and 45 patients underwent partial nephrectomy with open, laparoscopic and robotic approaches, respectively. Mean ± SD contact surface area was 30.7±26.1 cm(2) and median (IQR) R.E.N.A.L. score was 7 (2.25). Spearman correlation analysis showed that contact surface area was significantly associated with estimated blood loss (p=0.04), operative time (p=0.04) and percent change in estimated glomerular filtration rate (p contact surface area and R.E.N.A.L. score independently affected percent change in estimated glomerular filtration rate (p contact surface area was a better independent predictor of a greater than 10% change in estimated glomerular filtration rate compared to R.E.N.A.L. score (AUC 0.86 vs 0.69). Using this simple mathematical method, contact surface area was associated with surgical outcomes. Compared to R.E.N.A.L. score, contact surface area was a better predictor of functional change after partial nephrectomy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Application of modified R.E.N.A.L. nephrometry score system in evaluating the retroperitoneal partial nephrectomy for T1 renal cell carcinoma.

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Wang, Qinzhang; Qian, Biao; Li, Qiang; Ni, Zhao; Li, Yinglong; Wang, Xinmin

2015-01-01

This study aims to investigate the application of the modified R.E.N.A.L. nephrometry score system in evaluating the operation difficulty of retroperitoneal partial nephrectomy in T1 renal cell carcinoma patients. A total of 52 patients with T1 renal cell carcinoma were enrolled. They all had retroperitoneal partial nephrectomy. Their clinical data was retrospectively analyzed. R.E.N.A.L. nephrometry score system was modified based on the features of retroperitoneal partial nephrectomy. The specificity, sensitivity and Youden index were compared between R.E.N.A.L. nephrometry score system and the modified R.E.N.A.L. nephrometry score system. The effect of the modified R.E.N.A.L. nephrometry score system on perioperative outcomes was analyzed. Three degrees of operation difficulty were defined by the modified R.E.N.A.L. nephrometry score system, which included the low, medium and high degree of operation difficulty. The specificity, sensitivity and Youden index of the modified R.E.N.A.L. nephrometry score system were better than those of the original R.E.N.A.L. nephrometry score system. Compared with low degree of operation difficulty, patients with medium and high degree of operation difficulty had significantly higher levels of operative time, warm ischemia time, and intraoperative blood loss (P system has a good effect in evaluating the operation difficulty of retroperitoneal partial nephrectomy.

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy.

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Zhang, Ruiyun; Wu, Guangyu; Huang, Jiwei; Shi, Oumin; Kong, Wen; Chen, Yonghui; Xu, Jianrong; Xue, Wei; Zhang, Jin; Huang, Yiran

2017-06-06

The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p renal function outcome after laparoscopic partial nephrectomy.

[Comparison of validity and safety between holmium: YAG laser and traditional surgery in partial nephrectomy].

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Bi, Sheng; Xia, Ming

2015-08-11

To compare the validity and safety between holmium: YAG laser and traditional surgery in partial nephrectomy. A total of 28 patients were divided into two groups (holmium: YAG laser group without renal artery clamping and traditional surgery group with renal artery clamping). The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were recorded. The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were 80 ml, 77 min, 0 min, 7.4 days, 35 ml/min, 0, 0.9 cm, respectively, in holmium: YAG laser group. And in traditional surgery group were 69 ml, 111 min, 25.5 min, 7.3 days, 34 ml/min, 0, 2.0 cm, respectively. The differences of total operative time, renal artery clamping time and depth of tissue injury between two groups were statistically significant. The others were not statistically significant. Holmium: YAG laser is effective and safe in partial nephrectomy. It can decrease the total operative time, minimize the warm ischemia time and enlarge the extent of surgical excision.

Cost comparison of open and robotic partial nephrectomy using a short postoperative pathway.

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Mano, Roy; Schulman, Ariel; Hakimi, A Ari; Sternberg, Itay A; Bernstein, Melanie; Bochner, Bernard H; Coleman, Jonathan A; Russo, Paul

2015-03-01

To compare immediate perioperative direct costs of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), managed under a common care pathway. Retrospective review of detailed institutional cost data for patients treated with OPN and RPN during 2011 was conducted. Cost and clinical data of OPN and RPN were compared for all patients and for patients stratified by length of stay (LOS), American Society of Anesthesiologists (ASA), and RENAL nephrometry scores. The study cohort included 190 OPN and 63 RPN cases. OPN was associated with higher ASA scores (P days (2-3 days) for OPN compared with 1 day (1-2 days) for RPN (P cost of OPN was lower than that of RPN with a difference of $3091 (P costs were higher in OPN, surgical costs were higher in RPN ($854 and $3695 difference in median costs, respectively; P cost of OPN for patients with an above-average LOS remained lower than that of RPN ($2680 difference in median costs; P = .001). RPN costs remained significantly higher when stratifying patients by their ASA and RENAL nephrometry scores. Despite the shorter hospital LOS associated with RPN, the immediate perioperative cost of OPN was lower than that of RPN for patients managed under a common care pathway, mainly due to high robotic purchase and maintenance costs. In light of the current health care debate, such financial disincentives may compromise the sustainability of advances in medical technology. Copyright © 2015 Elsevier Inc. All rights reserved.

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

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Homayoun Zargar

2014-12-01

Full Text Available Purpose To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group and those without (NC-group. Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak. Results A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases. Five hundred twenty eight patients (51.8% were in the C-group, whereas 491 of them (48.2% in the NC-group. Urine leak occurred in 31(3% cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001. Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01, surgeon’s early operative experience (OR=7.8; p<0.01 and preoperative moderate to severe CKD (OR=3.1; p<0.01 significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.

Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

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Gupta, Nakul; Patel, Anish; Ensor, Joe; Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael; Matin, Surena; Gupta, Sanjay

2017-01-01

PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

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Gupta, Nakul [Houston Methodist Hospital (United States); Patel, Anish [The University of Texas Southwestern Medical Center (United States); Ensor, Joe [Houston Methodist Research Institute, The Houston Methodist Cancer Center (United States); Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States); Matin, Surena [The University of Texas MD Anderson Cancer Center, Department of Urology (United States); Gupta, Sanjay, E-mail: sgupta@mdanderson.org [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States)

2017-02-15

PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

Hilar Parenchymal Oversew: a novel technique for robotic partial nephrectomy hilar tumor renorrhaphy.

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Chavali, Jaya Sai S; Nelson, Ryan; Maurice, Matthew J; Kara, Onder; Mouracade, Pascal; Dagenais, Julien; Reese, Jeremy; Bayona, Pilar; Haber, Georges-Pascal; Stein, Robert J

2018-01-01

A renorrhaphy technique which is effective for hemostasis but does not place undue tension on the branch vessels of the renal sinus remains one of the challenging steps after hilar tumor resection during robotic partial nephrectomy (RPN). The published V-hilar suture (VHS) technique is one option for reconstruction after an RPN involving the hilum. The objective of this video is to show a novel renorrhaphy technique, Hilar Parenchymal Oversew that has been effective for such cases. We present two cases of RPN for renal hilar tumors. The first case depicts use of the VHS renorrhaphy technique for a tumor that abuts the renal hilum along 20% of its diameter. The second case demonstrates tumor resection and reconstruction for a tumor that has >50% involvement of the hilum along its diameter. After tumor resection, individual sinus vessels can be selectively oversewn with 2-0 Vicryl suture on SH needle. The remaining exposed parenchyma is controlled using the Hilar Parenchymal Oversew technique with a #0 Vicryl on CT-1 needle. For the Hilar Parenchymal Oversew surgery operative time was 225 min, estimated blood loss was 140 ml, warm ischemia time was 19 minutes, and there were no intraoperative complications. Pathology was consistent with clear cell renal cancer with negative margins. Robotic partial nephrectomy with the Hilar Parenchymal Oversew technique is a good alternative to VHS renorrhaphy in the management of renal hilar tumors "bulging" into the renal sinus with >50% of the tumor diameter abutting the hilum. Copyright® by the International Brazilian Journal of Urology.

Partial nephrectomy online: a preliminary evaluation of the quality of health information on the Internet.

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Fast, Angela M; Deibert, Christopher M; Boyer, Celia; Hruby, Gregory W; McKiernan, James M

2012-12-01

What's known on the subject? and What does the study add? Patients are highly likely to access the Internet for health information, and studies have reported that inaccurate or low-quality information may alter patients' expectations and negatively impact informed decision-making. In a unique collaboration with the Health On the Internet (HON) Foundation, we evaluated the top 20 search results for the urology search term 'partial nephrectomy,' and identified the highest and lowest scoring criteria to increase awareness of areas of concern and improvement. To further evaluate the quality of information available on the Internet with regard to the management of localized renal cancer, we evaluated websites providing information on 'partial nephrectomy' in conjunction with the Health On the Internet (HON) Foundation. Many patients now utilize the Internet as a resource to provide further information on disease, treatments and outcomes, and health information on the Internet is largely unregulated. Inaccurate information may contribute to unrealistic expectations and dissatisfied patients. A google.com search identified the top 30 websites for the search term 'partial nephrectomy'. The HON Foundation evaluated each website according to the eight principles for Health on the Internet code of conduct (HONcode) certification and reported the overall frequency of certification, as well as individual website compliance with each of the principles. Overall, seven (23.3%) of 30 websites met the requirements of HONcode certification and an additional two (6.7%) websites were under review to maintain their certification based on updating their resources. The remaining 21 (70%) websites did not meet the standards for certification. The lowest performing criteria included proper citation of medical information and a clear distinction of advertising from editorial content. The low rate of HONcode compliance for these websites illustrates the poor quality of information that

Retroperitoneal Laparoscopic Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1 Renal Hilar Tumor: Comparison of Perioperative Characteristics and Short-Term Functional and Oncologic Outcomes.

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Yang, Chuance; Wang, Zhenlong; Huang, Shanlong; Xue, Li; Fu, Delai; Chong, Tie

2018-04-18

To present our single-center experience with retroperitoneal laparoscopic partial nephrectomy (LPN) and retroperitoneal laparoscopic radical nephrectomy (LRN) for T1 renal hilar tumors and evaluate which one is better. A retrospective review of 63 patients with hilar tumors undergoing retroperitoneal LPN or LRN was performed. The perioperative characteristics, change in estimated glomerular filtration rate (eGFR) from baseline to month 3, and oncologic outcomes were summarized. In total, 25 patients underwent LPN, and 38 patients underwent LRN. The mean tumor size in the LPN and LRN groups was 4.5 and 4.9 cm, respectively. The mean operation time was longer in the LPN group than that in the LRN group (212.5 minutes versus 160.7 minutes, respectively; P  .05). In experienced hands, although retroperitoneal LRN can result in shorter operation times and shorter lengths of stay, retroperitoneal LPN can preserve renal function better than LRN. Retroperitoneal LPN should be the priority in selected patients with T1 renal hilar tumors, especially for patients with renal insufficiency.

Impact of Renal Hilar Control on Outcomes of Robotic Partial Nephrectomy: Systematic Review and Cumulative Meta-analysis.

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Cacciamani, Giovanni E; Medina, Luis G; Gill, Tania S; Mendelsohn, Alec; Husain, Fatima; Bhardwaj, Lokesh; Artibani, Walter; Sotelo, Renè; Gill, Inderbir S

2018-02-05

During robotic partial nephrectomy (RPN), various techniques of hilar control have been described, including on-clamp, early unclamping, selective/super-selective clamping, and completely-unclamped RPN. To evaluate the impact of various hilar control techniques on perioperative, functional, and oncological outcomes of RPN for tumors. We conducted a systematic literature review and meta-analysis of all comparative studies on various hilar control techniques during RPN using PubMed, Scopus, and Web of Science according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement, and Methods and Guide for Effectiveness and Comparative Effectiveness Review of the Agency for Healthcare Research and Quality. Cumulative meta-analysis of comparative studies was conducted using Review Manager 5.3. Of 987 RPN publications in the literature, 19 qualified for this analysis. Comparison of off-clamp versus on-clamp RPN (n=9), selective clamping versus on-clamp RPN (n=3), super selective clamping versus on-clamp RPN (n=5), and early unclamped versus on-clamp (n=3) were reported. Patients undergoing RPN using off-clamp, selective/super selective, or early unclamp techniques had higher estimated blood loss compared with on-clamp RPN (weight mean difference [WMD]: 47.83, p=0.000, WMD: 41.06, p=0.02, and WMD: 37.50, p=0.47); however, this did not seem clinically relevant, since transfusion rates were similar (odds ratio [OR]: 0.98, p=0.95, OR: 0.72, p=0.7, and OR: 1.36, p=0.33, respectively). All groups appeared similar with regards to hospital stay, transfusions, overall and major complications, and positive cancer margin rates. Short- and long-term renal functional outcomes appeared superior in the off-clamp and super selective clamp groups compared with the on-clamp RPN cohort. Off-clamp, selective/super selective clamp, and early unclamp hilar control techniques are safe and feasible approaches for RPN surgery, with similar perioperative and oncological

Unilateral Partial Nephrectomy with Warm Ischemia Results in Acute Hypoxia Inducible Factor 1-Alpha (HIF-1α and Toll-Like Receptor 4 (TLR4 Overexpression in a Porcine Model.

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Zhiyong Zhang

Full Text Available Ischemia/reperfusion (I/R during partial nephrectomy (PN contributes to acute kidney injury (AKI, which is inaccurately assessed using existent clinical markers of renal function. We evaluated I/R-related changes in expression in hypoxia inducible factor 1α (HIF-1α and toll-like receptor 4 (TLR4, within kidney tissue and peripheral blood leukocytes (PBL in a porcine model of PN.Three adult pigs each underwent unilateral renal hilar cross clamping for 180 min followed by a 15 min reperfusion. The contralateral kidney served as control. Biopsies of clamped kidneys were obtained at baseline (time 0, every 60 min during the hypoxic phase, and post-reperfusion. Control kidneys were biopsied once at 180 min. Peripheral blood was sampled at time 0, every 30 min during the hypoxic phase, and post-reperfusion. HIF-1α and TLR4 expression in kidney tissue and PBL were analyzed by Western blotting. I/R-related histological changes were assessed.Expression of HIF-1α in clamped kidneys and PBL was below detection level at baseline, rising to detectable levels after 60 min of hypoxia, and continuing to rise throughout the hypoxic and reperfusion phases. Expression of TLR-4 in clamped kidneys followed a similar trend with initial detection after 30-60 min of hypoxia. Control kidneys exhibited no change in HIF-1α or TLR-4 expression. I/R-related histologic changes were minimal, primarily mild tubular dilatation.In a porcine model of PN, HIF-1α and TLR4 exhibited robust, I/R-related increases in expression in kidney tissue and PBL. Further studies investigating these molecules as potential markers of AKI are warranted.

Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome

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Bilal Chughtai

2008-01-01

Full Text Available Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway. Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD. Defined goals are (1 ambulation and liquid diet on the evening of the operative day; (2 out of bed (OOB at least 4 times on POD 1; (3 removal of Foley catheter on the morning of POD 2; (4 removal of Jackson Pratt drain on the afternoon of POD 2; (4 discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway. Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61% out of 36 fast track patients and 4 (16% out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days; P = .012. Age (median, 55 versus 57 years, tumor size (median, 2.5 versus 2.5 cm, readmission within 30 days (5.5% versus 5.1%, and complications (10.2% versus 13.8% were similar in the fast track patients and control, respectively. Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

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Flacke, Sebastian, E-mail: Sebastian.Flacke@lahey.org [Lahey Clinic, Tuft University Medical School, Department of Radiology (United States); Harty, Niall J.; Laskey, Daniel H.; Moinzadeh, Alireza [Lahey Clinic, Tuft University Medical School, Department of Urology (United States); Benn, James A. [Pluromed Inc (United States); Villani, Rosanna [DaVinci Biomedical Research Products (United States); Kalra, Aarti [Lahey Clinic, Tuft University Medical School, Department of Pathology (United States); Libertino, John A.; Madras, Peter N. [Lahey Clinic, Tuft University Medical School, Department of Urology (United States)

2012-10-15

Purpose: To determine whether reversible blood flow interruption to a randomly chosen target region of the kidney may be achieved with the injection of a reverse thermoplastic polymer through an angiographic catheter, thereby facilitating partial nephrectomy without compromising blood flow to the remaining kidney or adding risks beyond those encountered by the use of hilar clamping. Methods: Fifteen pigs underwent partial nephrectomy after blood flow interruption by vascular cross-clamping or injection of polymer (Lumagel Trade-Mark-Sign ) into a segmental artery. Five animals were euthanized after surgery (three open and two laparoscopic resection, cross-clamping n = 2), and 10 (open resection, cross-clamping n = 4) were euthanized after 6 weeks' survival. Blood specimens were obtained periodically, and angiogram and necropsy were performed at 6 weeks. Results: Selective renal ischemia was achieved in all cases. Surgical resection time averaged 9 and 24.5 min in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an accessory renal artery was originally overlooked. Reversal of the polymer to a liquid state was consistent angiographically and visually in all cases. Time to complete flow return averaged 7.4 and 2 min for polymer and clamping, respectively. Angiography at 6 weeks revealed no evidence of vascular injury. Laboratory data and necropsies revealed no differences between animals undergoing vascular clamping or polymer injection. Conclusion: Lumagel was as effective as vascular clamping in producing a near bloodless operative field for partial nephrectomy while maintaining flow to the uninvolved portion of the affected kidney.

Clinical application of calculated split renal volume using computed tomography-based renal volumetry after partial nephrectomy: Correlation with technetium-99m dimercaptosuccinic acid renal scan data.

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Lee, Chan Ho; Park, Young Joo; Ku, Ja Yoon; Ha, Hong Koo

2017-06-01

To evaluate the clinical application of computed tomography-based measurement of renal cortical volume and split renal volume as a single tool to assess the anatomy and renal function in patients with renal tumors before and after partial nephrectomy, and to compare the findings with technetium-99m dimercaptosuccinic acid renal scan. The data of 51 patients with a unilateral renal tumor managed by partial nephrectomy were retrospectively analyzed. The renal cortical volume of tumor-bearing and contralateral kidneys was measured using ImageJ software. Split estimated glomerular filtration rate and split renal volume calculated using this renal cortical volume were compared with the split renal function measured with technetium-99m dimercaptosuccinic acid renal scan. A strong correlation between split renal function and split renal volume of the tumor-bearing kidney was observed before and after surgery (r = 0.89, P volumetry had a strong correlation with the split renal function measured using technetium-99m dimercaptosuccinic acid renal scan. Computed tomography-based split renal volume measurement before and after partial nephrectomy can be used as a single modality for anatomical and functional assessment of the tumor-bearing kidney. © 2017 The Japanese Urological Association.

Commentary on "a matched comparison of perioperative outcomes of a single laparoscopic surgeon versus a multisurgeon robot-assisted cohort for partial nephrectomy." Ellison JS, Montgomery JS, Wolf Jr JS, Hafez KS, Miller DC, Weizer AZ, Department of Urology, University of Michigan, Ann Arbor, MI, USA: J Urol 2012;188(1):45-50.

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Kane, Christopher

2013-02-01

Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared. All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications. Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively). Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot

Review of laparoscopic partial nephrectomy in the treatment of renal tumors, T1 stadium in adults; Revision de la nefrectomia parcial laparoscopica en el tratamiento de los tumores renales, estadio T1 en adultos

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Zamora Montes de Oca, Maria Jose

2012-07-01

The T1 renal cancer in adults is made known; incidence, characteristics and management. Renal cell carcinoma has been the most common malignancy of the kidney, percentage is close to three percent of solid tumors of adults. The treatments for this tumor are analyzed: open radical nephrectomy, laparoscopic radical nephrectomy, open partial nephrectomy and laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy has represented an alternative option acceptable, safely and with good oncological and surgical outcomes for patients, as it is used to conserve nephrons and simultaneously to resect the tumor of a complete form promoting in the future the patient present a good renal function. Additionally, a adequate oncological control has reduced the risk of submit postoperative renal failure. An evolution of laparoscopic partial nephrectomy is presented determining the procedure for renal tumors in state T1 in the adults [Spanish] El cancer renal T1 en adultos es dado a conocer; su incidencia, caracteristicas y manejo. El carcinoma de celulas renales ha sido la malignidad mas comun de los rinones, su porcentaje se acerca al tres porciento de los tumores solidos de los adultos. Los tratamientos para combatir ese tumor son analizados: nefrectomia radical abierta, nefrectomia radical laparoscopica, nefrectomia parcial abierta y nefrectomia parcial laparoscopica. La nefrectonomia parcial laparoscopica ha representado una opcion alternativa aceptable, segura y con buenos resultados oncologicos y quirurgicos para los pacientes, ya que es utilizada para conservar nefronas y a la vez poder resecar el tumor de una forma completa promoviendo en el futuro que el paciente presente un buen funcionamiento renal. Ademas, un adecuado control oncologico ha reducido el riesgo de presentar insuficiencia renal postoperatoria. Una evolucion de la nefrectonomia parcial laparoscopica es presentada determinando el procedimiento para tumores renales en estado T1 en los adultos.

Augmented reality during robot-assisted laparoscopic partial nephrectomy: toward real-time 3D-CT to stereoscopic video registration.

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Su, Li-Ming; Vagvolgyi, Balazs P; Agarwal, Rahul; Reiley, Carol E; Taylor, Russell H; Hager, Gregory D

2009-04-01

To investigate a markerless tracking system for real-time stereo-endoscopic visualization of preoperative computed tomographic imaging as an augmented display during robot-assisted laparoscopic partial nephrectomy. Stereoscopic video segments of a patient undergoing robot-assisted laparoscopic partial nephrectomy for tumor and another for a partial staghorn renal calculus were processed to evaluate the performance of a three-dimensional (3D)-to-3D registration algorithm. After both cases, we registered a segment of the video recording to the corresponding preoperative 3D-computed tomography image. After calibrating the camera and overlay, 3D-to-3D registration was created between the model and the surgical recording using a modified iterative closest point technique. Image-based tracking technology tracked selected fixed points on the kidney surface to augment the image-to-model registration. Our investigation has demonstrated that we can identify and track the kidney surface in real time when applied to intraoperative video recordings and overlay the 3D models of the kidney, tumor (or stone), and collecting system semitransparently. Using a basic computer research platform, we achieved an update rate of 10 Hz and an overlay latency of 4 frames. The accuracy of the 3D registration was 1 mm. Augmented reality overlay of reconstructed 3D-computed tomography images onto real-time stereo video footage is possible using iterative closest point and image-based surface tracking technology that does not use external navigation tracking systems or preplaced surface markers. Additional studies are needed to assess the precision and to achieve fully automated registration and display for intraoperative use.

Robotic retroperitoneal partial nephrectomy: a step-by-step guide.

Science.gov (United States)

Ghani, Khurshid R; Porter, James; Menon, Mani; Rogers, Craig

2014-08-01

To describe a step-by-step guide for successful implementation of the retroperitoneal approach to robotic partial nephrectomy (RPN) PATIENTS AND METHODS: The patient is placed in the flank position and the table fully flexed to increase the space between the 12th rib and iliac crest. Access to the retroperitoneal space is obtained using a balloon-dilating device. Ports include a 12-mm camera port, two 8-mm robotic ports and a 12-mm assistant port placed in the anterior axillary line cephalad to the anterior superior iliac spine, and 7-8 cm caudal to the ipsilateral robotic port. Positioning and port placement strategies for successful technique include: (i) Docking robot directly over the patient's head parallel to the spine; (ii) incision for camera port ≈1.9 cm (1 fingerbreadth) above the iliac crest, lateral to the triangle of Petit; (iii) Seldinger technique insertion of kidney-shaped balloon dilator into retroperitoneal space; (iv) Maximising distance between all ports; (v) Ensuring camera arm is placed in the outer part of the 'sweet spot'. The retroperitoneal approach to RPN permits direct access to the renal hilum, no need for bowel mobilisation and excellent visualisation of posteriorly located tumours. © 2014 The Authors. BJU International © 2014 BJU International.

The Role of Indocyanine Green for Robotic Partial Nephrectomy: Early Results, Limitations and Future Directions

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Zachary Klaassen

2014-07-01

Full Text Available The surgical management of small renal masses has continued to evolve, particularly with the advent of the robotic partial nephrectomy (RPN. Recent studies at high volume institutions utilizing near infrared imaging with indocyanine green (ICG fluorescent dye to delineate renal tumor anatomy has generated interest among robotic surgeons for improving warm ischemia times and positive margin rate for RPN. To date, early studies suggest positive margin rate using ICG is comparable to traditional RPN, however this technology improves visualization of the renal vasculature allowing selective clamping or zero ischemia. The precise combination of fluorescent compound, dose, and optimal tumor anatomy for ICG RPN has yet to be elucidated.

Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience.

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Zhu, Jundong; Jiang, Fan; Li, Pu; Shao, Pengfei; Liang, Chao; Xu, Aiming; Miao, Chenkui; Qin, Chao; Wang, Zengjun; Yin, Changjun

2017-09-11

To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumor of who have solitary kidney or contralateral kidney insufficiency. Nine patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and January 2017 were retrospectively analyzed. Clinical materials and parameters during and after the operation were summarized. Nineteen tumors were resected in nine patients and the operations were all successful. The operation time ranged from 100 to 180 min (125 min); clamping time of segmental renal artery was 10 ~ 30 min (23 min); the amount of blood loss during the operation was 120 ~ 330 ml (190 ml); hospital stay after the operation is 3 ~ 6d (5d). There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 13 renal clear cell carcinomas, two papillary carcinoma and four perivascular epithelioid cell tumors with negative margins from the 19 tumors. All patients were followed up for 3 ~ 60 months, and no local recurrence or metastasis was detected. At 3-month post-operation follow-up, the mean serum creatinine was 148.6 ± 28.1 μmol/L (p = 0.107), an increase of 3.0 μmol/L from preoperative baseline. For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the warm ischemia injury to the kidney and preserved the renal function effectively.

A multimodal imaging framework for enhanced robot-assisted partial nephrectomy guidance

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Halter, Ryan J.; Wu, Xiaotian; Hartov, Alex; Seigne, John; Khan, Shadab

2015-03-01

Robot-assisted laparoscopic partial nephrectomies (RALPN) are performed to treat patients with locally confined renal carcinoma. There are well-documented benefits to performing partial (opposed to radical) kidney resections and to using robot-assisted laparoscopic (opposed to open) approaches. However, there are challenges in identifying tumor margins and critical benign structures including blood vessels and collecting systems during current RALPN procedures. The primary objective of this effort is to couple multiple image and data streams together to augment visual information currently provided to surgeons performing RALPN and ultimately ensure complete tumor resection and minimal damage to functional structures (i.e. renal vasculature and collecting systems). To meet this challenge we have developed a framework and performed initial feasibility experiments to couple pre-operative high-resolution anatomic images with intraoperative MRI, ultrasound (US) and optical-based surface mapping and kidney tracking. With these registered images and data streams, we aim to overlay the high-resolution contrast-enhanced anatomic (CT or MR) images onto the surgeon's view screen for enhanced guidance. To date we have integrated the following components of our framework: 1) a method for tracking an intraoperative US probe to extract the kidney surface and a set of embedded kidney markers, 2) a method for co-registering intraoperative US scans with pre-operative MR scans, and 3) a method for deforming pre-op scans to match intraoperative scans. These components have been evaluated through phantom studies to demonstrate protocol feasibility.

Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes.

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Eyraud, Rémi; Long, Jean-Alexandre; Snow-Lisy, Devon; Autorino, Riccardo; Hillyer, Shahab; Klink, Joseph; Rizkala, Emad; Stein, Robert J; Kaouk, Jihad H; Haber, Georges-Pascal

2013-06-01

To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for hilar vs nonhilar tumors. The study retrospectively reviewed 364 patients with available computed tomography scans undergoing RAPN. Demographic data and perioperative outcomes results were compared between the hilar (group 1, n = 70) and nonhilar tumors (group 2, n = 294). Multivariate analysis was used to identify predictors of warm ischemia time (WIT), estimated blood loss (EBL), major perioperative complications, and postoperative renal function. There were no differences with respect to demographic variables. Hilar tumors had higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) scores (P hilar tumors were associated with greater operative time (210 vs 180 minutes, P hilar vs nonhilar patients on postoperative day 3 (70.12 vs 74.71 mL/min/1.73 m(2), P = .31) or at last follow-up (72.62 vs 75.78 mL/min/1.73 m(2), P = .40), respectively. Multivariate analysis found hilar location was independently associated with increased WIT without significant changes in EBL, major complications, or postoperative renal function. RAPN represents a safe and effective procedure for hilar tumors. Hilar location for patients undergoing RAPN in a high-volume institution seems not be associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparing renal function preservation after laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: using a 3D parenchyma measurement system.

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Zhu, Liangsong; Wu, Guangyu; Huang, Jiwei; Wang, Jianfeng; Zhang, Ruiyun; Kong, Wen; Xue, Wei; Huang, Yiran; Chen, Yonghui; Zhang, Jin

2017-05-01

To compare the renal function preservation between laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy. Data were analyzed from 246 patients who underwent laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for solitary cT1a renal cell carcinoma from January 2013 to July 2015. To reduce the intergroup difference, we used a 1:1 propensity matching analysis. The functional renal parenchyma volume preservation were measured preoperative and 12 months after surgery. The total renal function recovery and spilt GFR was compared. Multivariable logistic analysis was used for predictive factors for renal function decline. After 1:1 propensity matching, each group including 100 patients. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation had a smaller decrease in estimate glomerular filtration rate at 1 day (-7.88 vs -20.01%, p renal parenchyma volume preservation (89.19 vs 84.27%, p renal parenchyma volume preservation, warm ischemia time and baseline renal function were the important independent factors in determining long-term functional recovery. The laparoscopic radio frequency ablation assisted tumor enucleation technology has unique advantage and potential in preserving renal parenchyma without ischemia damage compared to conventional laparoscopic partial nephrectomy, and had a better outcome, thus we recommend this technique in selected T1a patients.

Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases.

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Dulabon, Lori M; Kaouk, Jihad H; Haber, Georges-Pascal; Berkman, Douglas S; Rogers, Craig G; Petros, Firas; Bhayani, Sam B; Stifelman, Michael D

2011-03-01

Minimally invasive approaches to partial nephrectomy have been rapidly gaining popularity but require advanced laparoscopic surgical skills. Renal hilar tumors, due to their anatomic location, pose additional technical challenges to the operating surgeon. We compared the outcomes of robot-assisted partial nephrectomy (RPN) for hilar and nonhilar tumors in our large multicenter contemporary series of patients. We retrospectively reviewed prospectively collected data on 446 consecutive patients who underwent RPN by renal surgeons experienced in minimally invasive techniques at four academic institutions from June 2006 to March 2010. Patients were stratified into two groups: those with hilar lesions and those with nonhilar lesions. Patient demographics, operative outcomes, and postoperative outcomes, including oncologic outcomes, were recorded. Forty-one patients (9%) had hilar renal masses; 405 patients (91%) had nonhilar masses. There was no statistical differences in patient demographics except for larger median tumor size in the hilar cohort (3.2 cm vs 2.6 cm; p=0.001). The only significant difference in operative outcomes was an increase in warm ischemia times for the hilar group versus the nonhilar group (26.3±7.4 min vs 19.6±10.0 min; p=<0.0001). There were no differences in postoperative outcomes; however, there was a trend for increased risk of malignancy and higher stage tumors in the hilar lesion group. Final pathologic margin status was similar in both groups. Only one patient in the nonhilar group had evidence of recurrence at 21 mo. The study was limited by the lack of standard anatomic classification of renal tumors and the potential influence of the surgeons' prior robotic experience. The data represent the largest series of its kind and strongly suggest that RPN is a safe, effective, and feasible option for the minimally invasive approach to renal hilar tumors with no increased risk of adverse outcomes compared with nonhilar tumors in the hands of

Who is at risk of death from nephrectomy? An analysis of thirty-day mortality after 21 380 nephrectomies in 3 years of the British Association of Urological Surgeons (BAUS) National Nephrectomy Audit.

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Fernando, Archie; Fowler, Sarah; Van Hemelrijck, Mieke; O'Brien, Tim

2017-09-01

To ascertain contemporary overall and differential thirty-day mortality (TDM) rates after all types of nephrectomy in the UK, and to identify potential new risk factors for death. We conducted a retrospective analysis of the 110 deaths that occurred within 30 days of surgery out of the total of 21 380 nephrectomies performed, and calculated the odds ratio (OR) and 95% confidence interval (CI) for TDM based on peri-operative characteristics. The overall TDM rate was 110/21380 (0.5%). The TDM rates after radical, partial, simple nephrectomy and nephro-ureterectomy were 0.6% (63/11057), 0.1% (4/3931), 0.4% (11/2819) and 0.9% (28/3091), respectively. TDM increased with age, stage, estimated blood loss (EBL), operating time and performance status. EBL of 1-2 L was associated with a greater risk of TDM than EBL of 2-5 L (OR 1.38; 95% CI 1.03-2.24). Conversion from minimally invasive surgery was associated with higher risk than non-conversion (OR 2.53; 95% CI 1.14-4.51. Curative surgery was safer than cytoreductive surgery (OR 0.31; 95% CI 0.18-0.54). There was an association between surgical volume and TDM. This study provides contemporary insights into the true risks of all types of nephrectomy. The TDM rate after nephrectomy in the UK appears acceptably low at 0.5%. Established risk factors were confirmed and the following novel risk factors were identified: modest EBL (1-2 L) and conversion from minimally invasive surgery. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Impact of arterial occlusion during partial nephrectomy on residual renal function. An evaluation with {sup 99m}technetium-dimercaptosuccinic acid scintigraphy

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Kondo, Tsunenori; Nakazawa, Hayakazu; Ito, Fumio; Onitsuka, Shiro; Ryoji, Osamu; Yago, Rie; Hashimoto, Yasunobu; Toma, Hiroshi [Tokyo Women' s Medical Coll. (Japan)

2002-08-01

Partial nephrectomy (PNx) has been performed with temporary renal arterial occlusion and in situ renal hypothermia (conventional PNx). However, the impact of temporary renal arterial occlusion on residual renal function has not been well assessed. To address this question, we performed renal scintigraphy with {sup 99m}technetium-dimercaptosuccinic acid (DMSA) for the quantitative measurement of postoperative residual renal function after conventional PNx and partial nephrectomy without arterial occlusion (non-clamping PNx). Thirty-four patients underwent postoperative DMSA scintigraphy after PNx for renal cell carcinoma. No obvious difference in preoperative renal function between the diseased kidney and the contralateral kidney was found in any of the patients. Of these patients, 24 underwent conventional PNx, and 10 underwent non-clamping PNx. Residual renal function was evaluated using the relative DMSA uptake of the operated kidney. The relative DMSA uptake of the operated kidney was 39.9{+-}7.3% (25.1-58.8) after conventional PNx compared to 34.8{+-}8.9% (13.5-45.5) after non-clamping PNx. This difference was not statistically significant (P=0.15). Total ischemic time during conventional PNx had no adverse influence on the residual renal function. In the analysis of the other determinant factors influencing residual renal function, tumor size was the only significant factor that inversely correlated with the relative DMSA uptake. Our results showed that arterial clamping during PNx has no negative impact on the functional residual capacity as long as in situ renal hypothermia is adequately performed. (author)

Visual Enhancement of Laparoscopic Partial Nephrectomy With 3-Charge Coupled Device Camera: Assessing Intraoperative Tissue Perfusion and Vascular Anatomy by Visible Hemoglobin Spectral Response

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2010-10-01

reliably distinguish vascular structures during hilar dissection, and detect and monitor changes in renal tissue perfus:ion dw·ing and after warm...and in 25 patients with hilar tu- mors 16 in whom perioperative outcomes were com- parable to those of peripheral tumors. In a retro- spective study...Richstone et al also reported the safe performance of LPN for hilar tumors in 17 patients.17 Repeat partial nephrectomy for ipsilat- eral tumor has

Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes.

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Di Pierro, G B; Tartaglia, N; Aresu, L; Polara, A; Cielo, A; Cristini, C; Grande, P; Gentile, V; Grosso, G

2014-06-01

To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. Mean (range) age of patients was 45.3 years (38.2-64.1), tumor size 1.6 cm (1.2-2.0), warm ischemia time 24 min (19-32), operative time 140 min (110-200) and estimated blood loss 270 ml (100-750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15-43). In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

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Jose M. Cabello

2009-04-01

Full Text Available INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy?

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Khene, Zine-Eddine; Peyronnet, Benoit; Bosquet, Elise; Pradère, Benjamin; Robert, Corentin; Fardoun, Tarek; Kammerer-Jacquet, Solène-Florence; Verhoest, Grégory; Rioux-Leclercq, Nathalie; Mathieu, Romain; Bensalah, Karim

2017-10-01

To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time Training fellows to perform RAPN is associated with longer operating time and WIT but does not appear to compromise other peri-operative outcomes. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center.

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Vartolomei, Mihai Dorin; Matei, Deliu Victor; Renne, Giuseppe; Tringali, Valeria Maria; Crisan, Nicolae; Musi, Gennaro; Mistretta, Francesco Alessandro; Russo, Andrea; Cozzi, Gabriele; Cordima, Giovani; Luzzago, Stefano; Cioffi, Antonio; Di Trapani, Ettore; Catellani, Michele; Delor, Maurizio; Bottero, Danilo; Imbimbo, Ciro; Mirone, Vincenzo; Ferro, Matteo; de Cobelli, Ottavio

2017-10-27

Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of

Robotic partial nephrectomy with intracorporeal renal hypothermia using ice slush.

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Kaouk, Jihad H; Samarasekera, Dinesh; Krishnan, Jayram; Autorino, Riccardo; Acka, Oktay; Brando, Luis Felipe; Laydner, Humberto; Zargar, Homayoun

2014-09-01

To outline our technique for intracorporeal cooling with ice slush during robotic partial nephrectomy (RPN), with real-time parenchymal temperature monitoring. Eleven consecutive patients with enhancing solid renal masses suitable for treatment with RPN between September 2013 and January 2014 were included in the analysis. Institutional review board approval and informed consent were obtained. Preoperative patient characteristics, intraoperative surgical parameters including patient body temperature and ipsilateral kidney temperature with real-time monitoring, and short-term functional outcomes were analyzed. Median age was 55 years (range, 39-75 years) and American Society of Anesthesiologists score was 3 (range, 2-4). Median tumor size was 4 cm (range, 2.3-7.1) and RENAL nephrometry score was 9 (range, 5-11). One patient had a solitary kidney. During cooling, the lowest median renal parenchymal temperature was 17.05°C (range, 11°C-26°C) and cold ischemia time was 27.17 minutes (range, 18-49 minutes). Median time to latest postoperative estimated glomerular filtration rate was 12 days (range, 2-30 days). Median glomerular filtration rate preservation was 81% (range, 47.9%-126%). There was one positive margin. There were no postoperative complications, and no patients experienced a prolonged ileus. The limitations of this study include a small number of patients and short-term follow-up. RPN with renal hypothermia using intracorporeal ice slush is technically feasible. Our simplified method of introducing the ice slush was free of complications and highly reproducible. The use of a needle temperature probe allowed us to monitor in real time cooling of the renal parenchyma. Copyright © 2014 Elsevier Inc. All rights reserved.

Laparoscopic partial nephrectomy for hilar tumors: oncologic and renal functional outcomes.

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George, Arvin K; Herati, Amin S; Rais-Bahrami, Soroush; Waingankar, Nikhil; Kavoussi, Louis R

2014-01-01

To present our experience with laparoscopic partial nephrectomy (LPN) for hilar tumors and evaluate intermediate oncologic and renal functional outcomes. A retrospective review of LPN cases performed in 488 patients was performed. Hilar lesions were defined as renal cortical tumors in direct physical contact with the renal artery, vein, or both, as identified on preoperative imaging and confirmed intraoperatively. The clinicopathologic parameters, perioperative course, complications, and oncologic and 6-month renal functional outcomes were analyzed. A total of 488 patients underwent LPN, of which 43 were hilar. The mean tumor size for hilar and nonhilar tumors was 3.6 cm and 3.1 cm, respectively. The mean operative time was shorter for hilar as compared with nonhilar tumors (129.1 minutes vs 141.8 minutes). Mean estimated blood loss was greater in LPN for hilar tumors (311.65 mL vs 298.4 mL). There were no statistically significant differences noted in any of the perioperative parameters investigated despite a higher nephrometry complexity score in the hilar group. Change in estimated glomerular filtration rate at 6 months showed a decrease of 10.9 mL/min and 8.8 mL/min for hilar and nonhilar tumors, respectively (P = NS). There was 1 recurrence detected in the hilar group, with a median follow-up of 41.6 months. In the hands of an experienced laparoscopist, LPN can safely be performed for hilar tumors, with preservation of perioperative outcomes and durable renal functional and oncologic outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of zero-ischaemia laparoscopic minimally invasive partial nephrectomy using the modified sequential preplaced suture renorrhaphy technique on long-term renal functions.

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Sönmez, Mehmet Giray; Kara, Cengiz

2017-09-01

Laparoscopic minimally invasive partial nephrectomy (MIPN) is the preferred technique in renal surgery, especially T1 phase kidney tumours, and it is recommended for the protection of renal functions in methods that do not involve ischaemia. To evaluate long-term renal functions of zero-ischaemia laparoscopic MIPN patients who underwent a modified sequential preplaced suture renorrhaphy technique. In a total of 17 renal units in 16 patients with kidney tumours that were determined incidentally and did not cause any complaints, the masses were extracted via laparoscopic partial nephrectomy (LPN) using the modified sequential preplaced suture renorrhaphy technique. Creatinine and estimated glomerular filtration rate (eGFR) values of the patients were measured preoperatively and on the first day and after 12 months postoperatively, and the results were compared. The differences between the pre- and postoperative values were statistically significant (p = 0.033, p = 0.045), but the changes in postoperative creatinine and eGFR values were clinically insignificant. While the differences between preoperative and first-day postoperative creatinine and eGFR values were found to be statistically significant (p = 0.039, p = 0.042, respectively), a statistically significant difference was not detected between preoperative and 12-month postoperative creatinine and eGFR values (p = 0.09, p = 0.065, respectively). The global percentage of functional recovery was measured as 92.5% on the first day and 95.9% at the 12 th month. The modified sequential preplaced suture renorrhaphy technique is an effective, reliable method for avoiding complications and preserving renal functions and nephrons in appropriate patients.

Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

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Achilles Ploumidis

2013-01-01

Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

Evolving practice patterns for the management of small renal masses in the USA.

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Yang, Glen; Villalta, Jacqueline D; Meng, Maxwell V; Whitson, Jared M

2012-10-01

What's known on the subject? and What does the study add? Treatment options for small renal masses include radical nephrectomy (RN), partial nephrectomy (PN), ablation, and surveillance. PN provides equivalent oncological as RN for small tumours, but long-term outcomes for ablation and surveillance are poorly defined. Due to changing techniques and technology, treatment patterns for small renal masses are rapidly developing. Prior studies had analysed utilisation trends for PN and RN to 2006, revealing a relative rise in the rate of PN. However, overall treatment trends including surveillance and ablation had not been studied using a population-based cohort. It has become increasingly clear that RN is associated with greater renal and cardiovascular deterioration than nephron-sparing treatments. Thus, it is important to understand current population-based practice patterns for the treatment of small renal masses to assess whether practitioners are adhering to ever-changing principles in this field. The present study provides up-to-date treatment trends in the USA using a large population-based cohort. To describe the changing practice patterns in the management of small renal masses, including the use of surveillance and ablative techniques. All patients in the Surveillance, Epidemiology and End Results (SEER) registry treated for renal masses of ≤7 cm in diameter, from 1998 to 2008, were included for analysis. Annual trends in the use of surveillance, ablation, partial nephrectomy (PN), and radical nephrectomy (RN) were calculated. Multinomial logistic regression was used to determine the association of demographic and clinical characteristics with treatment method. In all, 48 148 patients from 17 registry sites with a mean age of 63.4 years were included for analysis. Between 1998 and 2008, for masses of vs 50%, 16% vs 33%, respectively) and ablation (1% vs 11%, 2% vs 9%, respectively). In multivariable analysis, later year of diagnosis, male gender, being

Laparoscopic donor nephrectomy

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Gupta Nitin

2005-01-01

Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

Use of the Satinsky clamp for hilar clamping during robotic partial nephrectomy: indications, technique, and multi-center outcomes.

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Abdullah, Newaj; Rahbar, Haider; Barod, Ravi; Dalela, Deepansh; Larson, Jeff; Johnson, Michael; Mass, Alon; Zargar, Homayoun; Kaouk, Jihad; Allaf, Mohamad; Bhayani, Sam; Stifelman, Michael; Rogers, Craig

2017-03-01

A Satinsky clamp may be a backup option for hilar clamping during robotic partial nephrectomy (RPN) if there are challenges with application of bulldog clamps, but there are potential safety concerns. We evaluate outcomes of RPN using Satinsky vs. bulldog clamps, and provide tips for safe use of the Satinsky as a backup option. Using a multi-center database, we identified 1073 patients who underwent RPN between 2006 and 2013, and had information available about method of hilar clamping (bulldog clamp vs. Satinsky clamp). Patient baseline characteristics, tumor features, and perioperative outcomes were compared between the Satinsky and bulldog clamp groups. A Satinsky clamp was used for hilar clamping in 94 (8.8 %) RPN cases, and bulldog clamps were used in 979 (91.2 %) cases. The use of a Satinsky clamp was associated with greater operative time (198 vs. 175 min, p hilar clamping during challenging RPN cases, but requires careful technique, and was rarely necessary.

'Trifecta' outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis.

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Arora, Sohrab; Abaza, Ronney; Adshead, James M; Ahlawat, Rajesh K; Challacombe, Benjamin J; Dasgupta, Prokar; Gandaglia, Giorgio; Moon, Daniel A; Yuvaraja, Thyavihally B; Capitanio, Umberto; Larcher, Alessandro; Porpiglia, Francesco; Porter, James R; Mottrie, Alexander; Bhandari, Mahendra; Rogers, Craig

2018-01-01

To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien-Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m 2 (11.01%). Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

High-fidelity simulation-based team training in urology: evaluation of technical and nontechnical skills of urology residents during laparoscopic partial nephrectomy.

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Abdelshehid, Corollos S; Quach, Stephen; Nelson, Corey; Graversen, Joseph; Lusch, Achim; Zarraga, Jerome; Alipanah, Reza; Landman, Jaime; McDougall, Elspeth M

2013-01-01

The use of low-risk simulation training for resident education is rapidly expanding as teaching centers integrate simulation-based team training (SBTT) sessions into their education curriculum. SBTT is a valuable tool in technical and communication skills training and assessment for residents. We created a unique SBTT scenario for urology residents involving a laparoscopic partial nephrectomy procedure. Urology residents were randomly paired with a certified registered nurse anesthetists or an anesthesia resident. The scenario incorporated a laparoscopic right partial nephrectomy utilizing a unique polyvinyl alcohol kidney model with an embedded 3cm lower pole exophytic tumor and the high-fidelity SimMan3G mannequin. The Urology residents were instructed to pay particular attention to the patient's identifying information provided at the beginning of the case. Two scripted events occurred, the patient had an anaphylactic reaction to a drug and, after tumor specimen was sent for a frozen section, the confederate pathologist called into the operating room (OR) twice, first with the wrong patient name and subsequently with the wrong specimen. After the scenario was complete, technical performance and nontechnical performance were evaluated and assessed. A debriefing session followed the scenario to discuss and assess technical performance and interdisciplinary nontechnical communication between the team. All Urology residents (n = 9) rated the SBTT scenario as a useful tool in developing communication skills among the OR team and 88% rated the model as useful for technical skills training. Despite cuing to note patient identification, only 3 of 9 (33%) participants identified that the wrong patient information was presented when the confederate "pathologist" called in to report pathology results. All urology residents rated SBTT sessions as useful for the development of communication skills between different team members and making residents aware of unlikely but

Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy: A case report

Directory of Open Access Journals (Sweden)

Ömer Acar

2016-01-01

Conclusion: To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic.

Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique.

Science.gov (United States)

Giberti, Claudio; Gallo, Fabrizio; Schenone, Maurizio; Cortese, Pierluigi

2014-06-16

We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

Laparoscopic Donor Nephrectomy: Early Experience at a Single Center in Pakistan.

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Mohsin, Rehan; Shehzad, Asad; Bajracharya, Uspal; Ali, Bux; Aziz, Tahir; Mubarak, Muhammed; Hashmi, Altaf; Rizvi, Adibul Hasan

2018-04-01

Laparoscopic donor nephrectomy has become the criterion standard for kidney retrieval from living donors. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Pakistan. The objective of the study was to identify benefits and harms of using laparoscopic compared with open nephrectomy techniques for renal allograft retrieval. In this a retrospective study, patient files from May 2014 to September 2015 were analyzed. Patients were divided into 2 groups: those with open donor nephrectomy and those with laparoscopic donor nephrectomy. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time, perioperative and postoperative complications, surgery time, and length of hospital stay. Finally, serum creatinine patterns of both donors and recipients were analyzed. Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, USA). Of 388 total donors, 190 (49%) had open donor nephrectomy and 198 (51%) had laparoscopic donor nephrectomy. For both groups, most donors were older than 25 years with male preponderance. Left-to-right kidney donation ratio was markedly higher in the laparoscopic group than in the open donor nephrectomy group, with 6 cases of double renal artery also included in this study. There were no significant differences in surgery times between the 2 groups, whereas the laparoscopic donor nephrectomy group had shorter hospital stay. Analgesic requirements were markedly shorter in the laparoscopic donor nephrectomy group. The 1-year graft function was not significantly different between the 2 groups. The results for laparoscopic donor nephrectomy were comparable to those for open donor nephrectomy, and its acceptability was high. Laparoscopic donor nephrectomy should be the preferred approach for procuring the kidney graft.

Relief of chronic partial ureteral obstruction attenuates salt-sensitive hypertension in rats

DEFF Research Database (Denmark)

Carlström, M.; Wåhlin, N.; Skøtt, Ole

2007-01-01

shown that animals with chronic partial unilateral ureteral obstruction develop salt-sensitive hypertension. In this study, the effects of ipsilateral and contralateral nephrectomy and ureterovesicostomy on blood pressure were studied in hydronephrotic animals. METHODS: Partial unilateral ureteral...... obstruction was created in 3-week-old male Sprague-Dawley rats and blood pressure was measured telemetrically 4-6 weeks later during a normal and high salt diet before and after uninephrectomy or ureterovesicostomy. Plasma samples for renin assay were collected during both diets before and after ipsilateral...... nephrectomy. RESULTS: All hydronephrotic animals developed salt-sensitive hypertension, of different degrees. Before nephrectomy the plasma renin concentration was significantly higher in the hydronephrotic animals than in controls (160 +/- 15 microGU mL(-1) vs. 96 +/- 12 microGU mL(-1), respectively...

Comparison of the significance of the RENAL, PADUA, and C-index nephrometric scales for the prediction of the complexity of laparoscopic nephrectomy

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Yu. G. Alyaev

2018-01-01

Full Text Available Objective: to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity  of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications.Materials and methods. Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 % cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm3. All patients before  the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL – 7.56 ± 1.12, on scale PADUA – 7.98 ± 1.55, on scale C-index – 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications.Results. In 265 (84.4 cases transperitoneal approach was perfomed and in 49 (15.6 % cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 % cases. Postoperative complications were estimated according to the Clavien–Dindo classification of surgical complications and were found in 31  (9.9 % cases, among them 12 (3.8 % patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic

Nephrectomy (Kidney Removal)

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... nephrectomy is needed because of other kidney diseases. Kidney function Most people have two kidneys — fist-sized ... and the disease that prompted the surgery? Monitoring kidney function Most people can function well with only ...

Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy

International Nuclear Information System (INIS)

Xu, Yi; Shao, Pengfei; Zhu, Xiaomei; Lv, Qiang; Liu, Wangyan; Xu, Hai; Zhu, Yinsu; Yang, Guangyu; Tang, Lijun; Yin, Changjun

2013-01-01

Aim: To evaluate the effectiveness of three-dimensional (3D) renal computed tomography angiography (CTA) in guiding segmental renal artery clamping during laparoscopic partial nephrectomy (LPN). Materials and methods: Forty-three patients with renal tumours undergoing renal CTA before LPN were retrospectively enrolled in this study. 3D arteriogram reconstructed images were created to identify the renal tumour-supplying arteries. The number and location of these targeted vessels were annotated on 3D images preoperatively and compared with the clamped vessels during LPN. The consistency between target vessels annotated at CTA and clamped arteries at LPN was compared both using a patient-based analysis and vessel-based analysis. The χ 2 test was applied to analyse the influence of tumour size, location, and growth pattern on the number of clamped segmental renal branches. Results: On patient-based analysis, the number of targeted vessels was consistent with the clamped vessels during LPN in 33 of 43 patients. On vessel-based analysis, 56 of 65 target vessels annotated at CTA were clamped during LPN. More segmental renal branches (p = 0.04) were clamped in patients with tumours of larger size. Tumour location and growth pattern had no association with the number of clamped segmental branches during LPN. Conclusion: High-quality CTA images and 3D reconstruction images can detect detailed information of tumour-supplying arteries to renal tumours. 3D renal CTA is an effective way to guide segmental renal artery clamping during LPN

Analysis of 88 nephrectomies in a rural tertiary care center of India

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Biswajit Datta

2012-01-01

Full Text Available Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.

Chylous ascites as a complication of left sided robot-assisted laparoscopic partial nephrectomy

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Gaurav Pahouja

2016-10-01

Full Text Available Objective: The aim of the study was to present a case series of the sparsely reported complication of chylous ascites (CA after left sided robot-assisted laparoscopic partial nephrectomy (RALPN, identify possible risk factors for the development of postoperative CA, and explore current recommendations for identification, management and prevention of CA. Material and methods: A retrospective review of patients that were treated with a RALPN during a one year time period (August 2012 to August 2013 by one surgeon at our institution was conducted. A total of 12 patients were included in the study. Demographics, tumor characteristics, and perioperative outcomes were assessed. Results: Three patients in the study experienced postoperative CA. All three patients had left sided surgery. The initial clinical suspicion for CA was raised due to complaints of abdominal pain with increased milky appearance of JP fluid. JP triglycerides were elevated in all three patients. The patients responded to conservative measures, with two patients treated with medium chain triglyceride diets and one patient treated with total parenteral nutrition (TPN. Among the patients treated with RALPN, the group that was diagnosed with postoperative CA (CA group was found to have a statistically significant lower average body mass index (BMI as compared to the group that did not have CA (non-CA group (24.67 kg/m2 in the CA group versus 31.77 kg/m2 in the non-CA group; P = 0.026. Other demographic data, tumor characteristics, and perioperative outcomes were similar in both groups. Conclusions: CA as a result of RALPN is a newly reported and rare postoperative complication. As utilization of RALPN continues to increase, urologists should be aware of this possible complication and be adept at diagnosing and managing CA. We suggest that left sided retroperitoneal surgery and a lower BMI preoperatively be considered risk factors for developing this complication.

National nephrectomy registries: Reviewing the need for population-based data.

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Pearson, John; Williamson, Timothy; Ischia, Joseph; Bolton, Damien M; Frydenberg, Mark; Lawrentschuk, Nathan

2015-09-01

Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.

TECHNIQUE OF EXTRACORPOREAL PARTIAL NEPHRECTOMY IN TERMS OF PHARMACO-COLD ISCHEMIA WITHOUT CROSSING THE URETER WITH RENAL VESSELS ORTHOTOPIC REPLANTATION IN PATIENTS WITH RENAL CELL CARCINOMA

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Alexander Gritskevitch

2015-01-01

Full Text Available Background. The most difficult is to determine medical tactics in patients with renal cell carcinoma (RCC with intraparenchimal and central localization in the single, the only functioning kidney, as well as with a combination of tumor and other illnesses in contralateral kidney. Partial nephrectomy leading to renal replacement therapy results in life-threatening complications and poor prognosis. The priority is to develop organ-preserving treatment: from minimally invasive endoscopic surgery to ex vivo kidney resection. Aim: to develop a technique of extracorporeal partial nephrectomy in terms of pharmaco-cold ischemia without crossing the ureter with renal vessels orthotopic replantation in patients with RCC. Materials and methods. The study included 37 patients with pT1a-T3vN0M0-1G1-3 RCC with intraparenchymal and central tumor location. The average age of the patients was 55.32 ± 13.1 years. The ratio of men and women - 2.7:1. Bilateral renal tumors were observed in 3 (8.1% patients, and the RCC of the single functioning kidney in 6 (16.2% patients. One patient (2.7% was diagnosed RCC of a single kidney with intraluminal invasion (cava-renal form. Results. The mean operation time was 413.97 ± 89.14 minutes. The mean warm ischemia time – 8.39 ± 4.75 minutes. Cold ischemia lasted from 70 to 240 minutes, on the average 151.41 ± 41.29 min. The amount of blood loss made up 729.03 ± 481.4 ml. Perioperative complications were detected in 3 (8.1% patients. In two cases after starting the renal blood flow the kidney was found to be nonviable and had to be removed. And in one case the recurrent prosthetic thrombosis of the renal artery resulted in a renal scarring. Postoperative complications were observed in 18 (48.6% patients. According to Clavien-Dindo classification there were 8 low grade (I-II degree complications (44.4%, 8 other of III degree, and one IV degree complication, and there was one lethal case (V degree. Conclusion

Intraoperative evaluation of renal blood flow during laparoscopic partial nephrectomy with a novel Doppler system.

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Mues, Adam C; Okhunov, Zhamshid; Badani, Ketan; Gupta, Mantu; Landman, Jaime

2010-12-01

Hemostasis remains a major challenge associated with laparoscopic renal surgery. We evaluated a cost-effective novel Doppler probe (DP) for assessment of vascular control during laparoscopic partial nephrectomy (LPN). We prospectively collected data during LPN procedures. We documented tumor location and size as well as subjective quality of the hilar dissection. The DP was compared with our standard intraoperative ultrasound system (SUS) for the ability to detect blood flow during hilar dissection and to determine parenchymal ischemia around the tumor after clamping of the renal vessels. Twenty patients underwent LPN by a single surgeon. The mean tumor size was 3.0 cm (range: 1.2-6.3 cm). The times to assess the kidney using the SUS and DP were 68.6 seconds (range: 20-155) and 44.5 seconds (range: 15-180), respectively. Evaluation prior to renal hilar clamping demonstrated the presence of blood flow in all 20 patients (100%) using the SUS and in 17 of 20 (85%) using the DP. Similarly, cessation of blood flow with clamping was documented in 100% of cases with SUS and 85% with DP. Persistent flow was detected by both SUS and DP in two patients requiring further dissection and reclamping. Then, both systems detected the absence of flow before tumor resection. With blood flow interruption confirmation, no patient had significant bleeding at the time of renal parenchymal transection. Intraoperative Doppler ultrasound technologies minimize the risk of significant bleeding during LPN. The DP is a small, simple, effective probe that can be used to assess blood flow interruption to the kidney during laparoscopic renal surgery.

Indications, Complications and Mortality of Nephrectomy in Tikur ...

African Journals Online (AJOL)

Background: Nephrectomy is a standard therapeutic urological procedure for malignancy of kidneys and upper urinary tract, and for damaged kidneys with little or no contribution to the overall renal function. There are geographical variations in indications for nephrectomy as certain urological diseases are more prevalent in ...

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Is simple nephrectomy truly simple? Comparison with the radical alternative.

Science.gov (United States)

Connolly, S S; O'Brien, M Frank; Kunni, I M; Phelan, E; Conroy, R; Thornhill, J A; Grainger, R

2011-03-01

The Oxford English dictionary defines the term "simple" as "easily done" and "uncomplicated". We tested the validity of this terminology in relation to open nephrectomy surgery. Retrospective review of 215 patients undergoing open, simple (n = 89) or radical (n = 126) nephrectomy in a single university-affiliated institution between 1998 and 2002. Operative time (OT), estimated blood loss (EBL), operative complications (OC) and length of stay in hospital (LOS) were analysed. Statistical analysis employed Fisher's exact test and Stata Release 8.2. Simple nephrectomy was associated with shorter OT (mean 126 vs. 144 min; p = 0.002), reduced EBL (mean 729 vs. 859 cc; p = 0.472), lower OC (9 vs. 17%; 0.087), and more brief LOS (mean 6 vs. 8 days; p < 0.001). All parameters suggest favourable outcome for the simple nephrectomy group, supporting the use of this terminology. This implies "simple" nephrectomies are truly easier to perform with less complication than their radical counterpart.

Development and Validity of a Silicone Renal Tumor Model for Robotic Partial Nephrectomy Training.

Science.gov (United States)

Monda, Steven M; Weese, Jonathan R; Anderson, Barrett G; Vetter, Joel M; Venkatesh, Ramakrishna; Du, Kefu; Andriole, Gerald L; Figenshau, Robert S

2018-04-01

To provide a training tool to address the technical challenges of robot-assisted laparoscopic partial nephrectomy, we created silicone renal tumor models using 3-dimensional printed molds of a patient's kidney with a mass. In this study, we assessed the face, content, and construct validity of these models. Surgeons of different training levels completed 4 simulations on silicone renal tumor models. Participants were surveyed on the usefulness and realism of the model as a training tool. Performance was measured using operation-specific metrics, self-reported operative demands (NASA Task Load Index [NASA TLX]), and blinded expert assessment (Global Evaluative Assessment of Robotic Surgeons [GEARS]). Twenty-four participants included attending urologists, endourology fellows, urology residents, and medical students. Post-training surveys of expert participants yielded mean results of 79.2 on the realism of the model's overall feel and 90.2 on the model's overall usefulness for training. Renal artery clamp times and GEARS scores were significantly better in surgeons further in training (P ≤.005 and P ≤.025). Renal artery clamp times, preserved renal parenchyma, positive margins, NASA TLX, and GEARS scores were all found to improve across trials (P <.001, P = .025, P = .024, P ≤.020, and P ≤.006, respectively). Face, content, and construct validity were demonstrated in the use of a silicone renal tumor model in a cohort of surgeons of different training levels. Expert participants deemed the model useful and realistic. Surgeons of higher training levels performed better than less experienced surgeons in various study metrics, and improvements within individuals were observed over sequential trials. Future studies should aim to assess model predictive validity, namely, the association between model performance improvements and improvements in live surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

Renal mass anatomic characteristics and perioperative outcomes of laparoscopic partial nephrectomy: a critical analysis.

Science.gov (United States)

Tsivian, Matvey; Ulusoy, Said; Abern, Michael; Wandel, Ayelet; Sidi, A Ami; Tsivian, Alexander

2012-10-01

Anatomic parameters determining renal mass complexity have been used in a number of proposed scoring systems despite lack of a critical analysis of their independent contributions. We sought to assess the independent contribution of anatomic parameters on perioperative outcomes of laparoscopic partial nephrectomy (LPN). Preoperative imaging studies were reviewed for 147 consecutive patients undergoing LPN for a single renal mass. Renal mass anatomy was recorded: Size, growth pattern (endo-/meso-/exophytic), centrality (central/hilar/peripheral), anterior/posterior, lateral/medial, polar location. Multivariable models were used to determine associations of anatomic parameters with warm ischemia time (WIT), operative time (OT), estimated blood loss (EBL), intra- and postoperative complications, as well as renal function. All models were adjusted for the learning curve and relevant confounders. Median (range) tumor size was 3.3 cm (1.5-11 cm); 52% were central and 14% hilar. While 44% were exophytic, 23% and 33% were mesophytic and endophytic, respectively. Anatomic parameters did not uniformly predict perioperative outcomes. WIT was associated with tumor size (P=0.068), centrality (central, P=0.016; hilar, P=0.073), and endophytic growth pattern (P=0.017). OT was only associated with tumor size (Panatomic parameter predicted EBL. Tumor centrality increased the odds of overall and intraoperative complications, without reaching statistical significance. Postoperative renal function was not associated with any of the anatomic parameters considered after adjustment for baseline function and WIT. Learning curve, considered as a confounder, was independently associated with reduced WIT and OT as well as reduced odds of intraoperative complications. This study provides a detailed analysis of the independent impact of renal mass anatomic parameters on perioperative outcomes. Our findings suggest diverse independent contributions of the anatomic parameters to the

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Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 42 cases

Directory of Open Access Journals (Sweden)

Kemal Ener

2016-01-01

Full Text Available The aim of this study was to evaluate outcomes of robotic partial nephrectomy (RAPN procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L. nephrometry and PADUA scores of patients were calculated by computed tomography (CT or magnetic resonance imaging (MRI. Intra- and perioperative (0–30 days complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 ± 6.5 years. Mean tumor size was 3.1 ± 1.0 (1.4–6.6 cm. R.E.N.A.L. nephrometry and PADUA scores were 6.0 ± 1.5 and 7.5 ± 0.9, respectively. Mean surgical time was 127.7 ± 18.7 minutes and estimated blood loss was 100 ± 18.1 cc. Mean warm ischemia time was 16.0 ± 8.9 (0–30 minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2–6 days. Except for 17 patients, hilar clamping was performed in 25 patients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell. Oncocytoma (n = 4, adenoma (n = 1, fibroadipose tissue (n = 1, papillary epithelial hyperplasia (n = 1, and chronic pyelonephritis (n = 1 were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 ± 10.9 (3–46 months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPN is a safe, minimally invasive surgical approach, with excellent surgical and oncological outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia.

Unilateral nephrectomy in a juvenile llama

International Nuclear Information System (INIS)

Van Hoogmoed, L.; Snyder, J.R.; Roberts, G.; Harmon, F.A.

1997-01-01

The purpose of this study was to describe the clinical presentation, diagnostic evaluation, and surgical management of a llama with an ectopic ureter. Nine-month-old female llama. The diagnostic evaluation included the use of computed tomography and an excretory ureterogram to confirm and identify the location of the ectopic ureter. Surgical management involved a unilateral nephrectomy. Computed tomography is a valuable asset to diagnose the presence and terminal location of an ectopic ureter in llamas, and nephrectomy appears to be a viable procedure to resolve the subsequent urinary incontinence

Robotic partial nephrectomy - Evaluation of the impact of case mix on the procedural learning curve.

Science.gov (United States)

Roman, A; Ahmed, K; Challacombe, B

2016-05-01

Although Robotic partial nephrectomy (RPN) is an emerging technique for the management of small renal masses, this approach is technically demanding. To date, there is limited data on the nature and progression of the learning curve in RPN. To analyse the impact of case mix on the RPN LC and to model the learning curve. The records of the first 100 RPN performed, were analysed at our institution that were carried out by a single surgeon (B.C) (June 2010-December 2013). Cases were split based on their Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score into the following groups: 6-7, 8-9 and >10. Using a split group (20 patients in each group) and incremental analysis, the mean, the curve of best fit and R(2) values were calculated for each group. Of 100 patients (F:28, M:72), the mean age was 56.4 ± 11.9 years. The number of patients in each PADUA score groups: 6-7, 8-9 and >10 were 61, 32 and 7 respectively. An increase in incidence of more complex cases throughout the cohort was evident within the 8-9 group (2010: 1 case, 2013: 16 cases). The learning process did not significantly affect the proxies used to assess surgical proficiency in this study (operative time and warm ischaemia time). Case difficulty is an important parameter that should be considered when evaluating procedural learning curves. There is not one well fitting model that can be used to model the learning curve. With increasing experience, clinicians tend to operate on more difficult cases. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

On the Adjacent Strong Equitable Edge Coloring of Pn ∨ Pn, Pn ∨ Cn and Cn ∨ Cn

OpenAIRE

Liu Jun; Zhao Chuan Cheng; Yao Shu Xia; Guo Ren Zhi; Yue Qiu Ju

2016-01-01

A proper edge coloring of graph G is called equitable adjacent strong edge coloring if colored sets from every two adjacent vertices incident edge are different,and the number of edges in any two color classes differ by at most one,which the required minimum number of colors is called the adjacent strong equitable edge chromatic number. In this paper, we discuss the adjacent strong equitable edge coloring of join-graphs about Pn ∨ Pn, Pn ∨ Cn and Cn ∨ Cn.

Unilateral pulmonary edema after laparoscopic nephrectomy

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Shreepathi Krishna Achar

2011-01-01

Full Text Available Unilateral-dependent pulmonary edema though reported in laparoscopic donor nephrectomies, has not been reported after laparoscopic non-donor nephrectomies. A 75-kg, 61-year-old man, a diagnosed case of right renal cell carcinoma was scheduled for laparoscopic nephrectomy. After establishing general anesthesia, the patient was positioned in the left-sided modified kidney (flank position. During the 5.75-hour procedure, he was hemodynamically stable except for a transient drop in blood pressure immediately after positioning. Intra-abdominal pressure was maintained less than 15 mmHg throughout the procedure. Blood loss was approximately 50 mL and urine output was 100 mL in the first hour followed by a total of 20 mL in the next 4.75 hours. Total fluid received during the procedure included 1.5 L of Ringer′s lactate and 1.0 L of 6% hydroxyethyl starch. After an uneventful procedure he developed respiratory distress in the postoperative period with a radiological evidence of dependent lung edema. Clinical and radiological improvement followed noninvasive ventilation, intravenous diuretics and oxygen therapy.

The perioperative outcomes between renal hilar and non-hilar tumors following robotic-assisted partial nephrectomy (RAPN).

Science.gov (United States)

Lu, Shih-Yen; Chung, Hsiao-Jen; Huang, Eric Yi-Hsiu; Lin, Tzu-Pin; Lin, Alex T L

2018-03-15

The aim of this study was to compare the perioperative outcomes between renal hilar tumors and non-hilar tumors after robotic-assisted partial nephrectomy (RAPN). A retrospective review of consecutive patients who underwent RAPN from December 2009 to September 2015 at our institution was recruited. Perioperative outcomes including demographic characteristics, perioperative, pathological and renal function outcomes were compared between the hilar group (n = 30) and non-hilar group (n = 170). In characteristics, hilar group was younger (52.4 vs. 58 years, p = 0.04) and had less body mass index (23.7 vs. 25.4 kg/m 2 , p = 0.018). Hilar group had larger tumor size (4.8 vs. 3.7 cm, p = 0.009), higher Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score (10.7 vs. 8.5, p Hilar tumor was associated with longer operative time (293.6 vs. 240.5 min, p = 0.001) and warm ischemia time (39.9 vs. 21.8 min, p hilar tumor patients had no difference of the change of creatinine and estimated glomerular filtration rate (eGFR) at postoperative 6 and 12 month as compared with non-hilar tumor patients. For renal hilar tumor, RAPN could provide acceptable results of perioperative, pathological and renal function outcome as compared with non-hilar tumor group. Thus RAPN is a safe and effective nephron-sparing surgery technique for renal hilar tumors. Copyright © 2018. Published by Elsevier Taiwan LLC.

An audit of nephrectomy by general surgeons | Mungadi | Nigerian ...

African Journals Online (AJOL)

... nephrectomy for non functioning hydronephrotic kidneys. The outcome in the treatment of the congenital renal anomalies, malignant and trauma to the kidney was not satisfactory suggesting the trained urologist will be better equipped to sort things out. Keywords: audit, nephrectomy, general surgeons. Nigerian Journal of ...

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Single access laparoscopic nephrectomy

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Jay D Raman

2008-01-01

Full Text Available Laparoscopic nephrectomy has assumed a central role in the management of benign and malignant kidney diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions each at least 1-2 cm in length. Each incision carries morbidity risks of bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single access or keyhole surgery, which utilizes magnetic anchoring and guidance system (MAGS technology or articulating laparoscopic instruments. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing for the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series demonstrate feasibility as well as safe and successful completion of keyhole nephrectomy. Future work is necessary to improve existing instrumentation, increase clinical experience, assess benefits of this surgical approach, and explore other potential applications for this technique.

Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

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Yang Qing

2013-01-01

Full Text Available Abstract Background The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Methods One hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1. The modified technique (n = 40 included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2. The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups. Results No significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05. The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P P P >0.05. Conclusions Early ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy.

Science.gov (United States)

Cutajar, Marica; Hilton, Rachel; Olsburgh, Jonathon; Marks, Stephen D; Thomas, David L; Banks, Tina; Clark, Christopher A; Gordon, Isky

2015-08-01

Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ((51)Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. • Non-invasive MRI measured renal blood flow and calculated renal plasma flow. • Effect of nephrectomy on blood flow and filtration in donors is presented. • Calculated filtration fraction may be a useful new kidney biomarker.

Nonfunctioning Renal Allograft Embolization as an Alternative to Graft Nephrectomy: Report on Seven Years' Experience

International Nuclear Information System (INIS)

Atar, Eli; Belenky, Alexander; Neuman-Levin, Margalit; Yussim, A.; Bar-Nathan, Nathan; Bachar, Gil N.

2003-01-01

Purpose: Graft nephrectomy is the treatment of choice in patients with graft intolerance syndrome, but it is associated with high morbidity and mortality rates. Renal vascular embolization has been suggested as a possible alternative. The aim of this study was to evaluate the efficacy and safety of arterial embolization of these nonfunctioning transplanted kidneys. Methods: Twenty-six transplanted kidneys in 25 patients with irreversible renal graft rejection and graft intolerance who underwent arterial embolization at our center from August 1994 to April 2001 we reanalyzed for procedural success and long-term outcome. Embolization was performed with absolute alcohol or with polyvinyl alcohol (Ivalon) and coils. Results: Twenty-four of the 26 (92%) procedures were technically successful, but in one patient only partial occlusion of one of two renal arteries was achieved, and in another the renal artery was already completely occluded. There were two major complications: emphysematous pyelonephritis necessitating nephrectomy and groin abscess that was drained. Follow-up ranged from 8 to 84 months. Clinical success was achieved in 24 of the 26 procedures(92%), and only in one patient did embolization fail to relieve the symptoms, and nephrectomy was performed 3 months later. Conclusion: Renal vascular embolization is a simple, safe and effective technique for the treatment of nonfunctioning renal allografts associated with graft intolerance syndrome. We suggest that it be considered the treatment of choice

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The most common cause of non-functioning kidney nephrectomy: Urolithiasis

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Şenol Adanur

2014-09-01

Full Text Available Objective: Our aim is to evaluate and present the characteristics of patients underwent nephrectomy due to nonfunctional kidney secondary to urolithiasis in our clinic. Methods:Totally 696 patients were anlyzed retrospectively who underwent nephrectomy in our clinic between January 2000 and December 2012. Etiologies and characteristics of nephrectomy applied patients due to nontumoral non-functional kidney related with urinary tract stones are evaluated. Diagnoses of the patients were confirmed by using urinary system ultrasonography, ab dominal computed tomography, intravenous urography and renal scintigraphy. Results:Nephrectomy was performed for 280 (40.2% patients due to tumor formation and for 416 (59.8% patients due to non-functional kidney of totally 696 patients.43.8% (182 of non-funtional kidney cases were resulted by upper urinary tract stones. Mean age of nephrectomy performed urolithiasis patients were 43.7±16.9 years. 53.3% (97 of patients were male and 46.7% (85 patients were female. Preoperative mean creatinine value of patients were detected 2.98±0.47 mg/dl. Renal stone local izatian was ureteropelvic junction in 81.3% (148, ureter in 14.3% (26 and renal+ureter in 4.4% (8 of the patients. 66.8% of reteropelvic junction stones were 10-30 mm in size. Conclusion: Upper urinary tract stones are primer responsible of non-functional kidney development besides forming most of the non-tumor related nephrectomies. Routine urinary system examination should be suggested to patients with a history of urolithiasis in order to prevent later probable organ losses.

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

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Anibal W. Branco

2010-12-01

Full Text Available PURPOSE: To confirm the feasibility of the laparoendoscopic Pfannenstiel nephrectomy using conventional laparoscopic instruments. MATERIALS AND METHODS: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been performed in selected patients in our service. The Veress needle was placed through the umbilicus which allowed carbon dioxide inflow. One 5 mm (or 10 mm trocar was placed at the umbilicus for the laparoscope, to guide the placement of three trocars over the Pfannenstiel incision. Additional trocars were placed as follows: a 10 mm in the midline, a 10 mm ipsilateral to the kidney to be removed (2 cm away from the middle one, and a 5 mm contralateral to the kidney to be removed (2 cm away from the middle one. The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for specimen retrieval. RESULTS: Five nephrectomies were performed following this technique: one atrophic kidney, one kidney donation, two renal cancers and one bilateral renal atrophy. Median operative time was 100 minutes and median intraoperative blood loss was 100 cc. No intraoperative complications occurred and no patients required blood transfusion. Median length of hospital stay was 1 day (range 1 to 2 days. CONCLUSIONS: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even when using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.

Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication

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M. C. Kriegmair

2015-01-01

Full Text Available Objectives. A symptomatic renal pseudoaneurysm (RPA is a severe complication after open partial nephrectomy (OPN. The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6% patients, on average 14 (4–42 days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p=0.004. There was a significant correlation between RPAs and transfusion and the duration of stay (p<0.001 and p=0.021. Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment.

Laparoscopic nephrectomy: initial experience with 120 cases.

LENUS (Irish Health Repository)

Cheema, I A

2010-02-01

Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

Laparoscopic nephrectomy: initial experience with 120 cases.

LENUS (Irish Health Repository)

Cheema, I A

2012-02-01

Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity

Why does the disorder of R-pn and rac-pn ligands in the quasi-one-dimensional bromo-bridged NiIII complexes, [Ni(pn)2Br]Br2 (pn=1,2-diaminopropane) afford similar STM patterns?

Science.gov (United States)

Wu, Hashen; Kawakami, Daisuke; Sasaki, Mari; Xie, Jimin; Takaishi, Shinya; Kajiwara, Takashi; Miyasaka, Hitoshi; Yamashita, Masahiro; Matsuzaki, Hiroyuki; Okamoto, Hiroshi

2007-09-03

The disordered patterns of R- and rac-1,2-diaminopropane (pn) in quasi-one-dimensional bromo-bridged Ni(III) complexes, [NiIII(pn)2Br]Br2, have been investigated by single-crystal X-ray structure determination and scanning tunneling microscopy (STM). X-ray structure determination shows that the methyl moieties are disordered on the right- and left-hand sides with half occupancies in both compounds, while the carbon atoms of the ethylene moieties of pn ligands are disordered in [Ni(rac-pn)2Br]Br2 and not disordered in [Ni(R-pn)2Br]Br2. In the STM images of both compounds, the bright spots are not straight but fluctuated with the similar patterns. We have concluded that tunnel current from the STM tip to metal ions are detected via methyl groups of pn ligands.

Hand-assisted right laparoscopic nephrectomy in living donor

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Fernando Meyer

2005-02-01

Full Text Available OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75. RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min and warm ischemia time from 2 to 6 minutes (mean 3.78 min with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81. On the graft assessment, immediate diuresis was seen in 15 cases (93.75% and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25% who required graft removal, and lymphocele was seen in 1 recipient (6.25%. CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

Efficacy of virtual computerized tomography laparoscopy for retroperitoneoscopic nephrectomy

International Nuclear Information System (INIS)

Shigeta, Masanobu; Kadonishi, Yuichi; Yasumoto, Hiroaki; Mita, Koji; Usui, Tsuguru; Marukawa, Kazushi

2004-01-01

Retroperitoneoscopic nephrectomy is less invasive than open nephrectomy, and is an alternative surgical procedure for renal tumors and upper urothelial tumors. We evaluated the efficacy of virtual computerized tomography laparoscopy (VCTL) as a navigator for retroperitoneoscopic nephrectomy to ascertain the correct anatomy of the renal hilum pre-operatively under the retroperitoneoscopic view. Seventy-three kidneys with localized renal tumors (n=44), upper urothelial tumors (n=23), or benign renal disease (n=6) underwent multidetector-row CT. VCTL was carried out by the volume-rendered technique. The findings were compared with those of real retroperitoneoscopy. After the operation, each operator scored 1 to 5 in evaluating the usefulness of virtual retroperitoneoscopy (score 5 indicated very useful). The percentages of renal arteries depicted by VCTL compared with those noted during real surgery were 93% for kidneys with renal tumors, 100% for upper urothelial tumors and 83% for benign renal disease. Two renal arteries of 2 kidneys were not detected by virtual imaging. These were about 1 mm in diameter and directly branched from the aorta, however retroperitoneoscopic nephrectomy was performed uneventfully. VCTL depicted all the renal veins. The anatomy of the renal hilum seen on VCTL and real retroperitoneoscopy was identical, without the minor angle deviation caused by drawing the kidney during the operation. The average score for the usefulness of VCTL was 4.1, ranging from 3 to 5. The accurate surgical anatomy of the renal hilum could be predicted in almost all patients pre-operatively. VCTL is an excellent navigator for retroperitoneoscopic nephrectomy. (author)

Doping of 6H-SiC pn structures by proton irradiation

International Nuclear Information System (INIS)

Strel'chuk, Anatoly M.; Lebedev, Alexandre A.; Kozlovski, Vitali V.; Savkina, Natali S.; Davydov, Denis V.; Solov'ev, Viktor V.; Rastegaeva, Marina G.

1999-01-01

The influence of proton irradiation on current-voltage characteristics, N d - N a values and parameters of deep centres in 6H-SiC pn structures grown by sublimation epitaxy has been studied. The irradiation was carried out with 8 MeV protons in the range of doses from 10 14 to 10 16 cm -2 . Irradiation with a dose of 3.6x10 14 cm -2 leaves the voltage drop at high forward currents (10 A/cm 2 ) practically unchanged. For higher irradiation dose of 1.8x10 15 cm -2 , the forward voltage drop and the degree of compensation in the samples increased ; partial annealing of the radiation defects and partial recovery of the electrical parameters occurred after annealing at T∼400-800 K. Irradiation with a dose of 5.4x10 15 cm -2 resulted in very high resistance in forward biased pn structures which remained high even after heating to 500 deg. C. It is suggested that proton irradiation causes decreasing of the lifetime and formation of an i- or an additional p-layer

Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

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Alwayn Ian PJ

2010-03-01

Full Text Available Abstract Background Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other. Methods/design The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs. Discussion This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy. Trial Registration Dutch Trial Register NTR1433

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors pre-nephrectomy and post-nephrectomy

Energy Technology Data Exchange (ETDEWEB)

Cutajar, Marica; Clark, Christopher A.; Gordon, Isky [University College London, Imaging and Biophysics Unit, Institute of Child Health, London (United Kingdom); Hilton, Rachel; Olsburgh, Jonathon [Renal Unit, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Marks, Stephen D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Paediatric Nephrology, London (United Kingdom); Thomas, David L. [University College London, Department of Brain Repair and Rehabilitation, Institute of Neurology, London (United Kingdom); Banks, Tina [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom)

2015-08-15

Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ({sup 51}Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. (orig.)

Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors pre-nephrectomy and post-nephrectomy

International Nuclear Information System (INIS)

Cutajar, Marica; Clark, Christopher A.; Gordon, Isky; Hilton, Rachel; Olsburgh, Jonathon; Marks, Stephen D.; Thomas, David L.; Banks, Tina

2015-01-01

Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ( 51 Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. (orig.)

Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer.

Science.gov (United States)

Tan, Hung-Jui; Filson, Christopher P; Litwin, Mark S

2015-01-01

Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, Pmanagement and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors. Published by Elsevier Inc.

Laparoscopic nephrectomy: analysis of 34 patients

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Domingos André Luís Alonso

2003-01-01

Full Text Available OBJECTIVE: To analyze the clinical experience of laparoscopic nephrectomy for benign and malignant diseases at a university hospital. METHODS: From February 2000 to March 2003, 34 patients (14 men and 20 women underwent transperitoneal laparoscopic total nephrectomy at the Hospital das Clinicas - FMRP-USP: 28 (82.3% patients had benign diseases and 6 (17.7% malignant neoplasias. Benign diseases were represented by: urinary stones (N-9, 32.1%, chronic pyelonephritis (N-8, 28.6%, vesicoureteral reflux (N-4, 14.3%, ureteropelvic obstruction (N-3, 10.7%, multicystic kidney (N-2, 7.1% and pyonephrosis (N-2, 7.1%. Patients age range was 2-79 years (mean - 35,1 years. RESULTS: In 32/34 patients the procedures were accomplished successfully. In 2 (5.8% cases of pyonephrosis, open conversion was necessary due to perinephric abscess and difficulties in dissection of renal hilum. Two patients had intraoperative complications (1 duodenum serous laceration an 1 vascular lesion of renal hilum, but both were managed laparoscopically. Two (5.8% post operative complications (1 delayed bleeding and 1 pancreatic fistula required open surgical exploration. The mean time of hospital stay was 58h (18 to 240h. CONCLUSION: Laparoscopic nephrectomy proved to be a method safe and associated with a low rate of morbidity, shorter hospital stay and no casualties.

Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles.

Science.gov (United States)

Han, Woong Kyu; Tan, Yung K; Olweny, Ephrem O; Yin, Gang; Liu, Zhuo-Wei; Faddegon, Stephen; Scott, Daniel J; Cadeddu, Jeffrey A

2013-04-01

To compare surgeon-assessed ergonomic and workload demands of magnetic anchoring and guidance system (MAGS) laparoendoscopic single-site surgery (LESS) nephrectomy with conventional LESS nephrectomy in a porcine model. Participants included two expert and five novice surgeons who each performed bilateral LESS nephrectomy in two nonsurvival animals using either the MAGS camera or conventional laparoscope. Task difficulty and workload demands of the surgeon and camera driver were assessed using the validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Surgeons were also asked to score 6 parameters on a Likert scale (range 1=low/easy to 5=high/hard): procedure-associated workload, ergonomics, technical challenge, visualization, accidental events, and instrument handling. Each step of the nephrectomy was also timed and instrument clashing was quantified. Scores for each parameter on the Likert scale were significantly lower for MAGS-LESS nephrectomy. Mean number of internal and external clashes were significantly lower for the MAGS camera (pNASA-TLX workload ratings by the surgeon and camera driver showed that MAGS resulted in a significantly lower workload than the conventional laparoscope during LESS nephrectomy (p<0.05). The use of the MAGS camera during LESS nephrectomy lowers the task workload for both the surgeon and camera driver when compared to conventional laparoscope use. Subjectively, it appears to also improve surgeons' impressions of ergonomics and technical challenge. Pending approval for clinical use, further evaluation in the clinical setting is warranted.

Compensatory renal hypertrophia in patients undergoing unilateral nephrectomy

DEFF Research Database (Denmark)

Mogensen, P; Munck, O; Tonnesen, K H

1977-01-01

Estimations of the residual glomerular filtration rate (GFR) were made from renography and GFR measurements before unilateral nephrectomy in 28 patients aged 42-77 years. The GFR was measured one week and three months after the operation and comparisons were made between the function of the remai......Estimations of the residual glomerular filtration rate (GFR) were made from renography and GFR measurements before unilateral nephrectomy in 28 patients aged 42-77 years. The GFR was measured one week and three months after the operation and comparisons were made between the function...

Protective response in renal transplantation: no clinical or molecular differences between open and laparoscopic donor nephrectomy

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Christiano Machado

2013-04-01

Full Text Available OBJECTIVE: Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation. METHODS: Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1 the control group, recipients of open donor nephrectomy (n = 29, and 2 the study group, recipients of laparoscopic donor nephrectomy (n = 26. Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS: The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047 and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01. CONCLUSION: The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure

Does robotic assistance confer an economic benefit during laparoscopic radical nephrectomy?

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Yang, David Y; Monn, M Francesca; Bahler, Clinton D; Sundaram, Chandru P

2014-09-01

While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit. From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges. We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Initial experience with transperitoneal laparoscopic nephrectomy in an Irish hospital setting.

LENUS (Irish Health Repository)

Forde, J C

2009-08-01

Laparoscopic nephrectomy has gained widespread acceptance as a treatment for both benign and malignant conditions and is becoming increasingly popular in Irish hospitals. We report a single surgeon, single centre experience with 20 consecutive laparoscopic nephrectomies comparing them to 20 open cases performed prior to the establishment of a laparoscopic service.

Risk reduction strategies in laparoscopic donor nephrectomy: A comparative study

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T Manohar

2006-01-01

Full Text Available OBJECTIVES: As the advancements, modifications and standardization of laparoscopy are taking place, there is a need for the reduction in morbidity associated with laparoscopic live donor nephrectomy. This study was performed to determine and reconfirm the advantages of laparoscopic donor nephrectomy over its open counterpart. MATERIALS AND METHODS: Two hundred open live donor nephrectomy (ODN cases were compared to 264 cases of laparoscopic live donor nephrectomy (LDN. Pretransplant functional and radiological evaluation was done routinely by excretory urogram and renal arteriography. In case of vascular variations, CT angiography was preferred. Open cases were done by conventional method and laparoscopic group underwent certain technical and surgical modifications, including meticulous planning for the port placement. Operative time, analgesia requirement, start of the orals, hospital stay, blood loss, late allograft function, incidence of rejection, complications and technical problems were analyzed. RESULTS: Operative time was 135.8 ± 43 and 165 ± 44.4 min ( P < 0.0001, requirement of analgesia was 60.5 ± 40 and 320 ± 120 mg ( P < 0.0001, hospital stay was 4 ± 0.04 and 5.7 ± 2.03 days ( P < 0.0001, warm ischemia time was 6.1 ± 2.0 and 4.1 ± 0.80 min ( P < 0.0001 and time taken for the serum creatinine to stabilize in the recipient was 4.1 ± 1.6 and 4.32 ± 1.40 days ( P =0.06 for LDN and ODN groups respectively. There was a significant reduction in the blood loss in LDN group ( P =0.0005. Overall complications were 6.81 and 14.5% and ureteric injury was seen in 0.37 and 1% in LDN and ODN respectively. CONCLUSION: Laparoscopic live donor nephrectomy can now be performed with low morbidity and mortality to both donors and recipients and is proving to be the preferred operation to open donor nephrectomy. Our continued innovations in technical modifications have made this novel operation successful.

Laparoscopic nephrectomy using the harmonic scalpel.

Science.gov (United States)

Helal, M; Albertini, J; Lockhart, J; Albrink, M

1997-08-01

Laparoscopic nephrectomy is gaining popularity. Improved instrumentation is making surgery easier with fewer complications. Our first three laparoscopic nephrectomies using the Harmonic Scalpel were performed on two women and one man. The surgical indications were nonfunctioning kidneys (two left, one right) with hypertension in one patient and stone disease in two. The three patients had a mean age of 46.3 years. The average hospital stay was 4 days, the average operative time 3.7 hours, and the average blood loss 160 mL. No complications occurred. Patients resumed oral intake within 8 hours postoperatively. We found the Harmonic Scalpel easy and safe to use. It saved time, was cost effective, and was capable of easily controlling small-vessel bleeding. In conclusion, the Harmonic Scalpel could be used effectively for both dissection and bleeding control without suction or other instrumentation.

Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience.

Science.gov (United States)

Abdel Raheem, Ali; Sheikh, Abulhasan; Kim, Dae Keun; Alatawi, Atalla; Alabdulaali, Ibrahim; Han, Woong Kyu; Choi, Young Deuk; Rha, Koon Ho

2017-03-01

The aims of this study were to compare the perioperative outcomes of da Vinci Xi to Si during robotic-assisted partial nephrectomy (RAPN) and to discuss the feasibility of our novel port placement scheme for the da Vinci Xi platform, to overcome the existing kinetic and technical difficulties we faced with the linear port placement in patients with a small body habitus. A retrospective data analysis of patients who underwent RPN using da Vinci Xi (n = 18) was carried out. The outcomes of the Xi group were compared with the Si group (n = 18) selected using a case-matched methodology. For da Vinci Xi, we applied the universal linear port placement in 12 patients and our modified port placement in the remaining 6 patients. The Xi group had a shorter mean docking time of 17.8 ± 2.6 min compared to the Si group of 20.5 ± 2.1 min (p = 0.002); otherwise, no significant difference was present with regard to the remaining perioperative variables (p > 0.05). The modified Xi port placement had a shorter mean console time of 70.8 ± 9.7 min compared to the universal linear port placement of 89.3 ± 17.2 min (p = 0.03). Moreover, it provided a broader field of vision with excellent robotic arms movement, minimizing collisions and allowing an easier and comfortable surgical assist. Da Vinci Xi appears to be feasible and safe during RPN with similar outcomes to Si. The novel Xi port placement makes surgery easier in patients with low BMI.

Laparoscopic nephrectomy in live donor

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Mitre Anuar I.

2004-01-01

Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

Laparoscopic nephrectomy in live donor

Directory of Open Access Journals (Sweden)

Anuar I. Mitre

2004-02-01

Full Text Available OBJECTIVE: To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS: In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56% and 22 female (44%. Mean age was 37.2 years, and the mean body mass index (BMI was 27.1 kg/m². RESULTS: Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%, the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2% its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS: The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.

Retroperitoneoscopic nephrectomy in benign pathology.

Science.gov (United States)

Quintela, Rodrigo S; Cotta, Leonardo R; Neves, Marcelo F; Abelha, David L; Tavora, Jose E

2006-01-01

We report our experience with 43 retroperitoneal laparoscopic nephrectomy for benign kidney disease. All patients had a poor function from obstructive uropathology and renal atrophy. None of these patients had a previous lumbotomy. Retroperitoneoscopy was performed with 4 trocar port technique in a lateral position. The retroperitoneal space is created by using a Gaur's balloon made of sterile glove. The approach to vascular pedicle was done posteriorly and vessels were clipped by metal and Hem-o-lock (Weck Closure Systems, North Carolina, USA) clips. The sample was intact extracted in an Endo-Bag prolonging one trocar incision. Median operative time was 160 minutes and median blood loss was 200 mL. Four cases (9%) were converted to open surgery: one case due to bleeding and 3 cases due to technical difficulties regarding perirenal adherences. Most patients (39) checked out from the Hospital in day two. Four of them were left over 3 days due to wound complications. Retroperitoneoscopy offers a safe, effective and reproductive access to nephrectomy for benign pathologies.

Superconductivity and Competing Ordered Phase in RuPn (Pn = As, P)

Science.gov (United States)

Hirai, Daigorou; Takayama, Tomohiro; Hashizume, Daisuke; Yamamoto, Ayako; Takagi, Hidenori

2011-03-01

Unconventional superconductivity likely manifests itself when some competing electronic phases are suppressed down to zero temperature such as cuprates and iron-pnictide superconductors. Therefore, the correlated metallic state neighboring a competing electronic ordering can be a promising playground for unconventional superconductivity. Here we report superconductivity emerging adjacent to electronically ordered phases of RuPn (Pn = As, P). We found that RuAs(P) exhibits phase transitions at 240 (265) K, which is discerned as a drop of magnetic susceptibility or a resistivity upturn. Such anomalies can be suppressed by substituting Rh to the Ru site. Accompanied by the disappearance of the electronic order, superconductivity was found to emerge below 1.8 K and 3.8 K for RuAs and RuP, respectively. The superconductivity in Rh substituted RuPn, which neighbors a competing electronic order, might exhibit an exotic pairing state as seen in the unconventional superconductors known to date.

Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma

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Pantelidou, Maria [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Challacombe, Ben [King’s Health Partners, Department of Urology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); McGrath, Andrew [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Brown, Matthew [King’s Health Partners, Department of Urology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Ilyas, Shahzad; Katsanos, Konstantinos, E-mail: konstantinos.katsanos@gstt.nhs.uk; Adam, Andreas [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

2016-11-15

IntroductionThe authors compared the oncologic outcomes of radiofrequency ablation (RFA) with robotic-assisted partial nephrectomy (RPN) for the treatment of T1 stage renal cell carcinoma (RCC).Materials and methodsThis was a retrospective data analysis of a high-volume single tertiary centre. Patients were treated with RFA or RPN following multidisciplinary decision making. Only histologically proven RCCs were included. Baseline demographics were collected, and PADUA scores of tumour features were calculated to standardize baseline anatomy. Peri-operative complications, kidney function and oncological outcomes were compared.ResultsSixty-three cases were included in each group. Baseline renal function was poorer in RFA, and 16/63 RFA patients had tumours in single kidneys compared to 1/63 RPN cases (p < 0.001). Length of stay was shorter in RFA (1 vs. 3 days, p < 0.0001). Post-procedure renal function decline at 30 days was significantly less in RFA [(−0.8) ± 9.6 vs. (−16.1) ± 19.5 mls/min/1.73 m{sup 2}; p < 0.0001]. More minor complications were recorded in RPN (10/63 vs. 4/63, p = 0.15), but local recurrence was numerically higher in RFA (6/63 vs. 1/63, p = 0.11). Disease-free survival (DFS) was not significantly different (adjusted HR = 0.6, 95 % Cl 0.1–3.7; p = 0.60). Increasing tumour size was an independent predictor of local recurrence (adjusted HR = 1.7; 95 % Cl 1.1–2.6 per cm; p = 0.02).ConclusionsBoth RPN and RFA offer very good oncological outcomes for the treatment of T1 RCC with low peri-operative morbidity and similar oncologic outcomes. RFA demonstrated fewer peri-operative complications and better preservation of renal function, whereas RPN had an insignificantly lower local recurrence rate. RFA should be offered alongside RPN for selected cases.

Percutaneous Radiofrequency Ablation Versus Robotic-Assisted Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma

International Nuclear Information System (INIS)

Pantelidou, Maria; Challacombe, Ben; McGrath, Andrew; Brown, Matthew; Ilyas, Shahzad; Katsanos, Konstantinos; Adam, Andreas

2016-01-01

IntroductionThe authors compared the oncologic outcomes of radiofrequency ablation (RFA) with robotic-assisted partial nephrectomy (RPN) for the treatment of T1 stage renal cell carcinoma (RCC).Materials and methodsThis was a retrospective data analysis of a high-volume single tertiary centre. Patients were treated with RFA or RPN following multidisciplinary decision making. Only histologically proven RCCs were included. Baseline demographics were collected, and PADUA scores of tumour features were calculated to standardize baseline anatomy. Peri-operative complications, kidney function and oncological outcomes were compared.ResultsSixty-three cases were included in each group. Baseline renal function was poorer in RFA, and 16/63 RFA patients had tumours in single kidneys compared to 1/63 RPN cases (p < 0.001). Length of stay was shorter in RFA (1 vs. 3 days, p < 0.0001). Post-procedure renal function decline at 30 days was significantly less in RFA [(−0.8) ± 9.6 vs. (−16.1) ± 19.5 mls/min/1.73 m"2; p < 0.0001]. More minor complications were recorded in RPN (10/63 vs. 4/63, p = 0.15), but local recurrence was numerically higher in RFA (6/63 vs. 1/63, p = 0.11). Disease-free survival (DFS) was not significantly different (adjusted HR = 0.6, 95 % Cl 0.1–3.7; p = 0.60). Increasing tumour size was an independent predictor of local recurrence (adjusted HR = 1.7; 95 % Cl 1.1–2.6 per cm; p = 0.02).ConclusionsBoth RPN and RFA offer very good oncological outcomes for the treatment of T1 RCC with low peri-operative morbidity and similar oncologic outcomes. RFA demonstrated fewer peri-operative complications and better preservation of renal function, whereas RPN had an insignificantly lower local recurrence rate. RFA should be offered alongside RPN for selected cases.

Palliative nephrectomy until targeted therapy of disseminated kidney cancer patients

Directory of Open Access Journals (Sweden)

A. V. Klimov

2015-01-01

Full Text Available Objective: to assess the role of palliative nephrectomy in disseminated kidney cancer patients planned to undergo targeted antiangiogenic treatment.Subjects and methods. The investigation included data on 83 patients with T1-4N0 / +M1 disseminated renal cell carcinoma (RCC who had received at least 2 targeted therapy cycles in 2009 to 2011. In 48 (57.8 % patients, the treatment was preceded by palliative nephrectomy that was not carried out in 35 (42.2 %. Before starting targeted therapy, all the cases were confirmed to be diagnosed with clear cell RCC, with a sarcomatoid component being in 7 (8.4 % patients. The median follow-up of all the patients was 21 (12–36 months.Results. The unremoved affected kidney in disseminated kidney cancer patients receiving targeted antiangiogenic therapy is an independent factor for the poor prognosis of progression-free (odds ratio (OR, 2.4; 95 % confidence interval (CI, 1.2–4.7 and overall (OR, 2.8; 95 % CI, 1.3–6.3 survival. Palliative nephrectomy does not improve the prognosis in patients with a low somatic status, the N+ category, and metastases into the bones and nonregional lymph nodes.Conclusion. Palliative nephrectomy in the selected patients with disseminated kidney cancer on targeted antiangiogenic therapy increases progression-free and overall survival.

Novel pneumoviruses (PnVs): Evolution and inflammatory pathology

International Nuclear Information System (INIS)

Glineur, Stephanie F.; Renshaw, Randall W.; Percopo, Caroline M.; Dyer, Kimberly D.; Dubovi, Edward J.; Domachowske, Joseph B.; Rosenberg, Helene F.

2013-01-01

A previous report of a novel pneumovirus (PnV) isolated from the respiratory tract of a dog described its significant homology to the rodent pathogen, pneumonia virus of mice (PVM). The original PnV–Ane4 pathogen replicated in and could be re-isolated in infectious state from mouse lung but elicited minimal mortality compared to PVM strain J3666. Here we assess phylogeny and physiologic responses to 10 new PnV isolates. The G/glycoprotein sequences of all PnVs include elongated amino-termini when compared to the characterized PVMs, and suggest division into groups A and B. While we observed significant differences in cytokine production and neutrophil recruitment to the lungs of BALB/c mice in response to survival doses (50 TCID 50 units) of representative group A (114378-10-29-KY-F) and group B (7968-11-OK) PnVs, we observed no evidence for positive selection (dN>dS) among the PnV/PnV, PVM/PnV or PVM/PVM G/glycoprotein or F/fusion protein sequence pairs. - Highlights: • We consider ten novel isolates of the pneumovirus (PnV) first described by Renshaw and colleagues. • The G/glycoprotein sequences of all PnVs include elongated amino-termini when compared to PVM. • We detect cytokine production and neutrophil recruitment to the lungs of mice in response to PnV. • We observed no evidence for positive selection (dN>dS) among the gene sequence pairs

Novel pneumoviruses (PnVs): Evolution and inflammatory pathology

Energy Technology Data Exchange (ETDEWEB)

Glineur, Stephanie F. [Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1883 (United States); Renshaw, Randall W. [Animal Health Diagnostic Center, College of Veterinary Medicine, Cornell University, PO Box 5786, Ithaca, New York, NY 14851-5786 (United States); Percopo, Caroline M.; Dyer, Kimberly D. [Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1883 (United States); Dubovi, Edward J. [Animal Health Diagnostic Center, College of Veterinary Medicine, Cornell University, PO Box 5786, Ithaca, New York, NY 14851-5786 (United States); Domachowske, Joseph B. [Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210 (United States); Rosenberg, Helene F., E-mail: hrosenberg@niaid.nih.gov [Inflammation Immunobiology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1883 (United States)

2013-09-01

A previous report of a novel pneumovirus (PnV) isolated from the respiratory tract of a dog described its significant homology to the rodent pathogen, pneumonia virus of mice (PVM). The original PnV–Ane4 pathogen replicated in and could be re-isolated in infectious state from mouse lung but elicited minimal mortality compared to PVM strain J3666. Here we assess phylogeny and physiologic responses to 10 new PnV isolates. The G/glycoprotein sequences of all PnVs include elongated amino-termini when compared to the characterized PVMs, and suggest division into groups A and B. While we observed significant differences in cytokine production and neutrophil recruitment to the lungs of BALB/c mice in response to survival doses (50 TCID{sub 50} units) of representative group A (114378-10-29-KY-F) and group B (7968-11-OK) PnVs, we observed no evidence for positive selection (dN>dS) among the PnV/PnV, PVM/PnV or PVM/PVM G/glycoprotein or F/fusion protein sequence pairs. - Highlights: • We consider ten novel isolates of the pneumovirus (PnV) first described by Renshaw and colleagues. • The G/glycoprotein sequences of all PnVs include elongated amino-termini when compared to PVM. • We detect cytokine production and neutrophil recruitment to the lungs of mice in response to PnV. • We observed no evidence for positive selection (dN>dS) among the gene sequence pairs.

Single P-N junction tandem photovoltaic device

Science.gov (United States)

Walukiewicz, Wladyslaw [Kensington, CA; Ager, III, Joel W.; Yu, Kin Man [Lafayette, CA

2011-10-18

A single P-N junction solar cell is provided having two depletion regions for charge separation while allowing the electrons and holes to recombine such that the voltages associated with both depletion regions of the solar cell will add together. The single p-n junction solar cell includes an alloy of either InGaN or InAlN formed on one side of the P-N junction with Si formed on the other side in order to produce characteristics of a two junction (2J) tandem solar cell through only a single P-N junction. A single P-N junction solar cell having tandem solar cell characteristics will achieve power conversion efficiencies exceeding 30%.

End Stage and Chronic Kidney Disease: Associations with Renal Cancer

International Nuclear Information System (INIS)

Russo, Paul

2012-01-01

There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephropathological changes are commonly observed in the non-tumor bearing portions of kidney resected at the time of partial and radical nephrectomy (RN). In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy (PN) or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with RN. Despite emerging evidence that PN provides equivalent local tumor control to RN while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

Personal network (PN) applications

DEFF Research Database (Denmark)

Prasad, R.; Skouby, Knud Erik

2005-01-01

The applications of PN will be realised under many scenarios where users can have access to their personal network all the time. This network will enable the user to share critical information, play games, control their home remotely, etc. All this will be achieved with seamless interworking...... and handover between networks and user devices. This paper presents an array of use case scenarios that validates the ubiquitous usage of PN....

Laparoscopic partial nephrectomy in rats Nefrectomia parcial laparoscópica em ratos

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Fernando Meyer

2007-04-01

Full Text Available PURPOSE: To establish an experimental model of laparoscopic partial nephrectomy (LPN in rats and to analyze morphological alterations in the renal parenchyma utilizing an electric cautery and harmonic scalpel. METHODS: Forty Wistar rats were used, divided in 2 experiments with 20 rats each: experiment I, LPN was performed with an electric cautery and the rats were subdivided into groups A and B; experiment II, LPN was performed with a harmonic scalpel and they were subdivided into groups C and D. The animals in groups A and C were sacrificed shortly after surgery and the remnant kidney was removed to study the following variables: necroses and degeneration. In groups B and D a laparatomy was performed for retrieval of the remnant kidney on the 14th day after surgery to analyze fibrous scarring. RESULTS: For the variables necroses and fibrous scarring, the electric cautery creates, on average, greater width than that produced by the harmonic scalpel (p=0.0002 and p=0.0068 respectively. Regarding the variable of degeneration, we found no significant difference between the two types of scalpels (p=0.1267. CONCLUSIONS: LPN in rats is an adequate and feasible experimental model. The electric cautery caused greater damage to remnant renal tissue when compared to harmonic scalpel.OBJETIVO: Estabelecer um modelo experimental de nefrectomia parcial laparoscópica (NPL em ratos e analisar as alterações morfológicas no parênquima renal utilizando-se bisturi elétrico e harmônico. MÉTODOS: Foram utilizados 40 ratos Wistar, distribuídos em dois experimentos com 20 ratos cada: experimento I, NPL utilizando-se de bisturi elétrico e subdividindo-se os ratos em grupos A e B; experimento II, NPL realizada com bisturi harmônico e subdividindo-se os ratos em grupos C e D. Os animais dos grupos A e C foram sacrificados após a cirurgia para a remoção do rim operado e estudo das seguintes variáveis: necrose e degeneração. Nos grupos B e D a laparotomia

Surgical treatment of metachronous metastases in different organs following radical nephrectomy

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Carlos M. N. de Jesus

2003-06-01

Full Text Available Renal clear cell carcinoma (RCCC is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy. CASE REPORT: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision. COMMENTS: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Agent-based Personal Network (PN) service architecture

DEFF Research Database (Denmark)

Jiang, Bo; Olesen, Henning

2004-01-01

In this paper we proposte a new concept for a centralized agent system as the solution for the PN service architecture, which aims to efficiently control and manage the PN resources and enable the PN based services to run seamlessly over different networks and devices. The working principle...

Safety and hemostatic efficacy of fibrin pad in partial nephrectomy: Results of an open-label Phase I and a randomized, standard-of-care-controlled Phase I/II study

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Nativ Ofer

2012-11-01

Full Text Available Abstract Background Bleeding severity, anatomic location, tissue characteristics, and visibility are common challenges encountered while managing intraoperative bleeding, and conventional hemostatic measures (suture, ligature, and cautery may sometimes be ineffective or impractical. While topical absorbable hemostats (TAH are useful hemostatic adjuvants, each TAH has associated disadvantages. Methods We evaluated the safety and hemostatic efficacy of a new advanced biologic combination product―fibrin pad―to potentially address some gaps associated with TAHs. Fibrin pad was assessed as adjunctive hemostat in open partial nephrectomy in single-center, open-label, Phase I study (N = 10, and as primary hemostat in multicenter, single-blind, randomized, standard-of-care (SOC-controlled Phase I/II study (N = 7 in Israel. It was used to control mild-to-moderate bleeding in Phase I and also spurting arterial bleeding in Phase I/II study. Phase I study assessed safety and Phase I/II study, proportion of successes at 10 min following randomization, analyzed by Fisher exact tests at 5% significance level. Results Phase I (N = 10: All patients completed the study. Hemostasis was achieved within 3–4 min (average = 3.1 min of a single application in all patients. Fibrin pad was found to be safe for human use, with no product-related adverse events reported. Phase I/II (N = 7: Hemostatic success at 10 min (primary endpoint was achieved in 3/4 patients treated with fibrin pad versus 0/3 patients treated with SOC. No clinically significant change in laboratory or coagulation parameters was recorded, except a case of post-procedural hemorrhage with fibrin pad, which was considered serious and related to the fibrin pad treatment, and required re-operation. Although Data Safety Monitoring Board authorized trial continuation, the sponsor decided against proceeding toward an indication for primary treatment of severe arterial

An adjuvant autologous therapeutic vaccine (HSPPC-96; vitespen) versus observation alone for patients at high risk of recurrence after nephrectomy for renal cell carcinoma: a multicentre, open-label, randomised phase III trial.

NARCIS (Netherlands)

Wood, C.; Srivastava, P.; Bukowski, R.; Lacombe, L.; Gorelov, A.I.; Gorelov, S.; Mulders, P.F.A.; Zielinski, H.; Hoos, A.; Teofilovici, F.; Isakov, L.; Flanigan, R.; Figlin, R.; Gupta, R; Escudier, B.

2008-01-01

BACKGROUND: Treatment of localised renal cell carcinoma consists of partial or radical nephrectomy. A substantial proportion of patients are at risk for recurrence because no effective adjuvant therapy exists. We investigated the use of an autologous, tumour-derived heat-shock protein (glycoprotein

Vector grammars and PN machines

Institute of Scientific and Technical Information of China (English)

蒋昌俊

1996-01-01

The concept of vector grammars under the string semantic is introduced.The dass of vector grammars is given,which is similar to the dass of Chomsky grammars.The regular vector grammar is divided further.The strong and weak relation between the vector grammar and scalar grammar is discussed,so the spectrum system graph of scalar and vector grammars is made.The equivalent relation between the regular vector grammar and Petri nets (also called PN machine) is pointed.The hybrid PN machine is introduced,and its language is proved equivalent to the language of the context-free vector grammar.So the perfect relation structure between vector grammars and PN machines is formed.

Mapping Pn amplitude spreading and attenuation in Asia

Energy Technology Data Exchange (ETDEWEB)

Yang, Xiaoning [Los Alamos National Laboratory; Phillips, William S [Los Alamos National Laboratory; Stead, Richard J [Los Alamos National Laboratory

2010-12-06

Pn travels most of its path in the mantle lid. Mapping the lateral variation of Pn amplitude attenuation sheds light on material properties and dynamics of the uppermost region of the mantle. Pn amplitude variation depends on the wavefront geometric spreading as well as material attenuation. We investigated Pn geometric spreading, which is much more complex than a traditionally assumed power-law spreading model, using both synthetic and observed amplitude data collected in Asia. We derived a new Pn spreading model based on the formulation that was proposed previously to account for the spherical shape of the Earth (Yang et. al., BSSA, 2007). New parameters derived for the spreading model provide much better correction for Pn amplitudes in terms of residual behavior. Because we used observed Pn amplitudes to construct the model, the model incorporates not only the effect of the Earth's spherical shape, but also the effect of potential upper-mantle velocity gradients in the region. Using the new spreading model, we corrected Pn amplitudes measured at 1, 2, 4 and 6 Hz and conducted attenuation tomography. The resulting Pn attenuation model correlates well with the regional geology. We see high attenuation in regions such as northern Tibetan Plateau and the western Pacific subduction zone, and low attenuation for stable blocks such as Sichuan and Tarim basins.

Synthesis and structural characterization of the ternary Zintl phases AE3Al2Pn4 and AE3Ga2Pn4 (AE=Ca, Sr, Ba, Eu; Pn=P, As)

International Nuclear Information System (INIS)

He, Hua; Tyson, Chauntae; Saito, Maia; Bobev, Svilen

2012-01-01

Ten new ternary phosphides and arsenides with empirical formulae AE 3 Al 2 Pn 4 and AE 3 Ga 2 Pn 4 (AE=Ca, Sr, Ba, Eu; Pn=P, As) have been synthesized using molten Ga, Al, and Pb fluxes. They have been structurally characterized by single-crystal and powder X-ray diffraction to form with two different structures—Ca 3 Al 2 P 4 , Sr 3 Al 2 As 4 , Eu 3 Al 2 P 4 , Eu 3 Al 2 As 4 , Ca 3 Ga 2 P 4 , Sr 3 Ga 2 P 4 , Sr 3 Ga 2 As 4 , and Eu 3 Ga 2 As 4 crystallize with the Ca 3 Al 2 As 4 structure type (space group C2/c, Z=4); Ba 3 Al 2 P 4 and Ba 3 Al 2 As 4 adopt the Na 3 Fe 2 S 4 structure type (space group Pnma, Z=4). The polyanions in both structures are made up of TrPn 4 tetrahedra, which share common corners and edges to form 2 ∞ [TrPn 2 ] 3– layers in the phases with the Ca 3 Al 2 As 4 structure, and 1 ∞ [TrPn 2 ] 3– chains in Ba 3 Al 2 P 4 and Ba 3 Al 2 As 4 with the Na 3 Fe 2 S 4 structure type. The valence electron count for all of these compounds follows the Zintl–Klemm rules. Electronic band structure calculations confirm them to be semiconductors. - Graphical abstract: AE 3 Al 2 Pn 4 and AE 3 Ga 2 Pn 4 (AE=Ca, Sr, Ba, Eu; Pn=P, As) crystallize in two different structures—Ca 3 Al 2 P 4 , Sr 3 Al 2 As 4 , Eu 3 Al 2 P 4 , Eu 3 Al 2 As 4 , Ca 3 Ga 2 P 4 , Sr 3 Ga 2 P 4 , Sr 3 Ga 2 As 4 , and Eu 3 Ga 2 As 4 , are isotypic with the previously reported Ca 3 Al 2 As 4 (space group C2/c (No. 15)), while Ba 3 Al 2 P 4 and Ba 3 Al 2 As 4 adopt a different structure known for Na 3 Fe 2 S 4 (space group Pnma (No. 62). The polyanions in both structures are made up of TrPn 4 tetrahedra, which by sharing common corners and edges, form 2 ∞ [TrPn 2 ] 3– layers in the former and 1 ∞ [TrPn 2 ] 3– chains in Ba 3 Al 2 P 4 and Ba 3 Al 2 As 4 . Highlights: ► AE 3 Ga 2 Pn 4 (AE=Ca, Sr, Ba, Eu; Pn=P, As) are new ternary pnictides. ► Ba 3 Al 2 P 4 and Ba 3 Al 2 As 4 adopt the Na 3 Fe 2 S 4 structure type. ► The Sr- and Ca-compounds crystallize with the Ca 3

Comparison of donor, and early and late recipient outcomes following hand assisted and laparoscopic donor nephrectomy.

Science.gov (United States)

Lucas, Steven M; Liaw, Aron; Mhapsekar, Rishi; Yelfimov, Daniel; Goggins, William C; Powelson, John A; Png, Keng Siang; Sundaram, Chandru P

2013-02-01

While laparoscopic donor nephrectomy has encouraged living kidney donation, debate exists about the safest laparoscopic technique. We compared purely laparoscopic and hand assisted laparoscopic donor nephrectomies in terms of donor outcome, early graft function and long-term graft outcome. We reviewed the records of consecutive laparoscopic and hand assisted laparoscopic donor nephrectomies performed by a single surgeon from 2002 to 2011. Donor operative time and perioperative morbidity were compared. Early graft function for kidneys procured by each technique was evaluated by rates of delayed graft function, need for dialysis and recipient discharge creatinine. Long-term outcomes were evaluated by graft function. A total of 152 laparoscopic donor nephrectomies were compared with 116 hand assisted laparoscopic donor nephrectomies. Hand assisted procedures were more often done for the right kidney (41.1% vs 17.1%, p recipient outcomes were also similar. Delayed function occurred after 0% hand assisted vs 0.9% purely laparoscopic nephrectomies, dialysis was required in 0.9% vs 1.7% and rejection episodes developed in 9.7% vs 18.4% (p >0.05). At last followup the organ was nonfunctioning in 6.1% of hand assisted and 7.7% of purely laparoscopic cases (p >0.05). The recipient glomerular filtration rate at discharge home was similar in the 2 groups. Hand assisted laparoscopic donor nephrectomy had shorter warm ischemia time but perioperative donor morbidity and graft outcome were comparable. The choice of technique should be based on patient and surgeon preference. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Role of pn-pairs in nuclear structure

International Nuclear Information System (INIS)

Nie, G.K.

2003-01-01

An α-cluster model of nuclear structure based on power of proton + neutron (pn)-pairs to bind themselves to α-clusters is proposed. The α-cluster is taken as the perfect condition of coupling of 2 pn- pairs, reminding complete electron shell in atomic physics. Pn-pairs create 2 other types of coupling of considerably less power between pn-pairs of nearby α-clusters ε α c and between pn-pair not bound into α-cluster with pn-pairs of nearby cluster ε pn c . Last two types of coupling are called covalent because of reminding similar electron coupling in chemistry. According the model nucleus is a liquid drop consisting of molecules, which are α-clusters, tied by covalent coupling with those ones which are in close vicinity. Then in case of even-even nuclei spin of the nucleus has to be zero I=0 + as sum of spinless particles. In case of nucleus has some nucleons (i) in intermolecular space, I=Σj i ; with taking into account that there is coupling of p and n in pn-pair. Therefore for 6 Li (1=0)I=2·1/2=1 + . The values ε α c , ε pn c and binding energy of the pn-pair itself ε pn have been estimated from analysis of binding energy of nuclei 6 Li, 10 B and 12 C. With the values the binding energy of the other nuclei with N=Z up to 58 Cu have been described with difference between experimental values and model ones in average less than 0.4 MeV. The structure reveals some regular forms, in which every cluster has reduced amount of covalent coupling, 3 or 4, and free pn-pair has 6 covalent coupling with 3 nearby clusters pn-pairs. Then the magic numbers are supposed to be the matter of geometry, when total amount of covalent couplings is optimal (minimal for the amount of clusters), α- clusters are placed in the same fixed distant from center of mass. It means that protons of the clusters can be considered as belonging to one shell. In the cluster model single particle effects have to be considered as single particle binding in one of the surface �

Comparison of renal function following donor nephrectomy versus radical nephrectomy for renal tumor

Directory of Open Access Journals (Sweden)

Mohamed Etafy

2015-01-01

Full Text Available In this study, we compared renal function in patients after donor nephrectomy (DN and radical nephrectomy (RN. We retrospectively reviewed 68 patients (mean follow-up 15 months, including 30 patients who had undergone DN and 38 patients who had undergone RN. The study was performed between April 2006 and July 2010 at a single institute. Patients were matched for age and co-morbidities (hypertension and diabetes mellitus. We calculated the estimated glomerular filtration rate (eGFR using the Modification of Diet in Renal Disease study group equation. Parameters studied included GFR (≥60 to 2.0 mg/dL, metabolic acidosis (serum bicarbonate 30 mg. There were no significant demographic differences between the two study groups. After a mean follow-up of 15 months, low eGFR (<60 mL/min/1.73 m 2 was seen in 28% and 6.7% of patients in the RN and DN groups, respectively (P = 0.03. Similarly, proteinuria was seen in 21% vs 0%, P = 0.007, and de novo elevated creatinine was seen in 13% vs 0%, respectively P = 0.04; thus the changes were greater in the RN group. Our study shows that undergoing RN had a significantly greater risk of developing renal insufficiency and proteinuria compared with age-and co-morbidity-matched patients undergoing DN. We concluded that patients undergoing RN show a significantly greater risk of developing renal insufficiency and proteinuria compared with the patients undergoing DN.

Need for intraoperative ultrasound and surgical recommendation for partial nephrectomy: correlation with tumor imaging features and urologist practice patterns.

Science.gov (United States)

Sun, Maryellen R M; Wagner, Andrew A; San Francisco, Ignacio F; Brook, Alexander; Kavoussi, Louis; Russo, Paul; Steele, Graeme; Viterbo, Rosalia; Pedrosa, Ivan

2012-03-01

This study aimed to evaluate the need for intraoperative ultrasound (IOUS) and recommendation for surgical approach in the resection of renal tumors through a survey of practicing urologists, with correlation to tumor imaging features and urologist practice pattern. An institutional review board-approved retrospective review, compliant with the Health Insurance Portability and Accountability Act, of 44 renal tumors that underwent laparoscopic partial nephrectomy at the study institution was performed. The numeric component of the RENAL nephrometry score (radius [diameter], % exophytic, nearness [to collecting system/renal sinus], location) was calculated for each case using preoperative computed tomography/magnetic resonance imaging. Five anonymized images of each tumor were presented to 4 academic urologists with varying practice patterns. Reviewers independently scored each case for its need for IOUS, for recommendation of a surgical technique, and for the difficulty of the proposed surgery. The RENAL scores were as follows: RENAL 1 (low complexity, score 4-6; n = 19); RENAL 2 (moderate complexity, score 7-9; n = 23); RENAL 3 (high complexity, score 10-12; n = 2). The only RENAL score component significantly influencing need for IOUS was percentage exophytic (P = 0.00002). There was an inverse relationship between normalized and averaged need for IOUS and percentage exophytic (P recommendation of surgical method was the reviewer him/herself, with each reviewer's recommendations closely matching his/her practice pattern. Size and percentage exophytic represented the only tumor features significantly (P = 0.03) influencing surgical recommendation. There was a significant difference in the perceived need for IOUS and surgical recommendation when 4 academic urologists reviewed a series of renal masses requiring resection. Percentage exophytic correlated inversely with need for IOUS. Urologist's practice pattern and tumor size and percentage exophytic were most

Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing.

Science.gov (United States)

Laviana, Aaron A; Tan, Hung-Jui; Hu, Jim C; Weizer, Alon Z; Chang, Sam S; Barocas, Daniel A

2018-03-01

To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC. Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P = 0.490), sex (P = 0.715), BMI (P = 0.273), and comorbidity (P = 0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P = 0.001) and length of stay (LOS) (1.8 versus 2.7 days, P factoring in disposable equipment, operative time, LOS, and personnel. In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.

Radical Nephrectomy for Primary Retroperitoneal Liposarcoma Near the Kidney has a Beneficial Effect on Disease-Free Survival.

Science.gov (United States)

Rhu, Jinsoo; Cho, Chan Woo; Lee, Kyo Won; Park, Hyojun; Park, Jae Berm; Choi, Yoon-La; Kim, Sung Joo

2018-01-01

The purpose of this study is to analyze the clinical impact of radical nephrectomy on retroperitoneal liposarcoma near the kidney. Data of patients who underwent surgery for unilateral primary retroperitoneal liposarcoma near the kidney were retrospectively collected. Patients were divided into four groups according to whether they underwent nephrectomy and combined resection of other organs. Kaplan-Meier survival analysis was used to estimate disease-free survival and overall survival. Multivariable Cox analysis was used to analyze factors related to disease-free survival and overall survival. Nephrectomy (HR = 0.260, CI = 0.078-0.873, p = 0.029) had a beneficial effect on disease-free survival, while interaction model of nephrectomy*other organ resection (HR = 4.655, CI = 1.767-12.263, p = 0.002) showed poor disease-free survival. Other organ resection was not related to disease-free survival (HR = 1.543, CI = 0.146-16.251, p = 0.718). Operation method (p = 0.007) and FNCLCC grade (p free survival. While combined organ resection without nephrectomy group (HR = 1.604, CI = 0.167-15.370, p = 0.682) and radical nephrectomy with combined organ resection group (HR = 1.309, CI = 0.448-3.825, p = 0.622) did not show significant difference in disease-free survival from the mass excision only group, radical nephrectomy without combined organ resection group (HR = 0.279, CI = 0.078-0.991, p = 0.048) showed superior disease-free survival. Radical nephrectomy of unilateral primary retroperitoneal liposarcoma near the kidney has a beneficial effect on disease-free survival.

Effect of Varying Pnictogen Elements (Pn=N, P, As, Sb, Bi) on the Optoelectronic Properties of SrZn2Pn2

Science.gov (United States)

Murtaza, G.; Yousaf, N.; Laref, A.; Yaseen, M.

2018-03-01

Pnictogen-based Zintl compounds have fascinating properties. Nowadays these compounds have gained exceptional interest in thermoelectric and optoelectronic fields. Therefore, in this work the structural, electronic and optical properties of SrZn2Pn2 (Pn=N, P, As, Sb, Bi) compounds were studied using state-of-the-art density functional theory. The optimised lattice parameters (ɑ, c, c/ɑ and bond lengths) are consistent with the experimental results. The bulk moduli and c/a showed a decrease when changing the Pnictogen (Pn) anion from N to Bi in SrZn2Pn2 (Pn=N, P, As, Sb, Bi). The modified Becke-Johnson potential is used for band structure calculations. All compounds show semiconducting behaviour except SrZn2Bi2, which is metallic. Pn-p, Zn-d and Sr-d play an important role in defining the electronic structure of the compounds. The optical conductivity and absorption coefficient strength are high in visible and ultraviolet regions. These band structures and optical properties clearly show that SrZn2Pn2 compounds are potential candidates in the fields of optoelectronic and photonic devices.

Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

Science.gov (United States)

Maciel, R F; Branco, A J; Branco, A W; Guterres, J C; Silva, A E; Ramos, L B; Rost, C; Vieira, C A; Cicogna, P E S; Daudt, C A; Deboni, L M; Vieira, M A; Luz, H A; Vieira, J A

2003-12-01

We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering

Directory of Open Access Journals (Sweden)

Shioyama Yasukazu

2010-04-01

Full Text Available Abstract Background Single minimum incision endoscopic surgery (MIES involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images. Methods Radical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer. Results Single MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity. These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies. Conclusions Single MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.

Actinide-pnictide (An-Pn) bonds spanning non-metal, metalloid, and metal combinations (An=U, Th; Pn=P, As, Sb, Bi)

Energy Technology Data Exchange (ETDEWEB)

Rookes, Thomas M.; Wildman, Elizabeth P.; Gardner, Benedict M.; Wooles, Ashley J.; Gregson, Matthew; Tuna, Floriana; Liddle, Stephen T. [School of Chemistry, The University of Manchester (United Kingdom); Balazs, Gabor; Scheer, Manfred [Institute of Inorganic Chemistry, University of Regensburg (Germany)

2018-01-26

The synthesis and characterisation is presented of the compounds [An(Tren{sup DMBS}){Pn(SiMe_3)_2}] and [An(Tren{sup TIPS}){Pn(SiMe_3)_2}] [Tren{sup DMBS}=N(CH{sub 2}CH{sub 2}NSiMe{sub 2}Bu{sup t}){sub 3}, An=U, Pn=P, As, Sb, Bi; An=Th, Pn=P, As; Tren{sup TIPS}=N(CH{sub 2}CH{sub 2}NSiPr{sup i}{sub 3}){sub 3}, An=U, Pn=P, As, Sb; An=Th, Pn=P, As, Sb]. The U-Sb and Th-Sb moieties are unprecedented examples of any kind of An-Sb molecular bond, and the U-Bi bond is the first two-centre-two-electron (2c-2e) one. The Th-Bi combination was too unstable to isolate, underscoring the fragility of these linkages. However, the U-Bi complex is the heaviest 2c-2e pairing of two elements involving an actinide on a macroscopic scale under ambient conditions, and this is exceeded only by An-An pairings prepared under cryogenic matrix isolation conditions. Thermolysis and photolysis experiments suggest that the U-Pn bonds degrade by homolytic bond cleavage, whereas the more redox-robust thorium compounds engage in an acid-base/dehydrocoupling route. (copyright 2018 The Authors. Published by Wiley-VCH Verlag GmbH and Co. KGaA.)

Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform.

Science.gov (United States)

LaMattina, John C; Alvarez-Casas, Josue; Lu, Irene; Powell, Jessica M; Sultan, Samuel; Phelan, Michael W; Barth, Rolf N

2018-02-01

Although single-port donor nephrectomy offers improved cosmetic outcomes, technical challenges have limited its application to selected centers. Our center has performed over 400 single-port donor nephrectomies. The da Vinci single-site robotic platform was utilized in an effort to overcome the steric, visualization, ergonomic, and other technical limitations associated with the single-port approach. Food and Drug Administration device exemption was obtained. Selection criteria for kidney donation included body mass index da Vinci single-site platform. Our experience supported the safety of this approach but found that the technology added cost and complexity without tangible benefit. Development of articulating instruments, energy, and stapling devices will be necessary for increased application of robotic single-site surgery for donor nephrectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors Affecting Changes in the Glomerular Filtration Rate after Unilateral Nephrectomy in Living Kidney Donors and Patients with Renal Disease

Energy Technology Data Exchange (ETDEWEB)

Kim, Hye Ok; Chae, Sun Young; Back, Sora; Moon, Dae Hyuk [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2010-04-15

We evaluated the factors affecting changes in the postoperative glomerular filtration rate (GFR) after unilateral nephrectomy in living kidney donors and patients with renal disease. We studied 141 subjects who underwent living donor nephrectomy for renal transplantation (n=75) or unilateral nephrectomy for renal diseases (n=66). The GFR of the individual kidney was determined by Tc-99m DTPA scintigraphy before and after nephrectomy. By performing multiple linear regression analysis, we evaluated the factors that are thought to affect changes in GFR, such as age, sex, body mass index (BMI), preoperative GFR, preoperative creatinine level, operated side, presence of diabetes mellitus (DM), presence of hypertension (HTN), and duration of follow-up. In both the donor nephrectomy and the disease nephrectomy groups, GFR increased significantly after nephrectomy (46.9{+-}8.4 to 58.1{+-}12.5 vs. 43.0{+-}9.6 to 48.6{+-}12.8 ml/min, p<0.05). In the donor nephrectomy group, age was significantly associated with change in GFR ({beta}=-0.3, P<0.005). In the disease nephrectomy group, HTN, preoperative creatinine level, and age were significantly associated with change in GFR ({beta}=-6.2, p<0.005; {beta}=-10.9, p<0.01; {beta}=-0.2, p<0.01, respectively). This compensatory change in GFR was not significantly related to sex, duration of follow-up, or operated side in either group. The compensatory change in the GFR of the remaining kidney declined with increasing age in both living kidney donors and patients with renal disease.

Silicon fiber with p-n junction

International Nuclear Information System (INIS)

Homa, D.; Cito, A.; Pickrell, G.; Hill, C.; Scott, B.

2014-01-01

In this study, we fabricated a p-n junction in a fiber with a phosphorous doped silicon core and fused silica cladding. The fibers were fabricated via a hybrid process of the core-suction and melt-draw techniques and maintained overall diameters ranging from 200 to 900 μm and core diameters of 20–800 μm. The p-n junction was formed by doping the fiber with boron and confirmed via the current-voltage characteristic. The demonstration of a p-n junction in a melt-drawn silicon core fiber paves the way for the seamless integration of optical and electronic devices in fibers.

Laparoscopic donor nephrectomy versus open donor nephrectomy: Recipient′s perspective

Directory of Open Access Journals (Sweden)

Tukaram E Jamale

2012-01-01

Full Text Available Effects of laparoscopic donor nephrectomy (LDN on graft function, especially early post-transplant, have been controversial. To assess and compare early and late graft function in kidneys procured by open and laparoscopic methods, a retrospective observational study was carried out on 37 recipients-donors who underwent LDN after introduction of this technique in February 2007 at our center, a tertiary care nephrology referral center. Demographic, immunological and intraoperative variables as well as immunosuppressive protocols and number of human leukocyte antigen (HLA mismatches were noted. Early graft function was assessed by serum creatinine on Days two, five, seven, 14 and 28 and at the time of discharge. Serum creatinine values at three months and at one year post-transplant were considered as the surrogates of late graft function. Data obtained were compared with the data from 33 randomly selected kidney transplants performed after January 2000 by the same surgical team, in whom open donor nephrectomy was used. Pearson′s chi square test, Student′s t test and Mann-Whitney U test were used for statistical analysis. Early graft function (serum creatinine on Day five 2.15 mg/dL vs 1.49 mg/dL, P = 0.027 was poorer in the LDN group. Late graft function as assessed by serum creatinine at three months (1.45 mg/dL vs 1.31 mg/dL, P = 0.335 and one year (1.56 mg/dL vs 1.34 mg/dL, P = 0.275 was equivalent in the two groups. Episodes of early acute graft dysfunction due to acute tubular necrosis were significantly higher in the LDN group (37.8% vs 12.1%, Z score 2.457, P = 0.014. Warm ischemia time was significantly prolonged in the LDN group (255 s vs 132.5 s, P = 0.002. LDN is associated with slower recovery of graft function and higher incidence of early acute graft dysfunction due to acute tubular necrosis. Late graft function at one year is however comparable.

Low-fat, high-carbohydrate parenteral nutrition (PN) may potentially reverse liver disease in long-term PN-dependent infants

DEFF Research Database (Denmark)

Jakobsen, Marianne Skytte; Jørgensen, Marianne Hørby; Husby, Steffen

2015-01-01

INTRODUCTION: Parenteral nutrition-associated cholestasis (PNAC) is a complication of long-term parenteral nutrition (PN). Removal of lipids may reverse PNAC but compromises the energy to ensure infant growth. The purpose of this study was to test whether a low-fat, high-carbohydrate PN regimen......, which prevents and reverses PNAC in adults, could do the same in infants. This regimen could potentially avoid the problem of diminished energy input after removing nutritional lipids. METHODS: Infants developing PNAC over a 2-year period were started on a low-fat PN regimen with calories primarily from...

Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity.

Science.gov (United States)

Tobert, Conrad M; Shoemaker, Allen; Kahnoski, Richard J; Lane, Brian R

2015-04-01

To investigate whether a combination of variables from each nephrometry system improves performance. There are 3 first-generation systems that quantify tumor complexity: R.E.N.A.L. nephrometry score (RNS), preoperative aspects and dimensions used for an anatomical (PADUA) classification (PC), and centrality index (CI). Although each has been subjected to validation and comparative analysis, to our knowledge, no work has been done to combine variables from each method to optimize their performance. Scores were assigned to each of 276 patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Individual components of all 3 systems were evaluated in multivariable logistic regression analysis of surgery type (PN vs. RN) and combined into a "second-generation model." In multivariable analysis, each scoring system was a significant predictor of PN vs. RN (Psystems, CI was most highly correlated with surgery type (area under the curve [AUC] = 0.91), followed by RNS (AUC = 0.90) and PC (AUC = 0.88). Each individual component of these scoring systems was also a predictor of surgery type (Psystem (RNS), location along the lateral rim (PC), and centrality (CI). A novel model in which these 4 variables were rescaled outperformed each first-generation system (AUC = 0.91). Optimization of first-generation models of renal tumor complexity results in a novel scoring system, which strongly predicts surgery type. This second-generation model should aid comprehension, but future work is still needed to establish the most clinically useful model. Copyright © 2015 Elsevier Inc. All rights reserved.

Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report.

Science.gov (United States)

Gonzalez-Heredia, Raquel; Garcia-Roca, Raquel; Benedetti, Enrico

2016-01-01

Total situs inversus" is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor nephrectomies. We report here the first right donor nephrectomy in a patient with total situs inversus that is performed using the Da Vinci platform. Published by Elsevier Ltd.

Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report

Directory of Open Access Journals (Sweden)

Raquel Gonzalez-Heredia

2016-01-01

Full Text Available Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor nephrectomies. We report here the first right donor nephrectomy in a patient with total situs inversus that is performed using the Da Vinci platform.

[Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

Science.gov (United States)

Lysenko, M A; Vtorenko, V I; Trushkin, R N; Lubennikov, A E; Sysoev, A M; Sokolov, A A

2016-02-01

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

Cecal Volvulus Following Laparoscopic Nephrectomy and Renal Transplantation

Science.gov (United States)

Ravindra, Kadiyala

2009-01-01

Cecal volvulus is a rare cause of bowel obstruction that carries a high mortality. Recent surgery is known to be a risk factor for the development of cecal volvulus. We present a case of cecal volvulus following laparoscopic nephrectomy and renal transplantation. PMID:20202405

Ternary CaCu4P2-type pnictides AAg4Pn2 (A=Sr, Eu; Pn=As, Sb)

Science.gov (United States)

Stoyko, Stanislav S.; Khatun, Mansura; Scott Mullen, C.; Mar, Arthur

2012-08-01

Four ternary pnictides AAg4Pn2 (A=Sr, Eu; Pn=As, Sb) were prepared by reactions of the elements at 850 °C and their crystal structures were determined from single-crystal X-ray diffraction studies. These silver-containing pnictides AAg4Pn2 adopt the trigonal CaCu4P2-type structure (Pearson symbol hR21, space group R3¯m, Z=3; a=4.5555(6) Å, c=24.041(3) Å for SrAg4As2; a=4.5352(2) Å, c=23.7221(11) Å for EuAg4As2; a=4.7404(4) Å, c=25.029(2) Å for SrAg4Sb2; a=4.7239(3) Å, c=24.689(2) Å for EuAg4Sb2), which can be derived from the trigonal CaAl2Si2-type structure of the isoelectronic zinc-containing pnictides AZn2Pn2 by insertion of additional Ag atoms into trigonal planar sites within [M2Pn2]2- slabs built up of edge-sharing tetrahedra. Band structure calculations on SrAg4As2 and SrAg4Sb2 revealed that these charge-balanced Zintl phases actually exhibit no gap at the Fermi level and are predicted to be semimetals.

Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results.

Science.gov (United States)

Teber, Dogu; Guven, Selcuk; Simpfendörfer, Tobias; Baumhauer, Mathias; Güven, Esref Oguz; Yencilek, Faruk; Gözen, Ali Serdar; Rassweiler, Jens

2009-08-01

Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures.

Partial scan artifact reduction (PSAR) for the assessment of cardiac perfusion in dynamic phase-correlated CT.

Science.gov (United States)

Stenner, Philip; Schmidt, Bernhard; Bruder, Herbert; Allmendinger, Thomas; Haberland, Ulrike; Flohr, Thomas; Kachelriess, Marc

2009-12-01

Cardiac CT achieves its high temporal resolution by lowering the scan range from 2pi to pi plus fan angle (partial scan). This, however, introduces CT-value variations, depending on the angular position of the pi range. These partial scan artifacts are of the order of a few HU and prevent the quantitative evaluation of perfusion measurements. The authors present the new algorithm partial scan artifact reduction (PSAR) that corrects a dynamic phase-correlated scan without a priori information. In general, a full scan does not suffer from partial scan artifacts since all projections in [0, 2pi] contribute to the data. To maintain the optimum temporal resolution and the phase correlation, PSAR creates an artificial full scan pn(AF) by projectionwise averaging a set of neighboring partial scans pn(P) from the same perfusion examination (typically N approximately 30 phase-correlated partial scans distributed over 20 s and n = 1, ..., N). Corresponding to the angular range of each partial scan, the authors extract virtual partial scans pn(V) from the artificial full scan pn(AF). A standard reconstruction yields the corresponding images fn(P), fn(AF), and fn(V). Subtracting the virtual partial scan image fn(V) from the artificial full scan image fn(AF) yields an artifact image that can be used to correct the original partial scan image: fn(C) = fn(P) - fn(V) + fn(AF), where fn(C) is the corrected image. The authors evaluated the effects of scattered radiation on the partial scan artifacts using simulated and measured water phantoms and found a strong correlation. The PSAR algorithm has been validated with a simulated semianthropomorphic heart phantom and with measurements of a dynamic biological perfusion phantom. For the stationary phantoms, real full scans have been performed to provide theoretical reference values. The improvement in the root mean square errors between the full and the partial scans with respect to the errors between the full and the corrected scans is

Morphological variants of renal carcinoma in radical nephrectomy specimens

International Nuclear Information System (INIS)

Humera, A.; Kehar, I.

2015-01-01

To determine the morphological variants of Renal Cell Carcinoma (RCC) to detect the commonest histopathological type with special focus to the newly introduced entity Clear Cell Papillary Renal Cell Carcinoma (CCPRCC). Study Design: Case series. Place and Duration of Study: Department of Pathology, Basic Medical Sciences Institute, JPMC, Karachi, from January 2007 to December 2012. Methodology: Paraffin embedded blocks of 32 cases of radical nephrectomy specimens for renal mass were selected from records of Pathology Department, BMSI. Cases were excluded due to inadequate biopsies. Remaining 30 cases of renal cell carcinoma were included in study. H and E staining was done for all cases and PAS stain was employed for a few cases. All cases were reviewed under light microscope. Results: The 30 cases of renal cell carcinoma included 21 (70%) clear cell renal cell carcinoma, 03 (10%) clear cell papillary renal cell carcinoma, 02 (6.6%) papillary renal cell carcinoma and 04 (13.33%) hybrid tumors. Majority of cases (53.3%) found in age range between 40 - 60 years while 23.33% cases were found in 7th and 6.6% in 8th decade of life. While 16.66% cases were in younger age group that is between 31 - 40 years of age. Sixty percent cases of right radical nephrectomies and 40% cases of left radical nephrectomies. Conclusion: CCRCC was most common histopathologic type followed by CCPRCC, hybrid tumors and PRCC. (author)

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 ...

African Journals Online (AJOL)

but the working space in the initial stages of the operation is ... To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic ... maintained during the early learning curve of the transition to minimalaccess donor nephrectomy ...

[Robotic assisted laparoscopic living donor nephrectomy: preoperative assessment and results of 100 cases].

Science.gov (United States)

Laplace, B; Ladrière, M; Claudon, M; Eschwege, P; Kessler, M; Hubert, J

2014-04-01

To assess short term morbidity and renal function after robotic laparoscopic living donor nephrectomy. We performed a retrospective analysis of 100 consecutives patients undergoing a robotic laparoscopic living donors nephrectomy. We analyzed isotopic measure of the renal function before and 4 months after surgery, the side, the number of arteries, the blood loss, the operative time and warm ischemia time. In the outcomes, we collected the complications, the length of stay, and for the receiver, the renal function recovery time, dialysis, survival and renal function at one year. Left kidney nephrectomy was performed in 85 patients and we observed 25 multiples renal arteries. Mean estimated blood loss was 0,8 g/dL. Mean operative time and warm ischemia time were respectively 174 ± 30 and 4.8 ± 1.7 minutes. Seven complications occured, with 2 major (Clavien-Dindo System). Mean length of stay was 5.1 ± 1.9 days. Mean glomerular filtration decrease was 26% and remains stable at one year after surgery. Grafts had an immediate renal function recovery for 99%, and were all functional after one year, with mean MDRD clearance of 57 ± 14mL/min. Robotic procedure in laparoscopic living donor nephrectomy seems to guarantee low morbidity and the stability of the renal function decrease of 26%. Copyright © 2013. Published by Elsevier Masson SAS.

An efficient p-n heterojunction photocatalyst constructed from a coordination polymer nanoplate and a partically reduced graphene oxide for visible-light hydrogen production.

Science.gov (United States)

Xu, Xinxin; Lu, Tingting; Liu, Xiaoxia; Wang, Xiuli

2015-10-05

A new p-n heterojunction photocatalyst has been synthesized successfully through chemical-bond-mediated combination of coordination polymer nanoplates (CPNPs) and partially reduced graphene oxide (PRGO) with a simple colloidal blending process. Photocatalytic H2 production by the p-n heterojunction photocatalyst PRGO/CPNP was investigated under visible-light irradiation, which illustrates that PRGO/CPNP exhibits a much higher photocatalytic H2 production rate than neat the CPNPs. The improvement of this photocatalytic property can be attributed to the inner electrical field formed in the p-n heterojunction, which impedes recombination of photogenerated electrons and holes. In PRGO/CPNP, the existence of the p-n heterojunction has been confirmed by electrochemical methods clearly. For PRGO/CPNP, the reductive degree of the PRGO has a great influence on the H2 production rate and an ideal condition to get a PRGO/CPNP photocatalyst with higher performance has been obtained. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Introduction of hand-assisted retroperitoneoscopic living donor nephrectomy at Karolinska University Hospital Huddinge.

Science.gov (United States)

Gjertsen, H; Sandberg, A-K A; Wadström, J; Tydén, G; Ericzon, B-G

2006-10-01

Living donor kidney transplantation accounts for about 50% of the total number of renal transplantations at our center. From 1999 through 2005, 75 out of 220 living donor nephrectomies were performed with a laparoscopic technique (LLDN). In June 2005, we introduced the technique of hand-assisted retroperitoneoscopic nephrectomy (HARS) for living donors. Since the introduction until the end of 2005, 11 out of 18 living donor nephrectomies (LDN) were performed with HARS. Reduced operation time was observed for the HARS group (mean, 166 minutes) compared with the LLDN (mean, 244 minutes). Two grafts showed delayed function, one in the LLND group and one in the HARS group. No major perioperative or postoperative complications were observed in the HARS group, whereas one patient who underwent LLDN developed severe pancreatitis. So far in our hands HARS is a fast and safe procedure with results comparable with open LDN. Compared to LLDN, we experienced reduced operation time together with the advantage of retroperitoneal access.

Ternary CaCu4P2-type pnictides AAg4Pn2 (A=Sr, Eu; Pn=As, Sb)

International Nuclear Information System (INIS)

Stoyko, Stanislav S.; Khatun, Mansura; Scott Mullen, C.; Mar, Arthur

2012-01-01

Four ternary pnictides AAg 4 Pn 2 (A=Sr, Eu; Pn=As, Sb) were prepared by reactions of the elements at 850 °C and their crystal structures were determined from single-crystal X-ray diffraction studies. These silver-containing pnictides AAg 4 Pn 2 adopt the trigonal CaCu 4 P 2 -type structure (Pearson symbol hR21, space group R3-bar m, Z=3; a=4.5555(6) Å, c=24.041(3) Å for SrAg 4 As 2 ; a=4.5352(2) Å, c=23.7221(11) Å for EuAg 4 As 2 ; a=4.7404(4) Å, c=25.029(2) Å for SrAg 4 Sb 2 ; a=4.7239(3) Å, c=24.689(2) Å for EuAg 4 Sb 2 ), which can be derived from the trigonal CaAl 2 Si 2 -type structure of the isoelectronic zinc-containing pnictides AZn 2 Pn 2 by insertion of additional Ag atoms into trigonal planar sites within [M 2 Pn 2 ] 2− slabs built up of edge-sharing tetrahedra. Band structure calculations on SrAg 4 As 2 and SrAg 4 Sb 2 revealed that these charge-balanced Zintl phases actually exhibit no gap at the Fermi level and are predicted to be semimetals. - Graphical abstract: SrAg 4 As 2 and related pnictides adopt a CaCu 4 P 2 -type structure in which additional Ag atoms enter trigonal planar sites within slabs built from edge-sharing tetrahedra. Highlights: ► AAg 4 Pn 2 are the first Ag-containing members of the CaCu 4 P 2 -type structure. ► Ag atoms are stuffed in trigonal planar sites within CaAl 2 Si 2 -type slabs. ► Ag–Ag bonding develops through attractive d 10 –d 10 interactions.

Laparoscopic donor nephrectomy: meeting the challenge of consumerism?

Science.gov (United States)

Siddins, Mark; Hart, Gabrielle; He, Bulang; Kanchanabat, Burapa; Mohan Rao, M

2003-11-01

Despite the increasing adoption of laparoscopic donor nephrectomy, no study has examined donor perceptions following this procedure. In particular, it has been tacitly assumed that a less invasive procedure might in itself provide a more satisfactory donor experience. The present study reviews the experience of donors undergoing laparoscopic nephrectomy, and examines the extent to which contemporary management practice addresses issues relevant to consumerism. Forty-two donors participated in a structured telephone interview, and 33 (79%) returned a written questionnaire. Coming through the survey was a strong sense of commitment to donation, and most respondents were satisfied with the experience. The main criticisms related to hotel services, the duration of the preoperative investigations, the perceived quality of nursing care on the general wards, medical communication and the duration of postoperative follow up. The self-reported time to meet recovery goals was extremely broad. Considering the nature of criticisms offered by the respondents, it is concluded that the expectations of donors as health-care consumers will only be met through modification of existing protocols.

Synthesis and structural characterization of the Zintl phases Na{sub 3}Ca{sub 3}TrPn{sub 4}, Na{sub 3}Sr{sub 3}TrPn{sub 4}, and Na{sub 3}Eu{sub 3}TrPn{sub 4} (Tr=Al, Ga, In; Pn=P, As, Sb)

Energy Technology Data Exchange (ETDEWEB)

Wang, Yi [Department of Chemistry & Biochemistry, University of Delaware, 304A Drake Hall, Newark, DE 19716 (United States); Suen, Nian-Tzu [Department of Chemistry & Biochemistry, University of Delaware, 304A Drake Hall, Newark, DE 19716 (United States); College of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225002 (China); Kunene, Thabiso; Stoyko, Stanislav [Department of Chemistry & Biochemistry, University of Delaware, 304A Drake Hall, Newark, DE 19716 (United States); Bobev, Svilen, E-mail: bobev@udel.edu [Department of Chemistry & Biochemistry, University of Delaware, 304A Drake Hall, Newark, DE 19716 (United States)

2017-05-15

15 new quaternary Zintl phases have been synthesized by solid-state reactions from the respective elements, and their structures have been determined by single-crystal X-ray diffraction. Na{sub 3}E{sub 3}TrPn{sub 4} (E=Ca, Sr, Eu; Tr=Al, Ga, In; Pn=P, As, Sb) crystallize in the hexagonal crystal system with the non-centrosymmetric space group P6{sub 3}mc (No. 186). The structure represents a variant of the K{sub 6}HgS{sub 4} structure type (Pearson index hP22) and features [TrPn{sub 4}]{sup 9–} tetrahedral units, surrounded by Na{sup +} and Ca{sup 2+}, Sr{sup 2+}, Eu{sup 2+} cations. The nominal formula rationalization [Na{sup +}]{sub 3}[E{sup 2+}]{sub 3}[TrPn{sub 4}]{sup 9–} follows the octet rule, suggesting closed-shell configurations for all atoms and intrinsic semiconducting behavior. However, structure refinements for several members hint at disorder and mixing of cations that potentially counteract the optimal valence electron count. - Graphical abstract: The hexagonal, non-centrosymmetric structure of Na{sub 3}E{sub 3}TrPn{sub 4} (E=Ca, Sr, Eu; Tr=Al, Ga, In; Pn=P, As, Sb) features [TrPn{sub 4}]{sup 9–} tetrahedral units, surrounded by Na{sup +} and Ca{sup 2+}, Sr{sup 2+}, Eu{sup 2+} cations. - Highlights: • 15 quaternary phosphides, arsenides, and antimonides are synthesized and structurally characterized. • The structure is a variant of the hexagonal K{sub 6}HgS{sub 4}-type, with distinctive pattern for the cations. • Occupational and/or positional disorder of yet unknown origin exists for some members of the series.

Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique.

Science.gov (United States)

Giacomoni, Alessandro; Di Sandro, Stefano; Lauterio, Andrea; Concone, Giacomo; Mangoni, Iacopo; Mihaylov, Plamen; Tripepi, Matteo; De Carlis, Luciano

2014-09-01

The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients. Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients). Intra-operative bleeding was similar in the two groups (90 vs 100 mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1 min for Group A and B, respectively, P-value = 0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275 min vs 250 min, respectively). Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety. Copyright © 2014 John Wiley & Sons, Ltd.

Impact of partial nitritation degree and C/N ratio on simultaneous Sludge Fermentation, Denitrification and Anammox process.

Science.gov (United States)

Wang, Bo; Peng, Yongzhen; Guo, Yuanyuan; Yuan, Yue; Zhao, Mengyue; Wang, Shuying

2016-11-01

This study presents a novel process (i.e. PN/SFDA) to remove nitrogen from low C/N domestic wastewater. The process mainly involves two reactors, a pre-Sequencing Batch Reactor for partial nitritation (termed as PN-SBR) and an anoxic reactor for integrated Denitrification and Anammox with carbon sources produced from Sludge Fermentation (termed as SFDA). During long-term Runs, NO2(-)/NH4(+) ratio (i.e. NO2(-)-N/NH4(+)-N calculated by mole) in the PN-SBR effluent was gradually increased from 0.2 to 37 by extending aerobic duration, meaning that partial nitritation turning to full nitritation could be achieved. Impact of partial nitritation degree on SFDA process was investigated and the result showed that, NO2(-)/NH4(+) ratios between 2 and 10 were appropriate for the co-existence of denitrification and anammox together in the SFDA reactor, and denitrification instead of anammox contributed greater for nitrogen removal. Further batch tests indicated that anammox collaborated well with denitrification at low C/N (1.0 in this study). Copyright © 2016 Elsevier Ltd. All rights reserved.

n-p Short-Range Correlations from (p,2p+n) Measurements

Science.gov (United States)

Tang, A.; Watson, J. W.; Aclander, J.; Alster, J.; Asryan, G.; Averichev, Y.; Barton, D.; Baturin, V.; Bukhtoyarova, N.; Carroll, A.; Gushue, S.; Heppelmann, S.; Leksanov, A.; Makdisi, Y.; Malki, A.; Minina, E.; Navon, I.; Nicholson, H.; Ogawa, A.; Panebratsev, Yu.; Piasetzky, E.; Schetkovsky, A.; Shimanskiy, S.; Zhalov, D.

2003-01-01

We studied the 12C(p,2p+n) reaction at beam momenta of 5.9, 8.0, and 9.0 GeV/c. For quasielastic (p,2p) events pf, the momentum of the knocked-out proton before the reaction, was compared (event by event) with pn, the coincident neutron momentum. For |pn|>kF=0.220 GeV/c (the Fermi momentum) a strong back-to-back directional correlation between pf and pn was observed, indicative of short-range n-p correlations. From pn and pf we constructed the distributions of c.m. and relative motion in the longitudinal direction for correlated pairs. We also determined that 49±13% of events with |pf|>kF had directionally correlated neutrons with |pn|>kF.

Compensatory changes in the function of the remaining kidney immediately after unilateral nephrectomy in sheep

International Nuclear Information System (INIS)

Ziada, G.; Khalil, M.; Youseif, H.

2009-01-01

Live kidney donation is an established form of organ donation but carries the risk of an unnecessary surgery in a normal individual for the benefit of the recipient. Despite a number of recent studies on the renal function of long-term kidney donors, little attention has been paid to the damaging effects of compensatory hyper-filtration on renal tubular cells immediately after donor nephrectomy. The present study therefore aimed to examine the immediate changes in renal function of the remaining kidney using a sheep model of unilateral nephrectomy. We used the gamma camera-based method to measure the glomerular filtration rate and the tubular excretion values after simultaneous injection of 99m Tc-diethylene triamine pentaacetic acid and 131 I-ortho-iodohippurate tracers. Compared were the differences in the functions between the remaining left kidney immediately after clamping the right renal pedicle and the baseline values that were measured one week before unilateral nephrectomy. After radionuclide data acquisition was completed, the right kidney was removed. The mean glomerular filtration rate (GFR) increased by 52.3% from the baseline values (29.5±2.7 to 45.0±6.7 ml/min; n=40, p<0.001), while the mean effective renal plasma flow (ERPF) increased by 40% (225.5±27.8 to 357.8±38.94 ml/min; p<0.001), respectively. Mean filtration fraction was increased from 0.117 to 0.127 immediately after nephrectomy (p<0.001). We conclude that after unilateral nephrectomy the remaining kidney immediately compensates for the loss of a donated kidney by increasing glomerular filtration rate and effective renal plasma flow. (author)

HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. THE FIRST RUSSIAN EXPERIENCE

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S. V. Gautier

2010-01-01

Full Text Available The first experience of hand-assisted laparoscopic donor nephrectomy is described in the article. A new technique of the operation and it’s results are discussed in details. Advantages of this type of the operation in comparison with open and full laparoscopic techniques are presented. 

Impact of radical nephrectomy on renal functional outcome in ...

African Journals Online (AJOL)

H.H. Qureshi

2015-10-09

Oct 9, 2015 ... Abstract. Introduction: Renal cell carcinoma (RCC) accounts for 3% of all adult tumors. The mainstay of treatment of. RCCs in the past has remained radical nephrectomy (RN). Studies have found a higher cumulative incidence of development of chronic renal insufficiency in patients undergoing RN for RCC ...

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study.

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Bunthof, Kim L W; Verhoeks, Carmen M; van den Brand, Jan A J G; Hilbrands, Luuk B

2018-02-01

Graft nephrectomy is recommended in case of early graft failure. When the graft fails more than 3-6 months after transplantation, it is current practice to follow a wait-and-see policy. A common indication for graft removal is the graft intolerance syndrome. We aimed to create a risk prediction model for the occurrence of graft intolerance resulting in graft nephrectomy. We collected data of kidney transplantations performed in our center between 1980 and 2010 that failed at least 6 months after transplantation. We evaluated the association between baseline characteristics and the occurrence of graft nephrectomy because of graft intolerance using a competing risk regression model. Prognostic factors were included in a multivariate prediction model. In- and exclusion criteria were met in 288 cases. In 48 patients, the graft was removed because of graft intolerance. Donor age, the number of rejections, and shorter graft survival were predictive factors for graft nephrectomy because of the graft intolerance syndrome. These factors were included in a prediction rule. Using donor age, graft survival, and the number of rejections, clinicians can predict the need for graft nephrectomy with a reasonable accuracy. © 2017 Steunstichting ESOT.

Laparoscopic radical nephrectomy versus open radical nephrectomy in T1-T3 renal tumors: An outcome analysis

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Arvind P Ganpule

2008-01-01

Full Text Available Aims: To compare laparoscopic radical nephrectomy (LRN with open radical nephrectomy (ORN in T1-T3 renal lesions. Materials and Methods: The records of 65 patients who underwent LRN between January 2002 and December 2006 were entered prospectively in a database. The patients were compared with 56 patients who had undergone ORN between January 2000 and December 2005. The two groups were comparable in terms of age, body mass index (BMI and tumor size. LRN was compared with ORN in terms of operative room time, blood loss, complications , analgesic requirement, hospital stay and start of oral intake. The oncologic efficacy was evaluated in stages T1 and T2 in terms of cancer-free and overall survival. Results: The laparoscopy group had a significantly shorter hospital stay (5.72, range 3-23 days vs. 9.18, range 4-23 days, p value: < 0.0001, analgesia requirement (175.65, range 50-550 mg vs. 236, range 0-1100 mg of tramadol, p value: < 0.03, hemoglobin decline (1.55, range 0.1 to 4.4 mg/dl vs. 2.25, range 0.2 - 7 mg/dL, p value: < 0.001 and hematocrit drop (4.83, range 0.3 - 12.9 vs. 7.06 range 2 -18, p value: < 0.0001. The majority of specimens showed renal cell carcinoma. In the laparoscopy group, 29 tumors were T1 stage, 18 were T2, while eight were T3. In the open surgery group, 25 tumors were T1, 19 were T2 and 12 were T3. The cancer-free survival rate at 24 months for ORN and LRN in T1 lesions was 91.7% and 93.15% respectively and the patient survival rate was 100% in both groups. The cancer-free survival rate at 24 months for ORN and LRN in T2 lesions was 88.9% and 94.1%, respectively and the patient survival was 100% and 94%, respectively. After LRN, there was one instance of port site metastasis, local recurrence and distant metastasis. All recurrences were distant after ORN. Conclusion: Laparoscopic radical nephrectomy has advantages in terms of shorter hospitalization and a lower analgesia requirement. It is feasible and produces effective

Non-invasive monitoring of tissue oxygenation during laparoscopic donor nephrectomy

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Kirk Allan D

2008-04-01

Full Text Available Abstract Background Standard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery. However, during laparoscopic surgery, these processes are impaired. This is of particular relevance during laparoscopic renal donation, where the condition of the kidney must be optimized despite considerable manipulation. However, there is no in vivo methodology to monitor renal parenchymal oxygenation during laparoscopic surgery. Methods We have developed a method for the real time, in vivo, whole organ assessment of tissue oxygenation during laparoscopic nephrectomy to convey meaningful biological data to the surgeon during laparoscopic surgery. We apply the 3-CCD (charge coupled device camera to monitor qualitatively renal parenchymal oxygenation with potential real-time video capability. Results We have validated this methodology in a porcine model across a range of hypoxic conditions, and have then applied the method during clinical laparoscopic donor nephrectomies during clinically relevant pneumoperitoneum. 3-CCD image enhancement produces mean region of interest (ROI intensity values that can be directly correlated with blood oxygen saturation measurements (R2 > 0.96. The calculated mean ROI intensity values obtained at the beginning of the laparoscopic nephrectomy do not differ significantly from mean ROI intensity values calculated immediately before kidney removal (p > 0.05. Conclusion Here, using the 3-CCD camera, we qualitatively monitor tissue oxygenation. This means of assessing intraoperative tissue oxygenation may be a useful method to avoid unintended ischemic injury during laparoscopic surgery. Preliminary results indicate that no significant changes in renal oxygenation occur as a result of pneumoperitoneum.

Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

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Skinner, Adrian; Maoate, Kiki; Beasley, Spencer

2010-05-01

Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

Residual kidney function after donor nephrectomy. Assessment by 99mTc-MAG3-Clearance

International Nuclear Information System (INIS)

Hamscho, N.; Doebert, N.; Menzel, C.; Berner, U.; Zaplatnikov, K.; Gruenwald, F.; Wilhelm, A.; Gossmann, J.; Scheuermann, E.H.

2005-01-01

Aim: We evaluated the long-term residual renal function after donor nephrectomy using 99m Tc-mercaptoacetyltriglycin (MAG3)-clearance. Donors, methods: Altogether 49 kidney donors were examined using 99m Tc-MAG3-clearance after nephrectomy for donation to a relative (m:f=11.38; age 55±27 years). The donors were examined 16±8 years postoperatively (1.5-26 years). 42 donors (86%) showed normal creatinine values, whereas the other seven (14%) exhibited slightly elevated levels. 20 donors were examined pre- and postoperatively and compared intraindividually. The kidney function was compared to the age adapted normal values of healthy persons with two kidneys (67-133% of age related mean). Results: After nephrectomy all donors showed a normal perfusion, good secretion, merely physiological intrarenal transit and a normal elimination from the kidneys. The 99m Tc-MAG3-clearance was 69±15% of the normal mean value of healthy carriers of two kidneys regardless of the gender. 20 donors with a preoperative examination showed a significantly reduced total renal function from 84±15% of the mean normal value preoperatively to 60±15% postoperatively (p 99m Tc-MAG3-clearance measured prior to nephrectomy and the clearance levels after nephrectomy. Also, no correlation between the preoperative 99m Tc-MAG3-clearance and the postoperative serum creatinine values could be observed. Althogether, 22% of the donors (11/49) developed arterial hypertension 10±8 years after donation (1-23 years). This corresponds to the normal age prevalence of hypertension in the carriers of two kidneys. Three donors suffered from arterial hypertension prior to the operation. Conclusion: Kidney donors with normal or slightly elevated creatinine values postoperatively show a 99m Tc-MAG3 clearance value of 69% of the mean value of healthy carriers of two kidneys. This may serve as a reference value for healthy carriers of one kidney. In our study we demonstrated a good compensation of the contralateral

A numerical model of p-n junctions bordering on surfaces

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Altermatt, P.P.; Aberle, A.G.; Jianhua Zhao; Aihua Wang; Heiser, G. [University of New South Wales, Sydney (Australia). Centre for Photovolatic Engineering

2002-10-01

Many solar cell structures contain regions where the emitter p-n junction borders on the surface. If the surface is not well passivated, a large amount of recombination occurs in such regions. This type of recombination is influenced by the electrostatics of both the p-n junction and the surface, and hence it is different from the commonly described recombination phenomena occurring in the p-n junction within the bulk. We developed a two-dimensional model for the recombination mechanisms occurring in emitter p-n junctions bordering on surfaces. The model is validated by reproducing the experimental I-V curves of specially designed silicon solar cells. It is shown under which circumstances a poor surface passivation, near where the p-n junction borders on the surface, reduces the fill factor and the open-circuit voltage. The model can be applied to many other types of solar cells. (author)

Renal function after unilateral nephrectomy for Wilms' tumour: the influence of radiation therapy

International Nuclear Information System (INIS)

Graaf, S.S.N. de; Gent, H. van; Reitsma-Bierens, W.Ch.C.; Luyk, W.H.J. van; Postma, A.; Dolsma, W.V.

1996-01-01

The effect of therapy on renal function after unilateral nephrectomy for Wilms' tumour was studied. In the second year following unilateral nephrectomy, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated simultaneously by measuring 125 I-iothalamate clearance and 131 I-hippurate clearance. Of 41 evaluable patients, 29 received chemotherapy as sole treatment modality following nephrectomy (group 1); 12 patients additionally received radiation therapy to a field that included the remaining kidney (group 2). Results were expressed as standard deviation scores (z-scores). In group 1, mean z-score for GFR was -0.27 (94.6% of normal) and in group 2 mean z-score was -1.51 (72.7% of normal for two kidneys) (P = 0.022, Mann-Whitney U-test). Mean z-score for ERPF was -0.09 (97.0%) in group 1 and -1.53 (73.8%) in group 2 (P 0.039). It was concluded that the combination of chemotherapy and radiation therapy, in contrast to chemotherapy alone, negatively affects the ability of the remaining kidney to adjust its function after the loss of its counterpart. (author)

Factors influencing the operating time for single-port laparoscopic radical nephrectomy: focus on the anatomy and distribution of the renal artery and vein.

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Matsumoto, Kazuhiro; Miyajima, Akira; Fukumoto, Keishiro; Komatsuda, Akari; Niwa, Naoya; Hattori, Seiya; Takeda, Toshikazu; Kikuchi, Eiji; Asanuma, Hiroshi; Oya, Mototsugu

2017-10-01

It is considered that laparoscopic single-site surgery should be performed by specially trained surgeons because of the technical difficulty in using special instruments through limited access. We investigated suitable patients for single-port laparoscopic radical nephrectomy, focusing on the anatomy and distribution of the renal artery and vein. This retrospective study was conducted in 52 consecutive patients who underwent single-port radical nephrectomy by the transperitoneal approach. In patients undergoing right nephrectomy, a 2-mm port was added for liver retraction. We retrospectively re-evaluated all of the recorded surgical videos and preoperative computed tomography images. The pneumoperitoneum time (PT) was used as an objective index of surgical difficulty. The PT was significantly shorter for right nephrectomy than left nephrectomy (94 vs. 123 min, P = 0.004). With left nephrectomy, dissection of the spleno-renal ligament to mobilize the spleen medially required additional time. Also, the left renal vein could only be divided after securing the adrenal, gonadal and lumbar veins. In patients whose renal artery was located cranial to the renal vein, PT tended to be longer than in the other patients (131 vs. 108 min, P = 0.070). In patients with a superior renal artery, the inferior renal vein invariably covered the artery and made it difficult to ligate the renal artery via the umbilical approach at the first procedure. These findings indicate that patients undergoing right nephrectomy in whom the renal artery is not located cranial to the renal vein are suitable for single-port laparoscopic radical nephrectomy. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Two-dimensional non-volatile programmable p-n junctions

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Li, Dong; Chen, Mingyuan; Sun, Zhengzong; Yu, Peng; Liu, Zheng; Ajayan, Pulickel M.; Zhang, Zengxing

2017-09-01

Semiconductor p-n junctions are the elementary building blocks of most electronic and optoelectronic devices. The need for their miniaturization has fuelled the rapid growth of interest in two-dimensional (2D) materials. However, the performance of a p-n junction considerably degrades as its thickness approaches a few nanometres and traditional technologies, such as doping and implantation, become invalid at the nanoscale. Here we report stable non-volatile programmable p-n junctions fabricated from the vertically stacked all-2D semiconductor/insulator/metal layers (WSe2/hexagonal boron nitride/graphene) in a semifloating gate field-effect transistor configuration. The junction exhibits a good rectifying behaviour with a rectification ratio of 104 and photovoltaic properties with a power conversion efficiency up to 4.1% under a 6.8 nW light. Based on the non-volatile programmable properties controlled by gate voltages, the 2D p-n junctions have been exploited for various electronic and optoelectronic applications, such as memories, photovoltaics, logic rectifiers and logic optoelectronic circuits.

Association of Live Donor Nephrectomy and Reversal of Renal Artery Spasm

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Jalal Azmandian

2014-01-01

Full Text Available Background: Kidney transplantation is the best treatment option for kidney failure. Major medical progress has been made in the field of renal transplantation over the last 40 years. The surgical procedure has been standardized and the complication rate is low. Overall, the outcome of renal transplantation is excellent and has improved over time. Vascular complications after renal transplantation are the most frequent type of complication following urological complications. Renal artery spasm (RAS following manipulation of renal artery is a common problem during live donor nephrectomy (LDN. The aim of this study was to determine whether or not it is necessary to wait for reverse of RAS and resumption of urinary flow before nephrectomy. Materials and Methods: In this clinical trial 16 cases of LDN who developed RAS during surgery received intra-arterial injection of 40 mg papaverine. In 8 cases surgery continued towards nephrectomy and in other 8 cases we waited for reverse of RAS. All analyses were performed using SPSS-11. Results: In both groups urinary flow started a few minutes (Mean, 12 min after declamping of transplanted kidney and normal renal consistency and color were achieved. There was no significant difference between urinary volume during 12 h after transplantation in two groups. Conclusion: The results showed that it might not be necessary to wait for reverse of RAS before LDN. Both patient (less anesthesia complications and hospital (less expenses will benefit from this time saving.

[Anesthesia experiences on laparoscopic nephrectomy with da Vinci S robotics].

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Mou, Ling; Lan, Zhixun

2015-09-01

To summarize the clinical anesthesia experiences in 20 patients who underwent laparoscopic nephrectomy with da Vinci S robotics.
 Anesthesia data of 20 patients from Sichuan Provincial People's Hospital, who underwent laparoscopic nephrectomy with da Vinci S robotics from August 2014 to November 2014, were analyzed and summarized. The anesthesia time, operation time, CO(2) pneumoperitoneum time, PaCO(2) and PETCO(2) were recorded.
 All patients were anesthetized and underwent surgery with da Vinci S robotics. The anesthesia time was (220±14) min, the operation time was (187±11) min, and the CO(2) pneumoperitoneum time was (180±13) min. The PaCO(2) and PETCO(2) were significantly elevated at 1.5 h after operation compared with those at the baseline (before pneumoperitoneum) (Pda vinci S robotics. However, the duration of CO(2) pneumoperitoneum is significantly increased compared to that of other surgical procedures, resulting in high airway resistance and acid-base disturbance.

Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center.

Science.gov (United States)

Garcia-Covarrubias, L; Prieto-Olivares, P; Bahena-Portillo, A; Cicero-Lebrija, A; Hinojosa-Heredia, H; Fernández-Lopez, L J; Almeida-Nieto, C; Visag-Castillo, V J; Carrión-Barrera, J; Castro-Ñuco, I; Pedraza-Rojas, E; Rosas-Herrera, A; García-Covarrubias, A; Fernández-Angel, D; Diliz-Perez, H S

2018-03-01

Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with

Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

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Young Kun Lee

2015-08-01

Full Text Available Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN, for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

Effects of Open versus Laparoscopic Nephrectomy Techniques on Oxidative Stress Markers in Patients with Renal Cell Carcinoma

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Celestyna Mila-Kierzenkowska

2013-01-01

Full Text Available The aim of the study was to determine the concentration of lipid peroxidation products, the activity of selected antioxidant and lysosomal enzymes, and protease inhibitor in patients with renal cell carcinoma who underwent radical nephrectomy. The studied group included 44 patients: 21 of them underwent open surgery, while 23 underwent laparoscopy. Blood samples were collected three times: before treatment and 12 hours and five days after nephrectomy. In blood of participants, the concentration of thiobarbituric acid reactive substances (TBARS, the activity of catalase (CAT, superoxide dismutase (SOD and glutathione peroxidase (GPx, and the activity of acid phosphatase (AcP, arylsulfatase (ASA, cathepsin D (CTSD, and α1-antitrypsin (AAT were assayed. No statistically significant differences in investigated parameters were found between studied groups. Moreover, TBARS concentration and CAT, SOD, and GPx activity were not altered in the course of both types of surgery. Five days after both open and laparoscopic nephrectomy techniques, AAT activity was higher than its activity 12 hours after the procedure. The obtained results suggest that laparoscopy may be used for nephrectomy as effectively as open surgery without creating greater oxidative stress. Reduced period of convalescence at patients treated with laparoscopy may be due to less severe response of acute-phase proteins.

Technetium-99m labeling of N-[N-(3-diphenylphosphino propionyl)glycyl]cysteine (PN2S-OH) and its methyl ester derivative (PN2S-OMe)

International Nuclear Information System (INIS)

Visentin, Roberta; Giron, Maria Cecilia; Bello, Michele; Mazzi, Ulderico

2004-01-01

N-[N-(3-diphenylphosphinopropionyl)glycyl]cysteine and its methyl ester derivative were labeled with 99m Tc at neutral pH, leading to a single species in high yield (>95%) in 30 min. RP-HPLC comparison with the analogue Re V -oxo complexes identified the labeled compounds as the anti isomers of pentacoordinated 99m TcO[PN 2 S]-OH and 99m TcO[PN 2 S]-OMe complexes. The compounds are stable from pH 7 to pH 9 when 99m TcO[PN 2 S]-OH interconverts to related syn isomer, while 99m TcO[PN 2 S]-OMe undergoes both saponification and interconversion. They exhibit high stability in human plasma and in vivo (mice), and a biodistribution characterized by hepatobiliary excretion

The Outcome for Patients With Pathologic Node-Positive Prostate Cancer Treated With Intensity Modulated Radiation Therapy and Androgen Deprivation Therapy: A Case-Matched Analysis of pN1 and pN0 Patients

International Nuclear Information System (INIS)

Van Hemelryk, Annelies; De Meerleer, Gert; Ost, Piet; Poelaert, Filip; De Gersem, Werner; Decaestecker, Karel; De Visschere, Pieter; Fonteyne, Valérie

2016-01-01

Purpose: Improved outcome is reported after surgery or external beam radiation therapy (EBRT) plus androgen deprivation therapy (ADT) for patients with lymph node (LN) positive (N1) prostate cancer (PC). Surgical series have shown that pathologic (p)N1 PC does not behave the same in all patients. The aim of this study was to perform a matched-case analysis to compare the outcome of pN1 and pN0 PC after high-dose EBRT plus ADT. Methods and Materials: Radiation therapy up to 80 Gy was delivered to the prostate with a minimal dose of 45 Gy to the pelvis for pN1 patients. After matching, Kaplan-Meier statistics were used to compare the 5-year biochemical and clinical relapse-free survival (bRFS and cRFS), prostate cancer–specific survival (PCSS), and overall survival (OS). Acute and late rectal and urinary toxicity was evaluated. Results: Sixty-nine pN1 PC patients were matched 1:1 with pN0 PC patients. The median follow-up time was 60 months. The 5-year bRFS and cRFS for pN1 versus pN0 PC patients were 65% ± 7% versus 79% ± 5% (P=.08) and 70% ± 6% versus 83% ± 5% (P=.04) respectively. No significant difference was found in bRFS or cRFS rates between low volume pN1 (≤2 positive LNs) and pN0 patients. The 5-year PCSS and OS were comparable between pN1 and pN0 PC patients: PCSS: 92% ± 4% versus 93% ± 3% (P=.66); OS: 82% ± 5% versus 80% ± 5% (P=.58). Severe toxicity was rare for both groups, although pN1 patients experienced significantly more acute grade 2 rectal toxicity. Conclusion: Primary EBRT plus 2 to 3 years of ADT is a legitimate treatment option for pN1 PC patients, especially those with ≤2 positive LNs, and this with bRFS and cRFS rates comparable to those in pN0 PC patients. For pN1 PC patients with >2 positive LNs, bRFS and cRFS are worse than in pN0 patients, but even in this subgroup, long-term disease control is obtained.

The Outcome for Patients With Pathologic Node-Positive Prostate Cancer Treated With Intensity Modulated Radiation Therapy and Androgen Deprivation Therapy: A Case-Matched Analysis of pN1 and pN0 Patients

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Van Hemelryk, Annelies [Department of Urology, Ghent University Hospital, Ghent (Belgium); De Meerleer, Gert; Ost, Piet [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Poelaert, Filip [Department of Urology, Ghent University Hospital, Ghent (Belgium); De Gersem, Werner [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Decaestecker, Karel [Department of Urology, Ghent University Hospital, Ghent (Belgium); De Visschere, Pieter [Department of Radiology, Ghent University Hospital, Ghent (Belgium); Fonteyne, Valérie, E-mail: valerie.fonteyne@uzgent.be [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium)

2016-10-01

Purpose: Improved outcome is reported after surgery or external beam radiation therapy (EBRT) plus androgen deprivation therapy (ADT) for patients with lymph node (LN) positive (N1) prostate cancer (PC). Surgical series have shown that pathologic (p)N1 PC does not behave the same in all patients. The aim of this study was to perform a matched-case analysis to compare the outcome of pN1 and pN0 PC after high-dose EBRT plus ADT. Methods and Materials: Radiation therapy up to 80 Gy was delivered to the prostate with a minimal dose of 45 Gy to the pelvis for pN1 patients. After matching, Kaplan-Meier statistics were used to compare the 5-year biochemical and clinical relapse-free survival (bRFS and cRFS), prostate cancer–specific survival (PCSS), and overall survival (OS). Acute and late rectal and urinary toxicity was evaluated. Results: Sixty-nine pN1 PC patients were matched 1:1 with pN0 PC patients. The median follow-up time was 60 months. The 5-year bRFS and cRFS for pN1 versus pN0 PC patients were 65% ± 7% versus 79% ± 5% (P=.08) and 70% ± 6% versus 83% ± 5% (P=.04) respectively. No significant difference was found in bRFS or cRFS rates between low volume pN1 (≤2 positive LNs) and pN0 patients. The 5-year PCSS and OS were comparable between pN1 and pN0 PC patients: PCSS: 92% ± 4% versus 93% ± 3% (P=.66); OS: 82% ± 5% versus 80% ± 5% (P=.58). Severe toxicity was rare for both groups, although pN1 patients experienced significantly more acute grade 2 rectal toxicity. Conclusion: Primary EBRT plus 2 to 3 years of ADT is a legitimate treatment option for pN1 PC patients, especially those with ≤2 positive LNs, and this with bRFS and cRFS rates comparable to those in pN0 PC patients. For pN1 PC patients with >2 positive LNs, bRFS and cRFS are worse than in pN0 patients, but even in this subgroup, long-term disease control is obtained.

Structural and thermoelectric properties of zintl-phase CaLiPn (Pn=As, Sb, Bi)

Energy Technology Data Exchange (ETDEWEB)

Chandran, Anoop K.; Gudelli, Vijay Kumar; Sreeparvathy, P.C.; Kanchana, V., E-mail: kanchana@iith.ac.in

2016-11-15

First-principles calculations were carried out to study the structural, mechanical, dynamical and transport properties of zintl phase materials CaLiPn (Pn=As, Sb and Bi). We have used two different approaches to solve the system based on density functional theory. The plane wave pseudopotential approach has been used to study the structural and dynamical properties whereas, full potential linear augment plane wave method is used to examine the electronic structure, mechanical and thermoelectric properties. The calculated ground-state properties agree quite well with experimental values. The computed electronic structure shows the investigated compounds to be direct band gap semiconductors. Further, we have calculated the thermoelectric properties of all the investigated compounds for both the carriers at various temperatures. We found a high thermopower for both the carriers, especially n-type doping to be more favourable, which enabled us to predict that CaLiPn might have promising applications as a good thermoelectric material. Further, the phonon dispersion curves of the investigated compounds showed flat phonon modes and we also find lower optical and acoustic modes to cut each other at the lower frequency range, which further indicate the investigated compounds to possess reasonably low thermal conductivity. We have also analysed the low value of the thermal conductivity through the empirical relations and discussions are presented here. - Highlights: • Electronic band structure and chemical bonding. • Single crystalline elastic constants and poly crystalline elastic moduli. • Thermoelectric properties of zintl phase. • Lattice dynamics and phonon density of states.

The effect of Mastin® on expression of Nrf2 in the rat heart with subtotally nephrectomy chronic Kidney disease model

Science.gov (United States)

Nathania, J.; Soetikno, V.

2017-08-01

Chronic kidney disease (CKD) is increasingly prevalent in Indonesia and worldwide. One of the major causes of morbidity and mortality in CKD is the complication of cardiovascular disease. Mastin® is a supplement that is locally produced in Indonesia and is made from extract of mangosteen pericarp, which is reported to have antioxidative, anti-inflammatory, and antitumor properties. The present study aimed to investigate whether Mastin® could improve antioxidant responses in the rat heart during CKD by measuring the expression of nuclear factor erythroid-2-related factor (Nrf)2, a master regulator of antioxidant response elements. RNA was extracted from the heart tissue of three groups of rats: a normal group, a nephrectomy group, and a nephrectomy with Mastin® group. Two-step real-time RT-PCR was then conducted to calculate the relative expression of the Nrf2 gene. Nrf2 expression was markedly decreased in the nephrectomy group vs the normal group, but slightly increas ed in the nephrectomy with Mastin® group vs the nephrectomy group. CKD resulted in impaired activation of the Nrf2 pathway in the rat heart. Although the administration of Mastin® slightly increased Nrf2 expression, it was not enough to confer cardioprotective effects through the Nrf2 pathway.

(p,n) reaction at intermediate energy

International Nuclear Information System (INIS)

Goodman, C.D.

1979-01-01

The use of the (p,n) reaction in exploring effective interactions is reviewed. Some recent data on self-conjugate nuclei taken at the Indiana University Cyclotron Facility (IUCF) are presented, and the differences between low- and high-energy data are emphasized. Experimental problems and techniques used are briefly described. It is concluded that forward-angle (p,n) spectra at energies greater than 100 MeV are dominated by Gamow-Teller (GT) transitions, while Fermi transitions (IAS transitions) dominate near 45 MeV. Prominent GT transitions are expected from a pion-exchange interaction, and it is expected that OPEP is the dominant component of the interaction in the energy range of 100 to 200 MeV. 27 figures, 2 tables

Cranial pole nephrectomy in the pig model: anatomic analysis of arterial injuries in tridimensional endocasts.

Science.gov (United States)

Pereira-Sampaio, Marco A; Henry, Robert W; Favorito, Luciano A; Sampaio, Francisco J B

2012-06-01

To assess the intrarenal arteries injuries after cranial pole nephrectomy in a pig model to compare these findings with those in humans. Polyester resin was injected through the ureter and the renal artery to make three-dimensional casts of 61 pig kidneys. The cranial pole of the kidneys was sectioned at four different sites before the solidification of the resin, and the casts were examined for arterial damage. Section performed through the hilus (15 kidneys): The cranial division of the renal artery was sectioned in two (13.33%) cases, the ventral branch of the cranial division of the renal artery was sectioned in 13 (86.7%) cases, and the dorsal branch of the cranial division of the renal artery was sectioned in 11 (73.34%) cases. Section at 0.5 cm cranial to the hilus (16 kidneys): The cranial division of the renal artery was sectioned in 1 (6.25%) case, the ventral branch of the cranial division of the renal artery was sectioned in 14 (87.5%) cases, and the dorsal branch of the cranial division of the renal artery was sectioned in 13 (81.25%) cases. Section at 1.0 cm cranial to the hilus (15 kidneys): The ventral branch of the cranial division of the renal artery was sectioned in five (33.33%) cases, and the dorsal branch of the cranial division of the renal artery was injured in five (33.33%) cases. Section at 1.5 cm cranial to the hilus (15 kidneys): No lesions were found in the main arteries, only in the interlobular branches. As previously demonstrated in humans, sections at 1.0 cm or more cranially to the hilus in pigs also showed a significant decrease in damage to the major intrarenal arteries. Therefore, as regards arterial damage, the pig kidney is a useful model for partial nephrectomy in the cranial (upper) pole.

Bootstrap inversion for Pn wave velocity in North-Western Italy

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C. Eva

1997-06-01

Full Text Available An inversion of Pn arrival times from regional distance earthquakes (180-800 km, recorded by 94 seismic stations operating in North-Western Italy and surrounding areas, was carried out to image lateral variations of P-wave velocity at the crust-mantle boundary, and to estimate the static delay time at each station. The reliability of the obtained results was assessed using both synthetic tests and the bootstrap Monte Carlo resampling technique. Numerical simulations demonstrated the existence of a trade-off between cell velocities and estimated station delay times along the edge of the model. Bootstrap inversions were carried out to determine the standard deviation of velocities and time terms. Low Pn velocity anomalies are detected beneath the outer side of the Alps (-6% and the Western Po plain (-4% in correspondence with two regions of strong crustal thickening and negative Bouguer anomaly. In contrast, high Pn velocities are imaged beneath the inner side of the Alps (+4% indicating the presence of high velocity and density lower crust-upper mantle. The Ligurian sea shows high Pn velocities close to the Ligurian coastlines (+3% and low Pn velocities (-1.5% in the middle of the basin in agreement with the upper mantle velocity structure revealed by seismic refraction profiles.

Electroplated Ni on the PN Junction Semiconductor

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin Joo; Uhm, Young Rang; Son, Kwang Jae; Kim, Jong Bum; Choi, Sang Moo; Park, Jong Han; Hong, Jintae [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2015-05-15

Nickel (Ni) electroplating was implemented by using a metal Ni powder in order to establish a Ni-63 plating condition on the PN junction semiconductor needed for production of betavoltaic battery. PN junction semiconductors with a Ni seed layer of 500 and 1000 A were coated with Ni at current density from 10 to 50 mA cm{sup 2}. The surface roughness and average grain size of Ni deposits were investigated by XRD and SEM techniques. The roughness of Ni deposit was increased as the current density was increased, and decreased as the thickness of Ni seed layer was increased.

Electroplated Ni on the PN Junction Semiconductor

International Nuclear Information System (INIS)

Kim, Jin Joo; Uhm, Young Rang; Son, Kwang Jae; Kim, Jong Bum; Choi, Sang Moo; Park, Jong Han; Hong, Jintae

2015-01-01

Nickel (Ni) electroplating was implemented by using a metal Ni powder in order to establish a Ni-63 plating condition on the PN junction semiconductor needed for production of betavoltaic battery. PN junction semiconductors with a Ni seed layer of 500 and 1000 A were coated with Ni at current density from 10 to 50 mA cm 2 . The surface roughness and average grain size of Ni deposits were investigated by XRD and SEM techniques. The roughness of Ni deposit was increased as the current density was increased, and decreased as the thickness of Ni seed layer was increased

LAPAROSCOPIC NEPHRECTOMY USING RADIOFREQUENCY THERMAL ABLATION

Directory of Open Access Journals (Sweden)

B. Ya. Alekseev

2012-01-01

Full Text Available The wide use of current diagnostic techniques, such as ultrasound study, computed tomography, and magnetic resonance imaging, has led to significantly increased detection rates for disease in its early stages. This gave rise to a change in the standards for the treatment of locally advanced renal cell carcinoma (RCC. Laparoscopic nephrectomy (LN has recently become the standard treatment of locally advanced RCC in the clinics having much experience with laparoscopic surgery. The chief drawback of LN is difficulties in maintaining intraoperative hemostasis and a need for creating renal tissue ischemia. The paper gives the intermediate results of application of the new procedure of LN using radiofrequency thermal ablation in patients with non-ischemic early-stage RCC.

Investigation of the transport properties and compositions of the Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5} series (RE=Pr, Sm, Gd, Dy; Pn=Sb, Bi)

Energy Technology Data Exchange (ETDEWEB)

Forbes, Scott [Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M1 (Canada); Yuan, Fang [Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M1 (Canada); Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044 (Japan); Kosuda, Kosuke; Kolodiazhnyi, Taras [Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044 (Japan); Mozharivskyj, Yurij, E-mail: mozhar@mcmaster.ca [Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M1 (Canada)

2016-10-15

The Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5} phases (RE=Pr, Sm, Gd, Dy; Pn=Sb, Bi) were successfully prepared from high temperature reactions at 1225–1300 °C. These phases maintain the same structure types as the parent RE{sub 9}Pn{sub 5}O{sub 5} phases, except for a Ca/RE mixing. The study and preparation of these phases was motivated by the desire to shift the metallic type properties of the parent RE{sub 9}Pn{sub 5}O{sub 5} phases to a level more suitable for thermoelectric applications. Electrical resistivity measurements performed on pure, bulk samples indicated all phases to be narrow band gap semiconductors or semimetals, supporting the charge balanced electron count of the Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5} composition. Unfortunately, all samples are too electrically resistive for any potential usage as thermoelectrics. Electronic band structure calculations performed on idealized RE{sub 9}Pn{sub 5}O{sub 5} structures revealed the presence of a pseudogap at the Fermi level, which is consistent with the observed electrical resistivity and Seebeck coefficient behavior. - Graphical abstract: Ca substitution in RE{sub 9}Pn{sub 5}O{sub 5} leads to charge-balanced Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5} phases with semiconducting or semimetallic properties. - Highlights: • The RE{sub 9}Pn{sub 5}O{sub 5} structure may be stabilized with calcium substitution in the form of Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5}. • The Ca{sub 2}RE{sub 7}Pn{sub 5}O{sub 5} phases maintain the parent P 4/n structure, albeit with Ca/RE mixing. • The Ca{sub 2}RE{sub 7}Sb{sub 5}O{sub 5} phases behave as semiconductors while Ca{sub 2}RE{sub 7}Bi{sub 5}O{sub 5} are semimetals with electron-electron correlations. • Electronic structure calculations yield a semimetal-like density of states for both Ca{sub 2}RE{sub 7}Sb{sub 5}O{sub 5} and Ca{sub 2}RE{sub 7}Bi{sub 5}O{sub 5}.

Homojunction p-n photodiodes based on As-doped single ZnO nanowire

International Nuclear Information System (INIS)

Cho, H. D.; Zakirov, A. S.; Yuldashev, Sh. U.; Kang, T. W.; Ahn, C. W.; Yeo, Y. K.

2013-01-01

Photovoltaic device was successfully grown solely based on the single ZnO p-n homojunction nanowire. The ZnO nanowire p-n diode consists of an as-grown n-type segment and an in-situ arsenic doped p-type segment. This p-n homojunction acts as a good photovoltaic cell, producing a photocurrent almost 45 times larger than the dark current under reverse-biased condition. Our results demonstrate that present ZnO p-n homojunction nanowire can be used as a self-powered ultraviolet photodetector as well as a photovoltaic cell, which can also be used as an ultralow electrical power source for nano-scale electronic, optoelectronic, and medical devices

Characterization of a pnCCD for applications with synchrotron radiation

Energy Technology Data Exchange (ETDEWEB)

Send, S., E-mail: send@physik.uni-siegen.de [University of Siegen, Department of Physics, Walter-Flex-Straße 3, 57068 Siegen (Germany); Abboud, A. [University of Siegen, Department of Physics, Walter-Flex-Straße 3, 57068 Siegen (Germany); Hartmann, R.; Huth, M. [PNSensor GmbH, Römerstraße 28, 80803 München (Germany); Leitenberger, W. [University of Potsdam, Department of Physics, Karl-Liebknecht-Straße 24/25, 14476 Potsdam (Germany); Pashniak, N. [University of Siegen, Department of Physics, Walter-Flex-Straße 3, 57068 Siegen (Germany); Schmidt, J. [PNSensor GmbH, Römerstraße 28, 80803 München (Germany); Strüder, L. [University of Siegen, Department of Physics, Walter-Flex-Straße 3, 57068 Siegen (Germany); PNSensor GmbH, Römerstraße 28, 80803 München (Germany); Max-Planck-Institut für extraterrestrische Physik, Giessenbachstraße, 85748 Garching (Germany); Pietsch, U. [University of Siegen, Department of Physics, Walter-Flex-Straße 3, 57068 Siegen (Germany)

2013-05-21

In this work we study the response of a pnCCD by means of X-ray spectroscopy in the energy range between 6 keV and 20 keV and by Laue diffraction techniques. The analyses include measurements of characteristic detector parameters like energy resolution, count rate capability and effects of different gain settings. The limit of a single photon counting operation in white beam X-ray diffraction experiments is discussed with regard to the occurrence of pile-up events, for which the energy information about individual photons is lost. In case of monochromatic illumination the pnCCD can be used as a fast conventional CCD with a charge handling capacity (CHC) of about 300,000 electrons per pixel. If the CHC is exceeded, any surplus charge will spill to neighboring pixels perpendicular to the transfer direction due to electrostatic repulsion. The possibilities of increasing the number of storable electrons are investigated for different voltage settings by exposing a single pixel with X-rays generated by a microfocus X-ray source. The pixel binning mode is tested as an alternative approach that enables a pnCCD operation with significantly shorter readout times. -- Highlights: ► The pnCCD acts as a four-dimensional detector for white X-rays. ► Its performance for applications with synchrotron radiation is investigated. ► The pnCCD can be used for single photon counting and photon integration. ► The operation mode depends on the local frequencies of pile-up events. ► The pnCCD can be optimized for X-ray spectroscopy and X-ray imaging.

Renal lymph nodes for tumor staging: appraisal of 871 nephrectomies with examination of hilar fat.

Science.gov (United States)

Mehta, Vikas; Mudaliar, Kumaran; Ghai, Ritu; Quek, Marcus L; Milner, John; Flanigan, Robert C; Picken, Maria M

2013-11-01

Despite decades of research, the role of lymphadenectomy in the management of renal cell carcinoma (RCC) is still not clearly defined. Before the implementation of targeted therapies, lymph node metastases were considered to be a portent of markedly decreased survival, regardless of the tumor stage. However, the role of lymphadenectomy and the relative benefit of retroperitoneal lymph node dissection in the context of modern adjunctive therapies have not been conclusively addressed in the clinical literature. The current pathologic literature does not offer clear recommendations with regard to the minimum number of lymph nodes that should be examined in order to accurately stage the pN in renal cell carcinoma. Although gross examination of the hilar fat to assess the nodal status is performed routinely, it has not yet been determined whether this approach is adequate. To evaluate the status of lymph nodes and their rate of identification in the pathologic examination of nephrectomy specimens in adult renal malignancies. We reviewed the operative and pathology reports of 871 patients with renal malignancies treated by nephrectomy. All tumors were classified according to the seventh edition of the Tumor-Nodes-Metastasis classification. Patients were divided into 3 groups: Nx, no lymph nodes recovered; N0, negative; and N1, with positive lymph nodes. Grossly visible lymph nodes were submitted separately; as per grossing protocol, hilar fatty tissue was submitted for microscopic examination. We evaluated the factors that affected the number of lymph nodes identified and the variables that allowed the prediction of nodal involvement. Lymph nodes were recovered in 333 of 871 patients (38%): hilar in 125 patients, nonhilar in 137 patients, and hilar and nonhilar in 71 patients. Patients with positive lymph nodes (n = 87) were younger, had larger primary tumors, and had lymph nodes of average size, as well as a higher pT stage, nuclear grade, and rate of metastases

Kidney transplantation: A new era of laparoscopic living donor nephrectomy in Indonesia

Directory of Open Access Journals (Sweden)

Albertus Marcelino

2018-01-01

Conclusion: Laparoscopic living donor nephrectomies had been performed successfully with improvement of surgical parameter in due time. Thus, laparoscopic approach has entered a new era for kidney procurement in Indonesia.

Novel Fractional Order Calculus Extended PN for Maneuvering Targets

Directory of Open Access Journals (Sweden)

Jikun Ye

2017-01-01

Full Text Available Based on the theory of fractional order calculus (FOC, a novel extended proportional guidance (EPN law for intercepting the maneuvering target is proposed. In the first part, considering the memory function and filter characteristic of FOC, the novel extended PN guidance algorithm is developed based on the conventional PN after introducing the properties and operation rules of FOC. Further, with the help of FOC theory, the average load and ballistics characteristics of proposed guidance law are analyzed. Then, using the small offset kinematic model, the robustness of the new guidance law against autopilot parameters is studied theoretically by analyzing the sensitivity of the closed loop guidance system. At last, representative numerical results show that the designed guidance law obtains a better performance than the traditional PN for maneuvering target.

Start-up and bacterial community compositions of partial nitrification in moving bed biofilm reactor.

Science.gov (United States)

Liu, Tao; Mao, Yan-Jun; Shi, Yan-Ping; Quan, Xie

2017-03-01

Partial nitrification (PN) has been considered as one of the promising processes for pretreatment of ammonium-rich wastewater. In this study, a kind of novel carriers with enhanced hydrophilicity and electrophilicity was implemented in a moving bed biofilm reactor (MBBR) to start up PN process. Results indicated that biofilm formation rate was higher on modified carriers. In comparison with the reactor filled with traditional carriers (start-up period of 21 days), it took only 14 days to start up PN successfully with ammonia removal efficiency and nitrite accumulation rate of 90 and 91%, respectively, in the reactor filled with modified carriers. Evident changes of spatial distributions and community structures had been detected during the start-up. Free-floating cells existed in planktonic sludge, while these microorganisms trended to form flocs in the biofilm. High-throughput pyrosequencing results indicated that Nitrosomonas was the predominant ammonia-oxidizing bacterium (AOB) in the PN system, while Comamonas might also play a vital role for nitrogen oxidation. Additionally, some other bacteria such as Ferruginibacter, Ottowia, Saprospiraceae, and Rhizobacter were selected to establish stable footholds. This study would be potentially significant for better understanding the microbial features and developing efficient strategies accordingly for MBBR-based PN operation.

pnCCD for photon detection from near-infrared to X-rays

International Nuclear Information System (INIS)

Meidinger, Norbert; Andritschke, Robert; Hartmann, Robert; Herrmann, Sven; Holl, Peter; Lutz, Gerhard; Strueder, Lothar

2006-01-01

A pnCCD is a special type of charge-coupled device developed for spectroscopy and imaging of X-rays with high time resolution and quantum efficiency. Its most famous application is the operation on the XMM-Newton satellite, an X-ray astronomy mission that was launched by the European space agency in 1999. The excellent performance of the focal plane camera has been maintained for more than 6 years in orbit. The energy resolution in particular has shown hardly any degradation since launch. In order to satisfy the requirements of future X-ray astronomy missions as well as those of ground-based experiments, a new type of pnCCD has been developed. This 'frame-store pnCCD' shows an enhanced performance compared to the XMM-Newton type of pnCCD. Now, more options in device design and operation are available to tailor the detector to its respective application. Part of this concept is a programmable analog signal processor, which has been developed for the readout of the CCD signals. The electronic noise of the new detector has a value of only 2 electrons equivalent noise charge (ENC), which is less than half of the figure achieved for the XMM-Newton-type pnCCD. The energy resolution for the Mn-K α line at 5.9 keV is approximately 130 eV FWHM. We have close to 100% quantum efficiency for both low- and high-energy photon detection (e.g. the C-K line at 277 eV, and the Ge-K α line at 10 keV, respectively). Very high frame rates of 1000 images/s have been achieved due to the ultra-fast readout accomplished by the parallel architecture of the pnCCD and the analog signal processor. Excellent spectroscopic performance is shown even at the relatively high operating temperature of -25 deg. C that can be achieved by a Peltier cooler. The applications of the low-noise and fast pnCCD detector are not limited to the detection of X-rays. With an anti-reflective coating deposited on the photon entrance window, we achieve high quantum efficiency also for near-infrared and optical

Electronic structure and transport properties of Ba2Cd2Pn3 (Pn = As and Sb): An efficient materials for energy conversion

International Nuclear Information System (INIS)

Reshak, A.H.

2016-01-01

The full potential method within the recently modified Becke-Johnson potential explore that the Ba 2 Cd 2 Pn 3 (Pn = As and Sb) compounds are narrow band gap semiconductors of about 0.49 and 0.32 eV, which confute the finding of the previous TB-LMTO-ASA calculation that Ba 2 Cd 2 Sb 3 is a poor metal. It has been found that there are subtle difference in band desperations of the two compounds, resulting in significant influence on the electronic and transport properties, taking into account the size and the electro-negativity differences between As and Sb atoms. Calculation show that there exists a strong hybridization between the orbitals which may lead to form covalent bonding which is more favorable for the transport of the carriers than ionic one. The electronic structure, the anisotropy and the inter-atomic interactions are further analyzed by calculating the valence electronic charge density distribution in two crystallographic planes. The semi-classical Boltzmann theory as incorporated in BoltzTraP code was used to calculate the transport properties of Ba 2 Cd 2 As 3 and Ba 2 Cd 2 Sb 3 at different temperatures and chemical potentials to ascertain the influence of temperatures and substituting As by Sb on the transport properties. The carries mobility decreases with increasing the temperature also with increasing the carriers concentration. We have observed that substituting As by Sb lead to increase the carries mobility of Ba 2 Cd 2 Sb 3 along the whole temperature interval and the carries concentration range. It has been found that Ba 2 Cd 2 As 3 exhibit higher carriers concentration, electronic electrical conductivity and Seebeck coefficient than that of Ba 2 Cd 2 Sb 3 along the investigated temperature range. The highest value of Seebeck coefficient occurs at 300 K, which show good agreement with the experimental data. The power factor increases linearly with increasing the temperature and Ba 2 Cd 2 As 3 exhibit a bit higher power factor than that of Ba

Evidence of mesoniums in anti pn annihilations and γγ reactions

International Nuclear Information System (INIS)

Liu, K.F.; Li, B.A.

1987-01-01

A new resonance at 1480 MeV with a width of 110 MeV is found in anti pn annihilations in the channel anti pn → π - X 0 (1480) → π - ρ 0 ρ 0 . Its mass, width and spin-parity are shown to be consistent with the ρ 0 ρ 0 enhancement observed in γγ reactions. Together with the suppression in the γγ → ρ + ρ - data which requires the admixture of an isotensor structure, this ρ 0 ρ 0 resonance in anti pn annihilation and γγ reactions and their small ππ branching ratios represent the best evidence yet for the Q 2 Q-bar 2 nature of the mesoniums. A ρ - ρ - resonance in anti pn annihilations which would betray the exotic isotensor nature of the resonance is predicted. (author)

A new class of PN3-pincer ligands for metal–ligand cooperative catalysis

KAUST Repository

Li, Huaifeng

2014-12-01

Work on a new class of PN3-pincer ligands for metal-ligand cooperative catalysis is reviewed. While the field of the pyridine-based PN3-transition metal pincer complexes is still relatively young, many important applications of these complexes have already emerged. In several cases, the PN3-pincer complexes for metal-ligand cooperative catalysis result in significantly improved or unprecedented activities. The synthesis and coordination chemistry of PN3-pincer ligands are briefly summarized first to cover the synthetic routes for their preparation, followed by a focus review on their applications in catalysis. A specific emphasis is placed on the later section about the role of PN3-pincer ligands\\' dearomatization-rearomatization steps during the catalytic cycles. The mechanistic insights from density functional theory (DFT) calculations are also discussed.

A new class of PN3-pincer ligands for metal–ligand cooperative catalysis

KAUST Repository

Li, Huaifeng; Zheng, Bin; Huang, Kuo-Wei

2014-01-01

Work on a new class of PN3-pincer ligands for metal-ligand cooperative catalysis is reviewed. While the field of the pyridine-based PN3-transition metal pincer complexes is still relatively young, many important applications of these complexes have already emerged. In several cases, the PN3-pincer complexes for metal-ligand cooperative catalysis result in significantly improved or unprecedented activities. The synthesis and coordination chemistry of PN3-pincer ligands are briefly summarized first to cover the synthetic routes for their preparation, followed by a focus review on their applications in catalysis. A specific emphasis is placed on the later section about the role of PN3-pincer ligands' dearomatization-rearomatization steps during the catalytic cycles. The mechanistic insights from density functional theory (DFT) calculations are also discussed.

Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

Directory of Open Access Journals (Sweden)

Marcello Alves Pinto

Full Text Available CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

Ternary CaCu{sub 4}P{sub 2}-type pnictides AAg{sub 4}Pn{sub 2} (A=Sr, Eu; Pn=As, Sb)

Energy Technology Data Exchange (ETDEWEB)

Stoyko, Stanislav S.; Khatun, Mansura; Scott Mullen, C. [Department of Chemistry, University of Alberta, Edmonton, Alberta, T6G 2G2 (Canada); Mar, Arthur, E-mail: arthur.mar@ualberta.ca [Department of Chemistry, University of Alberta, Edmonton, Alberta, T6G 2G2 (Canada)

2012-08-15

Four ternary pnictides AAg{sub 4}Pn{sub 2} (A=Sr, Eu; Pn=As, Sb) were prepared by reactions of the elements at 850 Degree-Sign C and their crystal structures were determined from single-crystal X-ray diffraction studies. These silver-containing pnictides AAg{sub 4}Pn{sub 2} adopt the trigonal CaCu{sub 4}P{sub 2}-type structure (Pearson symbol hR21, space group R3-bar m, Z=3; a=4.5555(6) A, c=24.041(3) A for SrAg{sub 4}As{sub 2}; a=4.5352(2) A, c=23.7221(11) A for EuAg{sub 4}As{sub 2}; a=4.7404(4) A, c=25.029(2) A for SrAg{sub 4}Sb{sub 2}; a=4.7239(3) A, c=24.689(2) A for EuAg{sub 4}Sb{sub 2}), which can be derived from the trigonal CaAl{sub 2}Si{sub 2}-type structure of the isoelectronic zinc-containing pnictides AZn{sub 2}Pn{sub 2} by insertion of additional Ag atoms into trigonal planar sites within [M{sub 2}Pn{sub 2}]{sup 2-} slabs built up of edge-sharing tetrahedra. Band structure calculations on SrAg{sub 4}As{sub 2} and SrAg{sub 4}Sb{sub 2} revealed that these charge-balanced Zintl phases actually exhibit no gap at the Fermi level and are predicted to be semimetals. - Graphical abstract: SrAg{sub 4}As{sub 2} and related pnictides adopt a CaCu{sub 4}P{sub 2}-type structure in which additional Ag atoms enter trigonal planar sites within slabs built from edge-sharing tetrahedra. Highlights: Black-Right-Pointing-Pointer AAg{sub 4}Pn{sub 2} are the first Ag-containing members of the CaCu{sub 4}P{sub 2}-type structure. Black-Right-Pointing-Pointer Ag atoms are stuffed in trigonal planar sites within CaAl{sub 2}Si{sub 2}-type slabs. Black-Right-Pointing-Pointer Ag-Ag bonding develops through attractive d{sup 10}-d{sup 10} interactions.

Initial experience with hand-assisted laparoscopic donor nephrectomy

DEFF Research Database (Denmark)

Wiborg, Majken Højrup; Toft, Anja; Jahn, Henrik

2017-01-01

-38 kg/m²) in males. The median intraoperative bleeding was 175 ml. The median warm ischaemia time was 3.2 min (1.5-6.7 min). The median operative time was 230 min (161-360 min). The median hospital stay was 4 days (2-10 days). Thirty donors (28%) had 34 early complications. Six donors (6%) needed...... recipients had a functional transplant after 1 year. CONCLUSION: Hand-assisted donor nephrectomy is a safe procedure. Potential candidates should be advised...

Solution-grown organic single-crystalline p-n junctions with ambipolar charge transport.

Science.gov (United States)

Fan, Congcheng; Zoombelt, Arjan P; Jiang, Hao; Fu, Weifei; Wu, Jiake; Yuan, Wentao; Wang, Yong; Li, Hanying; Chen, Hongzheng; Bao, Zhenan

2013-10-25

Organic single-crystalline p-n junctions are grown from mixed solutions. First, C60 crystals (n-type) form and, subsequently, C8-BTBT crystals (p-type) nucleate heterogeneously on the C60 crystals. Both crystals continue to grow simultaneously into single-crystalline p-n junctions that exhibit ambipolar charge transport characteristics. This work provides a platform to study organic single-crystalline p-n junctions. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Charge exchange probes of nuclear structure and interactions with emphasis on (p,n)

International Nuclear Information System (INIS)

Goodman, C.D.

1980-01-01

New results from (p,n) studies at IUCF show that it is possible to observe Gamow-Teller (GT) strength and extract GT matrix elements from (p,n) measurements. The charge exchange reactions ( 6 Li, 6 He) and (π + ,π 0 ) involve different projectile quantum numbers, and the relationships of these reactions to (p,n) is discussed

Relationship between changes of serum leptin levels and degree of glomerulosclerosis in rats after 5/6 nephrectomy

International Nuclear Information System (INIS)

Yang Licai; Zhang Daoyou; Zhu Xinjian; Wang Yuwei; Gao Chaoqing; Xu Haihong

2006-01-01

Objective: To investigate the relationship between changes of serum leptin levels and glomerulosclerosis index, TGF-β 1 expression at glomerulus as well as degree of ECM proliferation in rats after 5/6 nephrectomy. Methods: Eight rats underwent two-stage 5/6 nephrectomy to establish a progressive glomeruloselerosis model. Six weeks after the second operation, the rats were sacrificed, the renal tissue was examined with routine pathological sections for study of glomerulosclerosis as well as with immunohistochemical studies for TGF-β 1 , collagen IV and fibronectin expressions. Six rats underwent sham operation served as controls. Serum creatinine, urea nitrogen and leptin levels were measured in all these animals. Results: The serum levels of leptin were significantly higher in rats after 5/6 nephrectomy than the rats with sham operations (14.88 ± 1.46ng/ml vs 10.84 ± 2.67ng/ml, P < 0. 01 ). Serum levels of leptin were positively correlated with the glomeruloselerosis index and collagen IV, fibronectin expressions ( P < 0.01 ). Conclusion: Hyperleptinemia may be one of the causative factors of development of glomerulosclerosis. (authors)

Illumina MiSeq sequencing reveals the key microorganisms involved in partial nitritation followed by simultaneous sludge fermentation, denitrification and anammox process.

Science.gov (United States)

Wang, Bo; Peng, Yongzhen; Guo, Yuanyuan; Zhao, Mengyue; Wang, Shuying

2016-05-01

A combined process including a partial nitritation SBR (PN-SBR) followed by a simultaneous sludge fermentation, denitrification and anammox reactor (SFDA) was established to treat low C/N domestic wastewater in this study. An average nitrite accumulation rate of 97.8% and total nitrogen of 9.4mg/L in the effluent was achieved during 140days' operation. The underlying mechanisms were investigated by using Illumina MiSeq sequencing to analyze the microbial community structures in the PN-SBR and SFDA. Results showed that the predominant bacterial phylum was Proteobacteria in the external waste activated sludge (WAS, added to the SFDA) and SFDA while Bacteroidetes in the PN-SBR. Further study indicated that in the PN-SBR, the dominant nitrobacteria, Nitrosomonas genus, facilitated nitritation and little nitrate was generated in the PN-SBR effluent. In the SFDA, the co-existence of functional microorganisms Thauera, Candidatus Anammoximicrobium and Pseudomonas were found to contribute to simultaneous sludge fermentation, denitrification and anammox. Copyright © 2016 Elsevier Ltd. All rights reserved.

Segmental thoracic spinal anesthesia in patient with Byssinosis undergoing nephrectomy

OpenAIRE

Patel, Kiran; Salgaonkar, Sweta

2012-01-01

Byssinosis is an occupational disease occurring commonly in cotton mill workers; it usually presents with features of chronic obstructive pulmonary disease (COPD). The management of patients with COPD presents a significant challenges to the anesthetist. Regional anesthesia is preferred in most of these patients to avoid perioperative and postoperative complications related to general anesthesia. We report a known case of Byssinosis who underwent nephrectomy under segmental spinal anesthesia ...

Effects of adding butyric acid to PN on gut-associated lymphoid tissue and mucosal immunoglobulin A levels.

Science.gov (United States)

Murakoshi, Satoshi; Fukatsu, Kazuhiko; Omata, Jiro; Moriya, Tomoyuki; Noguchi, Midori; Saitoh, Daizoh; Koyama, Isamu

2011-07-01

Parenteral nutrition (PN) causes intestinal mucosal atrophy, gut-associated lymphoid tissue (GALT) atrophy and dysfunction, leading to impaired mucosal immunity and increased susceptibility to infectious complications. Therefore, new PN formulations are needed to maintain mucosal immunity. Short-chain fatty acids have been demonstrated to exert beneficial effects on the intestinal mucosa. We examined the effects of adding butyric acid to PN on GALT lymphocyte numbers, phenotypes, mucosal immunoglobulin A (IgA) levels, and intestinal morphology in mice. Male Institute of Cancer Research mice (n = 103) were randomized to receive either standard PN (S-PN), butyric acid-supplemented PN (Bu-PN), or ad libitum chow (control) groups. The mice were fed these respective diets for 5 days. In experiment 1, cells were isolated from Peyer's patches (PPs) to determine lymphocyte numbers and phenotypes (αβTCR(+), γδTCR(+), CD4(+), CD8(+), B220(+) cells). IgA levels in small intestinal washings were also measured. In experiment 2, IgA levels in respiratory tract (bronchoalveolar and nasal) washings were measured. In experiment 3, small intestinal morphology was evaluated. Lymphocyte yields from PPs and small intestinal, bronchoalveolar, and nasal washing IgA levels were all significantly lower in the S-PN group than in the control group. Bu-PN moderately, but significantly, restored PP lymphocyte numbers, as well as intestinal and bronchoalveolar IgA levels, as compared with S-PN. Villous height and crypt depth in the small intestine were significantly decreased in the S-PN group vs the control group, however Bu-PN restored intestinal morphology. A new PN formula containing butyric acid is feasible and would ameliorate PN-induced impairment of mucosal immunity.

Achieve efficient nitrogen removal from real sewage in a plug-flow integrated fixed-film activated sludge (IFAS) reactor via partial nitritation/anammox pathway.

Science.gov (United States)

Yang, Yandong; Zhang, Liang; Cheng, Jun; Zhang, Shujun; Li, Baikun; Peng, Yongzhen

2017-09-01

This study tested the feasibility of plug-flow integrated fixed-film activated sludge (IFAS) reactor in applying sewage partial nitritation/anammox (PN/A) process. The IFAS reactor was fed with real pre-treated sewage (C/N ratio=1.3) and operated for 200days. High nitrogen removal efficiency of 82% was achieved with nitrogen removal rates of 0.097±0.019kgN/(m 3 ·d). Therefore, plug-flow IFAS reactor could be an alternative to applying sewage PN/A process. Besides, it was found that the stability of sewage PN/A process was significantly affected by residual ammonium. Nitrate accumulated in effluent and PN/A performance deteriorated when residual ammonium was below 1mg/L. On the contrary, long-term stable PN/A operation was achieved when residual ammonium was over 3mg/L. Copyright © 2017 Elsevier Ltd. All rights reserved.

Investigating the effects of inhaling ginger essence on post-nephrectomy nausea and vomiting.

Science.gov (United States)

Adib-Hajbaghery, Mohsen; Hosseini, Fatemeh Sadat

2015-12-01

There is a knowledge gap regarding the effects of ginger essence on postoperative nausea and vomiting. This study aimed to evaluate the effect of ginger essence on post-nephrectomy nausea and vomiting. A randomized controlled trial was conducted. This study was conducted from third April to first October 2014 in Labbafinejad hospital, Tehran, Iran. Totally, 120 nephrectomy patients were randomly allocated to either the treatment or the control groups. After nephrectomy, we applied two drops of ginger essence to a 2 × 2-inch gauze that was attached to the patients' collars in the treatment group to allow patients to inhale the evaporated essence along with the air room and then repeated every 30 min for two hours. The control group was similarly treated with normal saline. Nausea was assessed using a visual analogue scale every 30 min for two hours and at the sixth hour after surgery. The paired- and independent-samples t and repeated measures analysis of variance tests were used for data analysis. The means nausea intensity were in the treatment and the control groups were 7.09 ± 1.59 and 7.40 ± 1.71 at thirty minutes after surgery (P value > 0.05). However, the mean nausea intensity in the treatment group at the four subsequent times were significantly lower than the control group (P value ginger essence has positive effect on postoperative nausea and vomiting. Using ginger essence for managing postoperative nausea and vomiting is recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.

C-reactive protein in patients with advanced metastatic renal cell carcinoma: Usefulness in identifying patients most likely to benefit from initial nephrectomy

International Nuclear Information System (INIS)

Ito, Hiroki; Kishida, Takeshi; Miura, Takeshi; Kubota, Yoshinobu; Yao, Masahiro; Shioi, Koichi; Murakami, Takayuki; Takizawa, Akitoshi; Sano, Futoshi; Kawahara, Takashi; Mizuno, Nobuhiko; Makiyama, Kazuhide; Nakaigawa, Noboru

2012-01-01

C-reactive protein (CRP) is considered a useful serum marker for patients with RCC. However, its clinical utility in advanced metastatic renal cell carcinoma (AM-RCC), particularly in deciding whether to perform nephrectomy at the onset, is not well studied. We retrospectively evaluated 181 patients with AM-RCC, including 18 patients underwent potentially curative surgery, 111 underwent cytoreductive nephrectomy, and 52 received medical treatment only. CRP cutoff points were determined by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier and Cox regression analyses were used for survival tests. ROC analysis suggested that grouping patients according to 3 CRP ranges was a rational model. Patients with highly elevated CRP (≥67.0 mg/L) presented remarkably poor prognosis despite treatment (nephrectomy or medical treatment only). Cox regression models demonstrated that risk factors of overall survival for patients who underwent nephrectomy were the CRP ranges defined in this study (≤18.0 mg/L, >18.0 and <67.0 mg/L, and ≥67.0 mg/L), ECOG PS (0, 1, and ≥2), and number of metastatic organ sites (0–1 and ≥2). The retrospective design is a limitation of this study. Our study demonstrated that the serum CRP level is a statistically significant prognostic parameter for patients with AM-RCC. The data also indicated that pretreatment serum CRP level provides useful prognostic information that helps in deciding whether to perform initial nephrectomy for patients with AM-RCC

The delicate electronic and magnetic structure of the LaFePnO system (Pn = pnicogen)

Energy Technology Data Exchange (ETDEWEB)

Lebegue, S [Laboratoire de Cristallographie et de Modelisation des Materiaux Mineraux et Biologiques, UMR 7036, CNRS-Universite Henri Poincare, BP 239, F-54506 Vandoeuvre-les-Nancy (France); Yin, Z P; Pickett, W E [Department of Physics, University of California Davis, Davis, CA 95616 (United States)], E-mail: sebastien.lebegue@lcm3b.uhp-nancy.fr

2009-02-15

The occurrence of high-temperature superconductivity, and the competition with magnetism, in stoichiometric and doped LaFeAsO and isostructural iron oxypnictides is raising many fundamental questions about the electronic structure and magnetic interactions in this class of materials. There are now sufficient experimental data that it may be possible to identify the important issues whose resolution will lead to the understanding of this system. In this paper, we address a number of the important issues. One important characteristic is the Fe-As distance (or more abstractly the pnicogen (Pn) height z(Pn)); we present results for the effect of z(Pn) on the electronic structure, energetics and Fe magnetic moment. We also study LaFeAsO under pressure, and investigate the effects of both electron and hole doping within the virtual crystal approximation. The electric field gradients for all atoms in the LaFeAsO compound are presented (undoped and doped) and compared with available data. The observed ({pi}, {pi}, {pi}) magnetic order is studied and compared with the computationally simpler ({pi}, {pi}, 0) order which is probably a very good model in most respects. We investigate the crucial role of the pnicogen atom in this class, and predict the structures and properties of the N and Sb counterparts that have not yet been reported experimentally. At a certain volume a gap opens at the Fermi level in LaFeNO, separating bonding from antibonding bands. This is the first evidence that this class of materials indeed has an underlying semimetallic character, and this separation suggests directions for a better simple understanding of the seemingly intricate electronic structure of this system. Finally, we address briefly differences resulting from substitution of post-lanthanum rare earth atoms, which have been observed to enhance the superconducting critical temperature substantially.

The electronic structure of radial p-n junction silicon nanowires

Science.gov (United States)

Chiou, Shan-Haw; Grossman, Jeffrey

2007-03-01

Silicon nanowires with radial p-n junctions have recently been suggested for photovoltaic applications because incident light can be absorbed along the entire length of the wire, while photogenerated carriers only need to diffuse a maximum of one radius to reach the p-n junction. If the differential of the potential is larger than the binding energy of the electron-hole pair and has a range larger than the Bohr radius of electron-hole pair, then the charge separation mechanism will be similar to traditional silicon solar cells. However, in the small-diameter limit, where quantum confinement effects are prominent, both the exciton binding energy and the potential drop will increase, and the p-n junction itself may have a dramatically different character. We present ab initio calculations based on the generalized gradient approximation (GGA) of silicon nanowires with 2-3 nm diameter in the [111] growth direction. A radial p-n junction was formed by symmetrically doping boron and phosphorous at the same vertical level along the axis of the nanowire. The competition between the slope and character of the radial electronic potential and the exciton binding energy will presented in the context of a charge separation mechanism.

Antiperovskite nitridophosphate oxide Ho{sub 3}[PN{sub 4}]O by high-pressure metathesis

Energy Technology Data Exchange (ETDEWEB)

Kloss, Simon D.; Weidmann, Niels; Schnick, Wolfgang [Department of Chemistry, University of Munich (LMU), Butenandtstrasse 5-13, 81377, Munich (Germany)

2017-04-03

Rare-earth nitridophosphates are a recently discovered class of materials, which are accessible by high-pressure metathesis. Antiperovskite-type Ho{sub 3}[PN{sub 4}]O was synthesized from HoF{sub 3}, LiPN{sub 2}, Li{sub 3}N, and Li{sub 2}O at 5 GPa and ca. 1025 C by this method and the multianvil technique. Ho{sub 3}[PN{sub 4}]O contains rarely observed isolated PN{sub 4} tetrahedra and can be derived by the hierarchical substitution of the ABX{sub 3} perovskite, in which Ho occupies the X positions, O occupies the B position, and the PN{sub 4} tetrahedra occupy the A position. The structure was refined on the basis of powder diffraction data [I4/mcm, a = 6.36112(3), c = 10.5571(1) Aa, Z = 4, R{sub wp} = 0.04, R{sub Bragg} = 0.01, χ{sup 2} = 2.275] starting from the structural model of isotypic Gd{sub 3}[SiN{sub 3}O]O. To characterize Ho{sub 3}[PN{sub 4}]O, elemental analyses were performed through energy-dispersive X-ray spectroscopy (EDX) and inductively coupled plasma optical emission spectroscopy (ICP-OES). Ho{sub 3}[PN{sub 4}]O is paramagnetic down to low temperatures with μ{sub eff} = 10.43(1) μ{sub B} and a Curie temperature (Θ) of 0.11(4) K. It shows the optical characteristics of Ho{sup 3+} ions and vibrations corresponding to isolated PN{sub 4} tetrahedra. On the basis of DFT calculations [generalized gradient approximation (GGA)], Ho{sub 3}[PN{sub 4}]O has an indirect band gap of 1.87 eV. We demonstrate the versatility of high-pressure metathesis by attaining the low end of the P/N atomic ratio κ = 1/4. This confirms the previous assumption that rare-earth nitridophosphates with κ = 1/2 to 1/4 are feasible by this method. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Segmental thoracic spinal anesthesia in patient with Byssinosis undergoing nephrectomy.

Science.gov (United States)

Patel, Kiran; Salgaonkar, Sweta

2012-01-01

Byssinosis is an occupational disease occurring commonly in cotton mill workers; it usually presents with features of chronic obstructive pulmonary disease (COPD). The management of patients with COPD presents a significant challenges to the anesthetist. Regional anesthesia is preferred in most of these patients to avoid perioperative and postoperative complications related to general anesthesia. We report a known case of Byssinosis who underwent nephrectomy under segmental spinal anesthesia at the low thoracic level.

Partial recovery of respiratory function and diaphragm reinnervation following unilateral vagus nerve to phrenic nerve anastomosis in rabbits.

Directory of Open Access Journals (Sweden)

Junxiang Wen

Full Text Available Respiratory dysfunction is the leading cause of mortality following upper cervical spinal cord injury (SCI. Reinnervation of the paralyzed diaphragm via an anastomosis between phrenic nerve and a donor nerve is a potential strategy to mitigate ventilatory deficits. In this study, anastomosis of vagus nerve (VN to phrenic nerve (PN in rabbits was performed to assess the potential capacity of the VN to compensate for lost PN inputs. At first, we compared spontaneous discharge pattern, nerve thickness and number of motor fibers between these nerves. The PN exhibited a highly rhythmic discharge while the VN exhibited a variable frequency discharge pattern. The rabbit VN had fewer motor axons (105.3±12.1 vs. 268.1±15.4. Nerve conduction and respiratory function were measured 20 weeks after left PN transection with or without left VN-PN anastomosis. Compared to rabbits subjected to unilateral phrenicotomy without VN-PN anastomosis, diaphragm muscle action potential (AP amplitude was improved by 292%, distal latency by 695%, peak inspiratory flow (PIF by 22.6%, peak expiratory flow (PRF by 36.4%, and tidal volume by 21.8% in the anastomosis group. However, PIF recovery was only 28.0%, PEF 28.2%, and tidal volume 31.2% of Control. Our results suggested that VN-PN anastomosis is a promising therapeutic strategy for partial restoration of diaphragm reinnervation, but further modification and improvements are necessary to realize the full potential of this technique.

Semiconductor device comprising a pn-heterojunction

NARCIS (Netherlands)

2007-01-01

An electric device is disclosed comprising a pn-heterojunction ( 4 ) formed by a nanowire ( 3 ) of 111 -V semiconductor material and a semiconductor body ( 1 ) comprising a group IV semiconductor material. The nanowire ( 3 ) is positioned in direct contact with the surface ( 2 ) of the semiconductor

New PN Even Balanced Sequences for Spread-Spectrum Systems

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Inácio JAL

2005-01-01

Full Text Available A new class of pseudonoise even balanced (PN-EB binary spreading sequences is derived from existing classical odd-length families of maximum-length sequences, such as those proposed by Gold, by appending or inserting one extra-zero element (chip to the original sequences. The incentive to generate large families of PN-EB spreading sequences is motivated by analyzing the spreading effect of these sequences from a natural sampling point of view. From this analysis a new definition for PG is established, from which it becomes clear that very high processing gains (PGs can be achieved in band-limited direct-sequence spread-spectrum (DSSS applications by using spreading sequences with zero mean, given that certain conditions regarding spectral aliasing are met. To obtain large families of even balanced (i.e., equal number of ones and zeros sequences, two design criteria are proposed, namely the ranging criterion (RC and the generating ranging criterion (GRC. PN-EB sequences in the polynomial range are derived using these criteria, and it is shown that they exhibit secondary autocorrelation and cross-correlation peaks comparable to the sequences they are derived from. The methods proposed not only facilitate the generation of large numbers of new PN-EB spreading sequences required for CDMA applications, but simultaneously offer high processing gains and good despreading characteristics in multiuser SS scenarios with band-limited noise and interference spectra. Simulation results are presented to confirm the respective claims made.

Medline Plus

Full Text Available ... Mission Medical Center, Merriam, KS, 05/04/2012) Kidney Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee Mission ... NC, 09/17/2015) Kidneys and Urinary System Kidney Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee Mission ...

Cytoreductive nephrectomy vs medical therapy as initial treatment: a rational approach to the sequence question in metastatic renal cell carcinoma.

Science.gov (United States)

Spiess, Philippe E; Fishman, Mayer N

2010-10-01

Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease. We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC. Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited. The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.

High-speed carrier-depletion silicon Mach-Zehnder optical modulators with lateral PN junctions

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Graham Trevor Reed

2014-12-01

Full Text Available This paper presents new experimental data from a lateral PN junction silicon Mach-Zehnder optical modulator. Efficiencies in the 1.4V.cm to 1.9V.cm range are demonstrated for drive voltages between 0V and 6V. High speed operation up to 52Gbit/s is also presented. The performance of the device which has its PN junction positioned in the centre of the waveguide is then compared to previously reported data from a lateral PN junction device with the junction self-aligned to the edge of the waveguide rib. An improvement in modulation efficiency is demonstrated when the junction is positioned in the centre of the waveguide. Finally we propose schemes for achieving high modulation efficiency whilst retaining self-aligned formation of the PN junction.

Physicochemical Characterization and Skin Permeation of Cationic Transfersomes Containing the Synthetic Peptide PnPP-19.

Science.gov (United States)

Almeida, Flavia De Marco; Silva, Carolina Nunes; de Araujo Lopes, Savia Caldeira; Santos, Daniel Moreira; Torres, Fernanda Silva; Cardoso, Felipe Lima; Martinelli, Patricia Massara; da Silva, Elizabeth Ribeiro; de Lima, Maria Elena; Miranda, Lucas Antonio Ferreira; Oliveira, Monica Cristina

2018-01-08

PnPP-19 is a 19-amino-acid synthetic peptide previously described as a novel drug for the treatment of erectile dysfunction. The aim of this work was to evaluate the physicochemical properties of cationic transfersomes containing PnPP-19 and the skin permeation of free PnPP-19 and PnPP-19-loaded transfersomes. Three different liposomal preparation methods were evaluated. Cationic transfersomes contained egg phosphatidyl choline: stearylamine (9:1 w/w) and Tween 20 (84.6:15.4 lipid:Tween, w/w). Lipid concentration varied from 20 to 40 mM. We evaluated the entrapment percentage, mean diameter, zeta potential and stability at 4 oC of the formulations. The skin permeation assays were performed with abdominal human skin using Franz diffusion cell with 3 cm2 diffusion area at 32 oC and a fluorescent derivative of the peptide, containing 5-TAMRA, bound to PnPP-19 C-terminal region, where an extra lysine was inserted. Our results showed variable entrapment efficiencies, from 6% to 30%, depending on the preparation method and the lipid concentration used. The reverse phase evaporation method using a total lipid concentration equal to 40 mM led to the best entrapment percentage (30.2 + 4.5%). Free PnPP-19 was able to permeate skin at a rate of 10.8 ng/cm2/h. However, PnPP-19 was specifically hydrolyzed by skin proteases, generating a fragment of 15 amino acid residues. Encapsulated PnPP-19 permeated the skin at a rate of 19.8 ng/cm2/h. The encapsulation of PnPP-19 in cationic transfersomes protected the peptide from degradation, favoring its topical administration. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

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Tanya Nazemi

2006-02-01

Full Text Available PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access DatabaseTM and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI, incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05, the median operative time was significantly shorter compared to the robotic method (p = 0.02. Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.

Novel prediction model of renal function after nephrectomy from automated renal volumetry with preoperative multidetector computed tomography (MDCT).

Science.gov (United States)

Isotani, Shuji; Shimoyama, Hirofumi; Yokota, Isao; Noma, Yasuhiro; Kitamura, Kousuke; China, Toshiyuki; Saito, Keisuke; Hisasue, Shin-ichi; Ide, Hisamitsu; Muto, Satoru; Yamaguchi, Raizo; Ukimura, Osamu; Gill, Inderbir S; Horie, Shigeo

2015-10-01

The predictive model of postoperative renal function may impact on planning nephrectomy. To develop the novel predictive model using combination of clinical indices with computer volumetry to measure the preserved renal cortex volume (RCV) using multidetector computed tomography (MDCT), and to prospectively validate performance of the model. Total 60 patients undergoing radical nephrectomy from 2011 to 2013 participated, including a development cohort of 39 patients and an external validation cohort of 21 patients. RCV was calculated by voxel count using software (Vincent, FUJIFILM). Renal function before and after radical nephrectomy was assessed via the estimated glomerular filtration rate (eGFR). Factors affecting postoperative eGFR were examined by regression analysis to develop the novel model for predicting postoperative eGFR with a backward elimination method. The predictive model was externally validated and the performance of the model was compared with that of the previously reported models. The postoperative eGFR value was associated with age, preoperative eGFR, preserved renal parenchymal volume (RPV), preserved RCV, % of RPV alteration, and % of RCV alteration (p volumetry and clinical indices might yield an important tool for predicting postoperative renal function.

Intravesical ligation as a new technique to manage a refluxing native ureter without simultaneous nephrectomy in renal transplantation.

Science.gov (United States)

Guzmán, J A

2012-12-01

This article aims to describe an original technique to correct refluxing native ureters observed during a prerenal transplantation study. The correction is performed by intravesical ligation of the native refluxing ureters at the same time as renal transplantation without simultaneous nephrectomy. Between January 2004 and December 2010 we performed intravesical ligation of a refluxing ureter simultaneous with a transplantation procedure without a concomittant native nephrectomy in 12 of 345 subjects (3.47%). The 8 bilateral and 4 unilateral ligations were performed on 11 cadaveric and 1 living-related nonidentical donor transplantations. The implantation of the kidney donor ureter was performed anatomically in the bladder trigone through a transvesical ureteroneocystostomy with a transmural, submucosal antireflux tunnel. Early and late postoperative recovery was satisfactory in all patients. There was no documented kidney area pain, proven urinary tract infection, morbidity or mortality attributed to the procedure. Intravesical ligation is a practical technique to manage vesicoureteral reflux into the native ureters simultaneously with the ureteral implantation of the kidney donor in a single surgical renal transplant procedure without native kidney nephrectomy. Copyright © 2012 Elsevier Inc. All rights reserved.

Effect of high pN2 and high pD2 on NH3 production, H2 evolution, and HD formation by nitrogenases

International Nuclear Information System (INIS)

Jensen, B.B.; Burris, R.H.

1985-01-01

We have investigated the effect of the partial pressure of N2 and D2 on HD formation, H2 evolution, and NH3 production by nitrogenase from Klebsiella pneumoniae and Clostridium pasteurianum. By using pressures up to 4 atm, we have been able to extend the concentration range of N2 and D2 in our investigations beyond that used in previous studies. The pN2 dependence of HD formation with constant pD2 ideally shows no HD formation under zero pN2, reaches a peak which depends on the pD2, and then decreases to zero at very high pN2. K. pneumoniae and C. pasteurianum nitrogenases differ in their Ki(D2) for nitrogen fixation. C. pasteurianum nitrogenase had the lower activity for formation of HD. With K. pneumoniae nitrogenase, D2 enhanced H2 evolution from 31% of the electron flux partitioned to H2 in the absence of D2 to 51% of the electron flux partitioned to H2 at 400 kPa of D2. With C. pasteurianum nitrogenase, the equivalent values were 33% and 48% of the total electron flux. Our results support previou findings on the mechanism for nitrogenase-catalyzed reductions proposed by W. W. Cleland

Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

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Deepak Dubey

2011-01-01

Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

Effects of multiple substitution upon the P...N noncovalent interaction

International Nuclear Information System (INIS)

Scheiner, Steve

2011-01-01

Graphical abstract: The presence of one halogen opposite the N results in strong attraction between P and N. This force is little affected by identity of Y atoms, whether H or halogen. Highlights: → Strong attractive force directly between trivalent P and N atoms. → P...N force is unlike H-bonds or halogen bonds, but stronger than both. → Multiple halogenation beyond a single atom on P slightly weakens the interaction. - Abstract: The attractive noncovalent interaction of a P atom with N is derived primarily from two sources. Charge transfer from the N lone pair into the σ * antibonding orbital of a P-X bond that is turned away from the N atom combines with attractive Coulombic forces. As in the case of H-bonding, which is parallel in some ways to P...N attraction, placement of an electron-withdrawing substituent on the P atom enhances both of these components, and strengthens the overall interaction. However, in stark contrast with H-bonding, halogenation beyond monosubstitution does not lead to any further strengthening of the P...N noncovalent bond. Indeed, di and tri-substitution lead to small reductions in the interaction energy. In all cases, the geometry which contains a P...N bond is more stable than other candidate structures, some of which contain hydrogen or halogen bonds.

Laparoscopic versus open nephrectomy for live kidney donors.

Science.gov (United States)

Wilson, Colin H; Sanni, Aliu; Rix, David A; Soomro, Naeem A

2011-11-09

Waiting lists for kidney transplantation continue to grow and live organ donation has become more important as the number of brain stem dead cadaveric organ donors continues to fall. The major disincentive to potential kidney donors is the pain and morbidity associated with open surgery. To identify the benefits and harms of using laparoscopic compared to open nephrectomy techniques to recover kidneys from live organ donors. We searched the online databases CENTRAL (in The Cochrane Library 2010, Issue 2), MEDLINE (January 1966 to January 2010) and EMBASE (January 1980 to January 2010) and handsearched textbooks and reference lists. Randomised controlled trials comparing laparoscopic donor nephrectomy (LDN) with open donor nephrectomy (ODN). Two review authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We contacted study authors for additional information where necessary. Six studies were identified that randomised 596 live kidney donors to either LDN or ODN arms. All studies were assessed as having low or unclear risk of bias for selection bias, allocation bias, incomplete outcome data and selective reporting bias. Four of six studies had high risk of bias for blinding. Various different combinations of techniques were used in each study, resulting in heterogeneity in the results. The conversion rate from LDN to ODN ranged from 1% to 1.8%. LDN was generally found to be associated with reduced analgesia use, shorter hospital stay, and faster return to normal physical functioning. The extracted kidney was exposed to longer warm ischaemia periods (2 to 17 minutes) with no associated short-term consequences. ODN was associated with shorter duration of procedure. For those outcomes that could be meta-analysed there were no significant differences between LDN or ODN for perioperative complications (RR 0.87, 95% CI 0.47 to 4.59), reoperations (RR 0.57, 95% CI 0.09 to 3.64), early graft loss (RR 0.31, 95% CI 0

Impact of Cytoreductive Nephrectomy on Survival in Patients with Metastatic Renal Cell Carcinoma Treated by Targeted Therapy

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Yan Song

2016-01-01

Conclusions: Five risk factors (age, BMI, LDH, serum calcium, and number of metastatic sites seemed to be helpful for selecting patients who would benefit from undergoing upfront cytoreductive nephrectomy.

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Full Text Available ... Center, Merriam, KS, 05/04/2012) Kidney Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee Mission Medical Center, Merriam, KS, 10/ ... 17/2015) Kidneys and Urinary System ... Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee Mission Medical Center, Merriam, KS, 10/ ...

Pn-waves Travel-time Anomaly beneath Taiwan from Dense Seismic Array Observations and its Possible Tectonic Implications

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Lin, Y. Y.; Huang, B. S.; Ma, K. F.; Hsieh, M. C.

2015-12-01

We investigated travel times of Pn waves, which are of great important for understanding the Moho structure in Taiwan region. Although several high quality tomographic studies had been carried out, observations of Pn waves are still the most comprehensive way to elucidate the Moho structure. Mapping the Moho structure of Taiwan had been a challenging due to the small spatial dimension of Taiwan island with two subduction systems. To decipher the tectonic structure and understanding of earthquake hazard, the island of Taiwan have been implemented by several high density seismic stations, including 71 short-period stations of Central Weather Bureau Seismic Network (CWBSN) and 42 broardband stations of Broadband Array in Taiwan for Seismology (BATS). High quality seismic records of these stations would be used to identify precise Pn-wave arrival times. After station-elevation correction, we measure the difference between the observed and theoretical Pn arrivals from the IASPI 91 model for each station. For correcting uncertainties of earthquake location and origin time, we estimate relative Pn anomaly, ΔtPn , between each station and a reference station. The pattern of ΔtPn reflects the depth anomaly of Moho beneath Taiwan. In general, Pn waves are commonly observed from shallow earthquake at epicentral distance larger than 120 km. We search the global catalog since 2005 and the criteria are M > 5.5, focal depth 150 km. The 12 medium earthquakes from north Luzon are considered for analysis. We choose a station, TWKB, in the most southern point of Taiwan as the reference station due to that all events are from the south. The results indicate obvious different patterns of ΔtPn from different back-azimuths. The ΔtPn pattern of the events in the first group from the south south-east indicates that the Pn arrivals delay suddenly when the Pn waves pass through the Central Range, suggesting the Moho becomes deep rapidly. However, we cannot recognize the same pattern when

Renal cell carcinoma-associated adult dermatomyositis treated laparoscopic nephrectomy

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Elizabeth Nevins

2013-01-01

Full Text Available A 77-year-old female, who suffered from rheumatoid arthritis and hypothyroidism, developed severe muscle weakness. Clinical features, blood results and muscle biopsy suggested a possible diagnosis of dermatomyositis. A computed tomography of the chest, abdomen and pelvis showed a solid mass in the left kidney. She underwent a left laparoscopic nephrectomy and histology confirmed conventional (clear cell renal cell carcinoma. She recovered slowly and almost back to normal life after 6 months. Early appreciation of the typical skin rash may provide a clue to the diagnosis and screening for neoplasm may improve prognosis.

Electrical/thermal transport and electronic structure of the binary cobalt pnictides CoPn2 (Pn = As and Sb

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Yosuke Goto

2015-06-01

Full Text Available We demonstrate the electrical and thermal transport properties of polycrystalline CoPn2 (Pn = As and Sb between 300 and 900 K. CoAs2 shows semiconducting electrical transport up to 900 K, while CoSb2 exhibits degenerate conduction. Sign inversion of the Seebeck coefficient is observed at ∼310 and ∼400 K for CoAs2 and CoSb2, respectively. Thermal conductivity at 300 K is 11.7 Wm−1K−1 for CoAs2 and 9.4 Wm−1K−1 for CoSb2. The thermoelectric power factor of CoAs2 is ∼10 μWcm−1K−2, although the dimensionless figure of merit is limited to ∼0.1 due to relatively high thermal conductivity. Using electronic structure calculations, the band gap value is calculated to be 0.55 eV for CoAs2 and 0.26 eV for CoSb2.

Unilateral Dependant Pulmonary Edema During Laparoscopic Donor Nephrectomy: Report of Three Cases

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Manisha Modi

2009-01-01

Full Text Available Unilateral pulmonary edema of the dependant lung was observed in three patients during laparoscopic donor nephrectomy. Patients were treated with 02 supplementation by face mask, fluid restriction and diuretic. All the patients were relieved of symptoms with radiological improvement. The possible causes of this unusual complication following laparoscopic surgery appear to be prolonged lateral decubitus position and high intraoperative fluid infusion.

High-resolution measurement of the 16O(γ,pn) reaction

International Nuclear Information System (INIS)

Isaksson, L.

1996-10-01

The 16 O(γ,pn) reaction has been measured with a resolution high enough to resolve individual low-lying states in the residual 14 N nucleus. Partial cross-sections, available to the acceptance of the detector system, have been extracted for the individual states, and compared to a recent calculation based on absorption on one-pion exchange currents and the Δ resonance current. The experiment was performed at the Maxlab accelerator laboratory in Lund, Sweden, using tagged photons at an energy of 67 - 76 MeV. The proton detector angular range was 60 - 100 deg and the corresponding for the neutron detector 81 - 103 deg. A missing energy resolution of 1.5 MeV was obtained. The relative population of the states in the residual 14 N nucleus indicates that the reaction takes place predominantly on proton-neutron pairs coupled to (J π ,T) = (1 + ,0). The cross-section for absorption on (0 + ,1) pairs is strongly suppressed. Furthermore, the relative population of the states indicates that both L=0 and L=2 pairs participate in the reaction. 45 refs

Atomic-scaled characterization of graphene PN junctions

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Zhou, Xiaodong; Wang, Dennis; Dadgar, Ali; Agnihotri, Pratik; Lee, Ji Ung; Reuter, Mark C.; Ross, Frances M.; Pasupathy, Abhay N.

Graphene p-n junctions are essential devices for studying relativistic Klein tunneling and the Veselago lensing effect in graphene. We have successfully fabricated graphene p-n junctions using both lithographically pre-patterned substrates and the stacking of vertical heterostructures. We then use our 4-probe STM system to characterize the junctions. The ability to carry out scanning electron microscopy (SEM) in our STM instrument is essential for us to locate and measure the junction interface. We obtain both the topography and dI/dV spectra at the junction area, from which we track the shift of the graphene chemical potential with position across the junction interface. This allows us to directly measure the spatial width and roughness of the junction and its potential barrier height. We will compare the junction properties of devices fabricated by the aforementioned two methods and discuss their effects on the performance as a Veselago lens.

Unusual complication after laparoscopic left nephrectomy for renal tumour: a case report

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Arantxa Arruabarrena

2010-06-01

Full Text Available In splenic rupture after blunt trauma, iatrogenic spleen injury or non-traumatic cases it is essential that the surgeonmakes correct decisions. Conservative treatment must include continual monitoring and repeated, stringent evaluationof the splenic injury (the American Association for the Surgery of Trauma – AAST in order to avoid any delay indiagnosis of delayed spleen rupture and the high mortality it causes. We present the case of an unexpected complicationafter radical nephrectomy performed for renal cell carcinoma. A 61-year old man sought medical help for acuteabdominal pain. He presented with some cardiovascular risk factors (diabetes mellitus, smoker of 30 cigarettes perday and moderate alcohol use. In the Emergency Unit, computed tomography scan revealed an incidental tumour ofthe left kidney. Nephrectomy via the laparoscopic approach was done without any iatrogenic complications, with lessthan 500 cc of blood loss. Firm adhesions between the spleen and abdominal wall, which caused some minor tractionthat resulted in a small subcapsular haematoma, were the only surprising intraoperative finding. Within the first 6 h,the patient presented with haemodynamic instability, while the drain evacuated less than 50 cc of discharge.However, CT scan showed that subcapsular haematoma had increased to the size of 10 × 10 cm without freeperitoneal fluid present. Unfortunately, 6 h later emergency surgery had to be performed due to rupture of thesubcapsular splenic haematoma. Massive haemoperitoneum was evacuated and the splenic capsule was the onlyremnant of the spleen that could be found on re-intervention. So far, it is the first case describing an increasing subcapsularhaematoma of the spleen, most likely caused by the traction of firm adhesions to the organ. We discussmeans to avoid such a complication: with liberation of the adhesions, placement of a perisplenic mesh, embolizationof the splenic artery or subcapsular nephrectomy. An acute

Identification of key nitrous oxide production pathways in aerobic partial nitrifying granules.

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Ishii, Satoshi; Song, Yanjun; Rathnayake, Lashitha; Tumendelger, Azzaya; Satoh, Hisashi; Toyoda, Sakae; Yoshida, Naohiro; Okabe, Satoshi

2014-10-01

The identification of the key nitrous oxide (N2O) production pathways is important to establish a strategy to mitigate N2O emission. In this study, we combined real-time gas-monitoring analysis, (15)N stable isotope analysis, denitrification functional gene transcriptome analysis and microscale N2O concentration measurements to identify the main N2O producers in a partial nitrification (PN) aerobic granule reactor, which was fed with ammonium and acetate. Our results suggest that heterotrophic denitrification was the main contributor to N2O production in our PN aerobic granule reactor. The heterotrophic denitrifiers were probably related to Rhodocyclales bacteria, although different types of bacteria were active in the initial and latter stages of the PN reaction cycles, most likely in response to the presence of acetate. Hydroxylamine oxidation and nitrifier denitrification occurred, but their contribution to N2O emission was relatively small (20-30%) compared with heterotrophic denitrification. Our approach can be useful to quantitatively examine the relative contributions of the three pathways (hydroxylamine oxidation, nitrifier denitrification and heterotrophic denitrification) to N2O emission in mixed microbial populations. © 2014 Society for Applied Microbiology and John Wiley & Sons Ltd.

On P2 ⋄ Pn -supermagic labeling of edge corona product of cycle and path graph

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Yulianto, R.; Martini, Titin S.

2018-04-01

A simple graph G = (V, E) admits a H-covering, where H is subgraph of G, if every edge in E belongs to a subgraph of G isomorphic to H. Graph G is H-magic if there is a total labeling f:V(G)\\cup E(G)\\to 1,2,\\ldots,|V(G)|+|E(G)|, such that each subgraph {H}{\\prime }=({V}{\\prime },{E}{\\prime }) of G isomorphic to H and satisfying f{({H}{\\prime })}=def{\\sum }\\upsilon \\in {V{\\prime }}f(\\upsilon )+{\\sum }e\\in {E{\\prime }}f(e)=m(f) where m(f) is a constant magic sum. Additionaly, G admits H-supermagic if f(V)=1,2,\\ldots,|V|. The edge corona {C}n \\diamond {P}n of Cn and Pn is defined as the graph obtained by taking one copy of Cn and n copies of Pn , and then joining two end-vertices of the i-th edge of Cn to every vertex in the i-th copy of Pn . This research aim is to find H-supermagic covering on an edge corona product of cycle and path graph {C}n \\diamond {P}n where H is {P}2 \\diamond {P}n. We use k-balanced multiset to solve our reserarch. Here, we find that an edge corona product of cycle and path graph {C}n \\diamond {P}n is {P}2 \\diamond {P}n supermagic for n > 3.

Magnetic electron focusing and tuning of the electron current with a pn-junction

Energy Technology Data Exchange (ETDEWEB)

Milovanović, S. P., E-mail: slavisa.milovanovic@uantwerpen.be; Ramezani Masir, M., E-mail: mrmphys@gmail.com; Peeters, F. M., E-mail: francois.peeters@uantwerpen.be [Departement Fysica, Universiteit Antwerpen, Groenenborgerlaan 171, B-2020 Antwerpen (Belgium)

2014-01-28

Transverse magnetic focusing properties of graphene using a ballistic four terminal structure are investigated. The electric response is obtained using the semiclassical billiard model. The transmission exhibits pronounced peaks as a consequence of skipping orbits at the edge of the structure. When we add a pn-junction between the two probes, snake states along the pn-interface appear. Injected electrons are guided by the pn-interface to one of the leads depending on the value of the applied magnetic field. Oscillations in the resistance are found depending on the amount of particles that end up in each lead.

Lack of effect of bilateral nephrectomy on the pharmacokinetics of 14C-indapamide (REV 2555) and its metabolites in the dog

International Nuclear Information System (INIS)

Klunk, L.J.; Mangat, S.; Treitman, J.A.; Grebow, P.E.

1983-01-01

Renal impairment can affect the disposition of metabolites, as well as unchanged drug, especially when there is significant renal clearance of metabolites. The pharmacokinetics of indapamide, a highly metabolized drug, and total indapamide equivalents (as an indicator of metabolites plus unchanged drug) were determined in the anephric dog. An intravenous dose of 14 C-indapamide was administered to dogs first after a sham-operation, and then following bilateral nephrectomy. The disposition of total indapamide equivalents, calculated from total radioactivity, was not substantially different after nephrectomy as compared to after sham-operation, with an increase after nephrectomy in the area under the blood level curve (+26.2%), and decreases in the elimination rate constant (-6.9%), volume of distribution (-12.7%) and total blood clearance (-21.9%). The only statistically significant change was the decrease in the volume of distribution. The elimination kinetics of unchanged drug were also qualitatively similar in both cases. After nephrectomy, a decrease was seen in the elimination rate constant (-10.9%) and the volume of distribution (-16.3%) while slight increases in the total blood clearance (+1.9%) and the area under the blood level curve (+4.8%) were noted. These findings could have important implications for advantageous use of indapamide in treatment of hypertensive patients with renal failure since these data suggest that metabolites as well as unchanged drug could still be effectively eliminated by an alternate, non-renal route, thus minimizing accumulation of these compounds

Polarization transfer in (p,n) reactions at 495 MeV

International Nuclear Information System (INIS)

Taddeucci, T.N.

1991-01-01

Polarization transfer observables have been measured with the NTOF facility at LAMPF for (p,n) reactions at 495 MeV. Measurements of the longitudinal polarization transfer parameter D LL for transitions to discrete states at 0 degrees show convincing evidence for tensor interaction effects. Complete sets of polarization transfer observables have been measured for quasifree (p,n) reactions on 2 H, 12 C, 40 Ca at a scattering angle of 18 degrees. These measurements show no evidence for an enhancement in the isovector spin longitudinal response. 19 refs., 10 figs

Anaesthesia for laparoscopic nephrectomy: Does end-tidal carbon dioxide measurement correlate with arterial carbon dioxide measurement?

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Jayan, Nithin; Jacob, Jaya Susan; Mathew, Mohan

2018-04-01

Not many studies have explored the correlation between arterial carbon dioxide tension (PaCO 2 ) and end-tidal carbon dioxide tension (ETCO 2 ) in surgeries requiring pneumoperitoneum of more than 1 hour duration with the patient in non-supine position. The aim of our study was to evaluate the correlation of ETCO 2 with PaCO 2 in patients undergoing laparoscopic nephrectomy under general anaesthesia. A descriptive study was performed in thirty patients undergoing laparoscopic nephrectomy from September 2014 to August 2015. The haemodynamic parameters, minute ventilation, PaCO 2 and ETCO 2 measured at three predetermined points during the procedure were analysed. Correlation was checked using Pearson's Correlation Coefficient Test. P <0.05 was considered statistically significant. Statistical analysis of the values showed a positive correlation between ETCO 2 and PaCO 2 ( P < 0.05). Following carbon dioxide insufflation, both ETCO 2 and PaCO 2 increased by 5.4 and 6.63 mmHg, respectively, at the end of the 1 st hour. The PaCO 2 -ETCO 2 gradient was found to increase during the 1 st hour following insufflation (4.07 ± 2.05 mmHg); it returned to the pre-insufflation values in another hour (2.93 ± 1.43 mmHg). Continuous ETCO 2 monitoring is a reliable indicator of the trend in arterial CO 2 fluctuations in the American Society of Anesthesiologists Grades 1 and 2 patients undergoing laparoscopic nephrectomy under general anaesthesia.

Ultrasound-guided transversus abdominis plane blocks for patients undergoing laparoscopic hand-assisted nephrectomy: a randomized, placebo-controlled trial

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Aniskevich S

2014-04-01

Full Text Available Stephen Aniskevich,1 C Burcin Taner,2 Dana K Perry,2 Christopher B Robards,3 Steven B Porter,3 Colleen S Thomas,4 Ilana I Logvinov,5 Steven R Clendenen41Department of Anesthesia, Division of Transplant Anesthesia, 2Department of Transplantation, 3Department of Anesthesia, Division of Regional Anesthesia, 4Division of Health Sciences Research, Section of Biostatistics, 5Department of Anesthesia, Mayo Clinic Florida, Jacksonville, FL, USAAbstract: Postoperative pain is a common complaint following living kidney donation or tumor resection using the laparoscopic hand-assisted technique. To evaluate the potential analgesic benefit of transversus abdominis plane blocks, we conducted a randomized, double-blind, placebo-controlled study in 21 patients scheduled to undergo elective living-donor nephrectomy or single-sided nephrectomy for tumor. Patients were randomized to receive either 20 mL of 0.5% ropivacaine or 20 mL of 0.9% saline bilaterally to the transversus abdominis plane under ultrasound guidance. We found that transversus abdominis plane blocks reduced overall pain scores at 24 hours, with a trend toward decreased total morphine consumption. Nausea, vomiting, sedation, and time to discharge were not significantly different between the two study groups.Keywords: transversus abdominis plane block, nephrectomy, kidney donor, ultrasound guidance

Systematics in p-n interaction vs deformation

International Nuclear Information System (INIS)

Singh, M.; Singh, Yuvraj; Kumar, Rajesh; Vrshney, A.K.; Gupta, K.K.

2017-01-01

The correlation of integrated valance p-n interaction in the onset of collectivity and deformation has been described phenomenologically in terms of N p N n scheme. L. Esser et al. presented the graphs between N p N n and deformation β and γ for some heavy nuclei

Laparoscopic donor nephrectomy increases the supply of living donor kidneys: a center-specific microeconomic analysis.

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Kuo, P C; Johnson, L B

2000-05-27

A tenet of microeconomics is that new technology will shift the supply curve to the right. Laparoscopic donor nephrectomy (LDN) is a new technique for removal of living donor kidneys. Centers performing this procedure have noted an increased number of patients presenting for donor evaluation. This has not been previously studied. The records of all LDN performed from May 1998 to February 1999 were reviewed. The following variables were examined: sex, age, related vs. unrelated donation, estimated blood loss, i.v. analgesia, length of stay, and time out of work. Donors undergoing traditional open donor nephrectomy during January 1997 to May 1998 served as the control group. A composite cost index was constructed. LDN significantly decreased length of stay, pain, and time out of work; the supply function shifted to the right. Telephone interviews revealed that 47% donated solely because of the LDN procedure. LDN increases the supply of living donor kidneys.

Renal structure and function evaluation of rats from dams that received increased sodium intake during pregnancy and lactation submitted or not to 5/6 nephrectomy.

Science.gov (United States)

Marin, Evelyn Cristina Santana; Balbi, Ana Paula Coelho; Francescato, Heloísa Della Coletta; Alves da Silva, Cleonice Giovanini; Costa, Roberto Silva; Coimbra, Terezila M

2008-01-01

Adult rats submitted to perinatal salt overload presented renin-angiotensin system (RAS) functional disturbances. The RAS contributes to the renal development and renal damage in a 5/6 nephrectomy model. The aim of the present study was to analyze the renal structure and function of offspring from dams that received a high-salt intake during pregnancy and lactation. We also evaluated the influence of the prenatal high-salt intake on the evolution of 5/6 nephrectomy in adult rats. A total of 111 sixty-day-old rat pups from dams that received saline or water during pregnancy and lactation were submitted to 5/6 nephrectomy (nephrectomized) or to a sham operation (sham). The animals were killed 120 days after surgery, and the kidneys were removed for immunohistochemical and histological analysis. Systolic blood pressure (SBP), albuminuria, and glomerular filtration rate (GFR) were evaluated. Increased SBP, albuminuria, and decreased GFR were observed in the rats from dams submitted to high-sodium intake before surgery. However, there was no difference in these parameters between the groups after the 5/6 nephrectomy. The scores for tubulointerstitial lesions and glomerulosclerosis were higher in the rats from the sham saline group compared to the same age control rats, but there was no difference in the histological findings between the groups of nephrectomized rats. In conclusion, our data showed that the high-salt intake during pregnancy and lactation in rats leads to structural changes in the kidney of adult offspring. However, the progression of the renal lesions after 5/6 nephrectomy was similar in both groups.

Chylous ascites following radical nephrectomy: a case report

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Shah Shahzad S

2008-01-01

Full Text Available Abstract Introduction Chylous ascites may result from diverse pathologies. Ascites results either due to blockage of the lymphatics or leak secondary to inadvertent trauma during surgery. Case presentation We report the first case of chylous ascites following radical nephrectomy for a renal cell carcinoma involving the right half of a crossed fused renal ectopia. The patient was managed conservatively. Conclusion Post-operative chylous ascites is a rare complication of retroperitoneal and mediastinal surgery. Most cases resolve with conservative treatment which aims at decreasing lymph production and optimizing nutritional requirements along with palliative measures. Refractory cases need either open or laparoscopic ligation of the leaking lymphatic channels. A review of the current literature on the management of post-operative chylous ascites is presented.

Constraining Phosphorus Chemistry in Carbon- and Oxygen-Rich Circumstellar Envelopes: Observations of PN, HCP, and CP

Science.gov (United States)

Milam, S. N.; Halfen, D. T.; Tenenbaum, E. D.; Apponi, A. J.; Woolf, N. J.; Ziurys, L. M.

2008-09-01

Millimeter-wave observations of PN, CP, and HCP have been carried out toward circumstellar envelopes of evolved stars using the Arizona Radio Observatory (ARO). HCP and PN have been identified in the carbon-rich source CRL 2688 via observations at 1 mm using the Submillimeter Telescope (SMT) and 2-3 mm with the Kitt Peak 12 m. An identical set of measurements were carried out toward IRC +10216, as well as observations of CP at 1 mm. PN was also observed toward VY Canis Majoris (VY CMa), an oxygen-rich supergiant star. The PN and HCP line profiles in CRL 2688 and IRC +10216 are roughly flat topped, indicating unresolved, optically thin emission; CP, in contrast, has a distinct "U" shape in IRC +10216. Modeling of the line profiles suggests abundances, relative to H2, of f(PN) ~ (3-5) × 10-9 and f(HCP) ~ 2 × 10-7 in CRL 2688, about an order of magnitude higher than in IRC +10216. In VY CMa, f(PN) is ~4 × 10-8. The data in CRL 2688 and IRC +10216 are consistent with LTE formation of HCP and PN in the inner envelope, as predicted by theoretical calculations, with CP a photodissociation product at larger radii. The observed abundance of PN in VY CMa is a factor of 100 higher than LTE predictions. In IRC +10216, the chemistry of HCP/CP mimics that of HCN/CN and suggests an N2 abundance of f ~ 1 × 10-7. The chemistry of phosphorus appears active in both carbon- and oxygen-rich envelopes of evolved stars.

The Oklahoma PN/ADN Articulation Project Report.

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Oklahoma State Regents for Higher Education, Oklahoma City.

In response to a critical nursing shortage in the state of Oklahoma, the Oklahoma Practical Nursing (PN)/Associate Degree Nursing (ADN) Articulation Project Coordinating Committee was formed in spring 1990 to develop a proposal for program articulation. A curriculum matrix was designed and adopted for use by five regional subcommittees which…

Hand-assisted robotic right donor nephrectomy in patient with total sinus inversus: A case report

Science.gov (United States)

Gonzalez-Heredia, Raquel; Garcia-Roca, Raquel; Benedetti, Enrico

2016-01-01

Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor neprectomies. We report here the first right donor nephrectomy in a patient with total sinus inversus that is performed using the Da Vinci platform. PMID:27085108

New Pn and Sn tomographic images of the uppermost mantle beneath the Mediterranean region

Science.gov (United States)

Gil, A.; Díaz, J.; Gallart, J.

2012-04-01

We present here new images of the seismic velocity and anisotropy variations in the uppermost mantle beneath the Mediterranean region, compiled from inversion of Pn and Sn phases. The method of Hearn (1996) has been applied to Pn and Sn lectures from the catalogs of the International Seismological Center and the Spanish Instituto Geografico Nacional. A total of 1,172,293 Pn arrivals coming from 16,527 earthquakes recorded at 1,657 stations with epicentral distances between 220 km and 1400 km have been retained (331,567 arrivals from 15,487events at 961 stations for Sn). Our results, grossly consistent with available 3D tomography images, show significant features well correlated with surface geology. The Pn velocities are high (>8.2 km/s) beneath major sedimentary basins (western Alboran Sea, Valencia Trough, Adriatic Sea, Aquitaine, Guadalquivir, Rharb, Aquitaine and Po basins), and low (Islands, probably related to a thermal anomaly associated to the westward displacement of the Alboran block along the Emile Baudot escarpment 16 Ma ago. The Pn anisotropic image shows consistent orientations sub-parallel to major orogenic structures, such as Betics, Apennines, Calabrian Arc and Alps. The station delays beneath Betic and Rif ranges are strongly negative, suggesting the presence of crustal thickening all along the Gibraltar Arc. However, only the Betics have a very strong low-velocity anomaly and a pronounced anisotropy pattern. The Sn tomographic image correlates well with the Pn image, even if some relevant differences can be observed beneath particular regions.

Valley detection using a graphene gradual pn junction with spin–orbit coupling: An analytical conductance calculation

Energy Technology Data Exchange (ETDEWEB)

Yang, Mou, E-mail: yang.mou@hotmail.com [Guangdong Provincial Key Laboratory of Quantum Engineering and Quantum Materials, School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006 (China); Wang, Rui-Qiang [Guangdong Provincial Key Laboratory of Quantum Engineering and Quantum Materials, School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006 (China); Bai, Yan-Kui [College of Physical Science and Information Engineering and Hebei Advance Thin Films Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024 (China)

2015-09-04

Graphene pn junction is the brick to build up variety of graphene nano-structures. The analytical formula of the conductance of graphene gradual pn junctions in the whole bipolar region has been absent up to now. In this paper, we analytically calculated that pn conductance with the spin–orbit coupling and stagger potential taken into account. Our analytical expression indicates that the energy gap causes the conductance to drop a constant value with respect to that without gap in a certain parameter region, and manifests that the curve of the conductance versus the stagger potential consists of two Gaussian peaks – one valley contributes one peak. The latter feature allows one to detect the valley polarization without using double-interface resonant devices. - Highlights: • Analytical conductance formula of the gradual graphene pn junction with spin–orbit coupling in the whole bipolar region. • Exploring the valley-dependent transport of gradual graphene pn junctions analytically. • Conductance peak without resonance.

19th Scientific Readings Devoted to P.N. Chirvinskiy

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I. Ya. Ilaltdinov

2017-03-01

Full Text Available Scientific conference devoted to P.N. Chirvinskiy was held in the Perm State University (January 2017. The problems of mineralogy, petrology, lithology, metallogeny and geochemistry were discussed.

Transport properties of monolayer and bilayer graphene p-n junctions with charge puddles in the quantum Hall regime

International Nuclear Information System (INIS)

Cheng Shuguang

2010-01-01

Recent experiments have confirmed that the electron-hole inhomogeneity in graphene is a new type of charge disorder. Motivated by such confirmation, we theoretically study the transport properties of a monolayer graphene (MLG) based p-n junction and a bilayer graphene (BLG) p-n junction in the quantum Hall regime where electron-hole puddles are considered. By using the non-equilibrium Green function method, both the current and conductance are obtained. We find that, in the presence of the electron-hole inhomogeneity, the lowest quantized conductance plateau at e 2 /h emerges in the MLG p-n junction under very small charge puddle disorder strength. For a BLG p-n junction, however, the conductance in the p-n region is enhanced with charge puddles, and the lowest quantized conductance plateau emerges at 2e 2 /h. Besides, when an ideal quantized conductance plateau is formed for a MLG p-n junction, the universal conductance fluctuation is found to be 2e 2 /3h. Furthermore, we also investigate the influence of Anderson disorder on such p-n junctions and the comparison and discussion are given accordingly. To compare the two models with different types of disorder, we investigate the conductance distribution specially. Finally the influence of disorder strength on the conductance of a MLG p-n junction is investigated.

Hydrogen bonding interactions in PN...HX complexes: DFT and ab initio studies of structure, properties and topology.

Science.gov (United States)

Varadwaj, Pradeep Risikrishna

2010-05-01

Spin-restricted DFT (X3LYP and B3LYP) and ab initio (MP2(fc) and CCSD(fc)) calculations in conjunction with the Aug-CC-pVDZ and Aug-CC-pVTZ basis sets were performed on a series of hydrogen bonded complexes PN...HX (X = F, Cl, Br) to examine the variations of their equilibrium gas phase structures, energetic stabilities, electronic properties, and vibrational characteristics in their electronic ground states. In all cases the complexes were predicted to be stable with respect to the constituent monomers. The interaction energy (Delta E) calculated using a super-molecular model is found to be in this order: PN...HF > PN...HCl > PN...HBr in the series examined. Analysis of various physically meaningful contributions arising from the Kitaura-Morokuma (KM) and reduced variational space self-consistent-field (RVS-SCF) energy decomposition procedures shows that the electrostatic energy has significant contribution to the over-all interaction energy. Dipole moment enhancement (Delta mu) was observed in these complexes expected of predominant dipole-dipole electrostatic interaction and was found to follow the trend PN...HF > PN...HCl > PN...HBr at the CCSD level. However, the DFT (X3LYP and B3LYP) and MP2 levels less accurately determined these values (in this order HF 0, nabla(2)rho(c) > 0 and H(c) > 0 at the BCP) whilst the bonds in PN (rho(c) > 0, nabla(2)rho(c) > 0 and H(c) 0, nabla(2)rho(c) BD*(HX) delocalization.

Laparoscopic radical nephrectomy: incorporating advantages of hand assisted and standard laparoscopy.

Science.gov (United States)

Ponsky, Lee E; Cherullo, Edward E; Banks, Kevin L W; Greenstein, Marc; Streem, Stevan B; Klein, Eric A; Zippe, Craig D

2003-06-01

We present an approach to laparoscopic radical nephrectomy and intact specimen extraction, which incorporates hand assisted and standard laparoscopic techniques. A refined approach to laparoscopic radical nephrectomy is described and our experience is reviewed. A low, muscle splitting Gibson incision is made just lateral to the rectus muscle and the hand port is inserted. A trocar is placed through the hand port and pneumoperitoneum is established. With the laparoscope in the hand port trocar 2 additional trocars are placed under direct vision. The laparoscope is then repositioned through the middle trocar and standard laparoscopic instruments are used through the other 2 trocars including the one in the hand port. If at any time during the procedure the surgeon believes the hand would be useful or needed, the trocar is removed from the hand port and the hand is inserted. This approach has been applied to 7 patients. Mean estimated blood loss was 200 cc (range 50 to 300) and mean operative time was 276.7 minutes (range 247 to 360). Mean specimen weight was 767 gm. (range 538 to 1,170). Pathologically 6 specimens were renal cell carcinoma (grades 2 to 4) and 1 was oncocytoma. Mean length of hospital stay was 3.71 days (range 2 to 7). There were no major complications. We believe that this approach enables the surgeon to incorporate the advantages of the hand assisted and standard laparoscopic approaches.

Control of the large renal vein in limited dissected space during laparoscopic nephrectomy: a simple and reliable method

NARCIS (Netherlands)

Kijvikai, Kittinut; Laguna, M. Pilar; de la Rosette, Jean

2006-01-01

We describe our technique for large renal vein control in the limited dissected space during laparoscopic nephrectomy. This technique is a simple, inexpensive and reliable method, especially for large and short renal vein ligation

The empirical connection between (p,n) cross sections and beta decay transition strengths

International Nuclear Information System (INIS)

Taddeucci, T.N.

1988-01-01

A proportionality is assumed to exist between 0/degree/ (p,n) cross sections and the corresponding beta decay transition strengths. The validity of this assumption is tested by comparison of measured (p,n) cross sections and analogous beta decay strengths. Distorted waves impulse approximation calculations also provide useful estimates of the accuracy of the proportionality relationship. 14 refs., 10 figs

The natural history of renal function after surgical management of renal cell carcinoma: Results from the Canadian Kidney Cancer Information System.

Science.gov (United States)

Mason, Ross; Kapoor, Anil; Liu, Zhihui; Saarela, Olli; Tanguay, Simon; Jewett, Michael; Finelli, Antonio; Lacombe, Louis; Kawakami, Jun; Moore, Ronald; Morash, Christopher; Black, Peter; Rendon, Ricardo A

2016-11-01

Patients who undergo surgical management of renal cell carcinoma (RCC) are at risk for chronic kidney disease and its sequelae. This study describes the natural history of renal function after radical and partial nephrectomy and explores factors associated with postoperative decline in renal function. This is a multi-institutional cohort study of patients in the Canadian Kidney Cancer Information System who underwent partial or radical nephrectomy for RCC. Estimated glomerular filtration rate (eGFR) and stage of chronic kidney disease were determined preoperatively and at 3, 12, and 24 months postoperatively. Linear regression was used to determine the association between postoperative eGFR and type of surgery (radical vs. partial), duration of ischemia, ischemia type (warm vs. cold), and tumor size. With a median follow-up of 26 months, 1,379 patients were identified from the Canadian Kidney Cancer Information System database including 665 and 714 who underwent partial and radical nephrectomy, respectively. Patients undergoing radical nephrectomy had a lower eGFR (mean = 19ml/min/1.73m 2 lower) at 3, 12, and 24 months postoperatively (Prenal function occurred early and remained stable throughout follow-up. A lower preoperative eGFR and increasing age were also associated with a lower postoperative eGFR (P0.05). Severe renal failure (eGFRrenal function remains stable in patients undergoing surgery for RCC. Patients undergoing radical nephrectomy have a greater long-term reduction in renal function compared with those undergoing partial nephrectomy. Ischemia duration and type are not predictive of postoperative renal function when adhering to generally short ischemia durations. Copyright © 2016 Elsevier Inc. All rights reserved.

Manufacturing P-N junctions in germanium bodies

International Nuclear Information System (INIS)

Hall, R.N.

1980-01-01

A method of producing p-n junctions in Ge so as to facilitate their use as radiation detectors involves forming a body of high purity p-type germanium, diffusing lithium deep into the body, in the absence of electrolytic processes, to form a junction between n-type and p-type germanium greater than 1 mm depth. (UK)

The ZnO p-n homojunctions modulated by ZnMgO barriers

International Nuclear Information System (INIS)

Yang, Jing-Jing; Fang, Qing-Qing; Wang, Dan-Dan; Du, Wen-Han

2015-01-01

In this paper, we fabricated the ultrathin ZnO p-n homojunctions, which modulated by ZnMgO asymmetrical double barriers (ADB). The ADB p-n homojunctions displays step-like curve in the absorption spectrums, this is the first time that quantum confinement effect has been observed in the absorption spectrums at room temperature (RT). The Hall-effect data confirm there is 2-dimensional electron gas in the interface of the ZnMgO ADB p-n junctions. The quantum confinement effect enhances the hall-mobility μ to 10 3 cm 2 V −1 s −1 based on the polarity of the films. There was no rectification property in the ZnO homojunctions with thickness of 250nm, however, when the ADB was added in the n-type layer of the homojunctions, it displays a typical Zener diode rectification property in the I-V curve

Success of mainstream partial nitritation/anammox demands integration of engineering, microbiome and modeling insights.

Science.gov (United States)

Agrawal, Shelesh; Seuntjens, Dries; Cocker, Pieter De; Lackner, Susanne; Vlaeminck, Siegfried E

2018-04-01

Twenty years ago, mainstream partial nitritation/anammox (PN/A) was conceptually proposed as pivotal for a more sustainable treatment of municipal wastewater. Its economic potential spurred research, yet practice awaits a comprehensive recipe for microbial resource management. Implementing mainstream PN/A requires transferable and operable ways to steer microbial competition as to meet discharge requirements on a year-round basis at satisfactory conversion rates. In essence, the competition for nitrogen, organic carbon and oxygen is grouped into 'ON/OFF' (suppression/promotion) and 'IN/OUT' (wash-out/retention and seeding) strategies, selecting for desirable conversions and microbes. Some insights need mechanistic understanding, while empirical observations suffice elsewhere. The provided methodological R&D framework integrates insights in engineering, microbiome and modeling. Such synergism should catalyze the implementation of energy-positive sewage treatment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Imaging the p-n junction in a gallium nitride nanowire with a scanning microwave microscope

Energy Technology Data Exchange (ETDEWEB)

Imtiaz, Atif [Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, Colorado 80305 (United States); Department of Electrical, Computer, and Energy Engineering, University of Colorado, Boulder, Colorado 80309 (United States); Wallis, Thomas M.; Brubaker, Matt D.; Blanchard, Paul T.; Bertness, Kris A.; Sanford, Norman A.; Kabos, Pavel, E-mail: kabos@boulder.nist.gov [Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, Colorado 80305 (United States); Weber, Joel C. [Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, Colorado 80305 (United States); Department of Mechanical Engineering, University of Colorado, Boulder, Colorado 80309 (United States); Coakley, Kevin J. [Information Technology Laboratory, National Institute of Standards and Technology, Boulder, Colorado 80305 (United States)

2014-06-30

We used a broadband, atomic-force-microscope-based, scanning microwave microscope (SMM) to probe the axial dependence of the charge depletion in a p-n junction within a gallium nitride nanowire (NW). SMM enables the visualization of the p-n junction location without the need to make patterned electrical contacts to the NW. Spatially resolved measurements of S{sub 11}{sup ′}, which is the derivative of the RF reflection coefficient S{sub 11} with respect to voltage, varied strongly when probing axially along the NW and across the p-n junction. The axial variation in S{sub 11}{sup ′}  effectively mapped the asymmetric depletion arising from the doping concentrations on either side of the junction. Furthermore, variation of the probe tip voltage altered the apparent extent of features associated with the p-n junction in S{sub 11}{sup ′} images.

Study on synthesis, kit formulation and chemical kinetics of dissociation of 99mTc labeled PnAO biotin complex

International Nuclear Information System (INIS)

Afshan, A.; Jafri, S.R.A.; Maecke, H.

2004-01-01

Full text: A bifunctional ligand of PnAO-biotin has recently been synthesized, with a better percentage yield of 63% in the presence of newly developed coupling agent 0-(7-azabenzotriazol-1-yl)-1,1,3,3-tetramethyluronium hexaflorophos phate (HATU). Then lyophilized kit with 150μg of PnAObiotin has been developed and labeled with high specific activity of technetium-99m (2500-3000MBq) to get maximum radiochemical purity of 99mTc-PnAO-biotin complex i.e. > 97%. The association of avidin and streptavidin is among the strongest known non-covalent protein ligand interaction Ka 1015 M-1 and 1013 M-1 respectively. We measured the dissociation rate constant of PnAO-biotin from avidin and streptavidin challenged with excess of cold biotin. For the separation of bound and free-labeled biotin we employed ultrafilteration technique. The results of these experiments demonstrated that the non-covalent binding between 99mTc-PnAO-biotin with avidin and 99mTc-PnAO-biotin with streptavidin is more than 99%. Both biotin-binding proteins exhibited a faster initial phase and the rate of dissociation of 99mTc-PnAO-biotin with avidin is found to be 8.2x10-8 at 250C and 2.6x10-7 at 370C while the rate of dissociation 99mTc-PnAO-biotin from streptavidin is found to be 6x10-7 at 250C and 1.06x10-6 at 370C. The in-vitro study of the kinetics of dissociation exhibits the strong interaction of 99mTc-PnAO-biotin complex with both proteins, which suggests that this bifunctional PnAO-biotin ligand can be used for tumor localization with monoclonal antibodies to achieve high tumor to non-tumor ratio. (author)

Fokker-Planck-Rosenbluth-type equations for self-gravitating systems in the 1PN approximation

International Nuclear Information System (INIS)

Ramos-Caro, Javier; Gonzalez, Guillermo A

2008-01-01

We present two formulations of Fokker-Planck-Rosenbluth-type (FPR) equations for many-particle self-gravitating systems, with first-order relativistic corrections in the post-Newtonian approach (1PN). The first starts from a covariant Fokker-Planck equation for a simple gas, introduced recently by Chacon-Acosta and Kremer (2007 Phys. Rev. E 76 021201). The second derivation is based on the establishment of an 1PN-BBGKY hierarchy, developed systematically from the 1PN microscopic law of force and using the Klimontovich-Dupree (KD) method. We close the hierarchy by the introduction of a two-point correlation function that describes adequately the relaxation process. This picture reveals an aspect that is not considered in the first formulation: the contribution of ternary correlation patterns to the diffusion coefficients, as a consequence of the nature of 1PN interaction. Both formulations can be considered as a generalization of the equation derived by Rezania and Sobouti (2000 Astron. Astrophys. 354 1110), to stellar systems where the relativistic effects of gravitation play a significant role

The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy.

Science.gov (United States)

Mitsui, Yosuke; Sadahira, Takuya; Araki, Motoo; Wada, Koichiro; Tanimoto, Ryuta; Ariyoshi, Yuichi; Kobayashi, Yasuyuki; Watanabe, Masami; Watanabe, Toyohiko; Nasu, Yasutomo

2018-04-01

Contrast-enhanced CT is necessary before donor nephrectomy and is usually combined with a Tc-99m-mercapto-acetyltriglycine (MAG3) scan to check split renal function (SRF). However, all transplant programs do not use MAG3 because of its high cost and exposure to radiation. We examined whether CT volumetry of the kidney can be a new tool for evaluating SRF. Sixty-three patients underwent live donor nephrectomy. Patients without a 1.0 mm slice CT or follow-up for volumetry was analyzed at 1, 3, and 12 months post nephrectomy. Strong correlations were observed preoperatively in a Bland-Altman plot between SRF measured by MAG3 and either CT cortex or parenchymal volumetry. In addition, eGFR after donation correlated with SRF measured by MAG3 or CT volumetry. The correlation coefficients (R) for eGFR Mag3 split were 0.755, 0.615, and 0.763 at 1, 3 and 12 months, respectively. The corresponding R values for cortex volume split were 0.679, 0.638, and 0.747. Those for parenchymal volume split were 0.806, 0.592, and 0.764. Measuring kidney by CT volumetry is a cost-effective alternative to MAG3 for evaluating SRF and predicting postoperative donor renal function. Both cortex and parenchymal volumetry were similarly effective.

Icariin protects rats against 5/6 nephrectomy-induced chronic kidney failure by increasing the number of renal stem cells.

Science.gov (United States)

Huang, Zhongdi; He, Liqun; Huang, Di; Lei, Shi; Gao, Jiandong

2015-10-21

Chronic kidney disease poses a serious health problem worldwide with increasing prevalence and lack of effective treatment. This study aimed to investigate the mechanism of icariin in alleviating chronic renal failure induced by 5/6 nephrectomy in rats. The chronic renal failure model was established by a two-phased 5/6 nephrectomy procedure. The model rats were given daily doses of water or icariin for 8 weeks. The kidney morphology was checked by HE staining. The levels of blood urea nitrogen, serum creatinine, and serum uric acid were measured by colometric methods. The expression of specified genes was analyzed by quantitative real-time PCR and immunohistochemical staining. The number of renal stem/progenitor cells was analyzed by CD133 and CD24 immunohistochemical staining. Icariin protected against CDK-caused damages to kidney histology and improved renal function, significantly reduced levels of BUN, creatinine, and uric acid. Icariin inhibited the expression level of TGF-β1 whereas upregulated HGF, BMP-7, WT-1, and Pax2 expression. Moreover, ccariin significantly increased the expression of CD24, CD133, Osr1, and Nanog in remnant kidney and the numbers of CD133(+)/CD24(+) renal stem/progenitor cells. These data demonstrated that icariin effectively alleviated 5/6 nephrectomy induced chronic renal failure through increasing renal stem/progenitor cells.

Epitaxial Growth of an Organic p-n Heterojunction: C60 on Single-Crystal Pentacene.

Science.gov (United States)

Nakayama, Yasuo; Mizuno, Yuta; Hosokai, Takuya; Koganezawa, Tomoyuki; Tsuruta, Ryohei; Hinderhofer, Alexander; Gerlach, Alexander; Broch, Katharina; Belova, Valentina; Frank, Heiko; Yamamoto, Masayuki; Niederhausen, Jens; Glowatzki, Hendrik; Rabe, Jürgen P; Koch, Norbert; Ishii, Hisao; Schreiber, Frank; Ueno, Nobuo

2016-06-01

Designing molecular p-n heterojunction structures, i.e., electron donor-acceptor contacts, is one of the central challenges for further development of organic electronic devices. In the present study, a well-defined p-n heterojunction of two representative molecular semiconductors, pentacene and C60, formed on the single-crystal surface of pentacene is precisely investigated in terms of its growth behavior and crystallographic structure. C60 assembles into a (111)-oriented face-centered-cubic crystal structure with a specific epitaxial orientation on the (001) surface of the pentacene single crystal. The present experimental findings provide molecular scale insights into the formation mechanisms of the organic p-n heterojunction through an accurate structural analysis of the single-crystalline molecular contact.

Photocurrent generation in lateral graphene p-n junction created by electron-beam irradiation

KAUST Repository

Yu, Xuechao; Shen, Youde; Liu, Tao; Wu, Tao; Jie Wang, Qi

2015-01-01

Graphene has been considered as an attractive material for optoelectronic applications such as photodetectors owing to its extraordinary properties, e.g. broadband absorption and ultrahigh mobility. However, challenges still remain in fundamental and practical aspects of the conventional graphene photodetectors which normally rely on the photoconductive mode of operation which has the drawback of e.g. high dark current. Here, we demonstrated the photovoltaic mode operation in graphene p-n junctions fabricated by a simple but effective electron irradiation method that induces n-type doping in intrinsic p-type graphene. The physical mechanism of the junction formation is owing to the substrate gating effect caused by electron irradiation. Photoresponse was obtained for this type of photodetector because the photoexcited electron-hole pairs can be separated in the graphene p-n junction by the built-in potential. The fabricated graphene p-n junction photodetectors exhibit a high detectivity up to ~3 × 1010 Jones (cm Hz1/2 W−1) at room temperature, which is on a par with that of the traditional III–V photodetectors. The demonstrated novel and simple scheme for obtaining graphene p-n junctions can be used for other optoelectronic devices such as solar cells and be applied to other two dimensional materials based devices.

Photocurrent generation in lateral graphene p-n junction created by electron-beam irradiation

KAUST Repository

Yu, Xuechao

2015-07-08

Graphene has been considered as an attractive material for optoelectronic applications such as photodetectors owing to its extraordinary properties, e.g. broadband absorption and ultrahigh mobility. However, challenges still remain in fundamental and practical aspects of the conventional graphene photodetectors which normally rely on the photoconductive mode of operation which has the drawback of e.g. high dark current. Here, we demonstrated the photovoltaic mode operation in graphene p-n junctions fabricated by a simple but effective electron irradiation method that induces n-type doping in intrinsic p-type graphene. The physical mechanism of the junction formation is owing to the substrate gating effect caused by electron irradiation. Photoresponse was obtained for this type of photodetector because the photoexcited electron-hole pairs can be separated in the graphene p-n junction by the built-in potential. The fabricated graphene p-n junction photodetectors exhibit a high detectivity up to ~3 × 1010 Jones (cm Hz1/2 W−1) at room temperature, which is on a par with that of the traditional III–V photodetectors. The demonstrated novel and simple scheme for obtaining graphene p-n junctions can be used for other optoelectronic devices such as solar cells and be applied to other two dimensional materials based devices.

Mercaptoacetyltriglycine-3 renogram is not superior to estimated glomerular filtration rate measurement for the prediction of long-term renal function after nephrectomy

International Nuclear Information System (INIS)

Kanamaru, Hiroshi; Yamamoto, Masakazu; Nagahama, Kanji

2011-01-01

The objective of this study was to evaluate the clinical usefulness of effective renal plasma flow (ERPF) measured using preoperative mercaptoacetyltriglycine-3 (MAG3) renogram for the prediction of chronic renal insufficiency after nephrectomy. A total of 47 patients underwent preoperative MAG3 renal scintigraphy and subsequent unilateral nephrectomy. Correlations between the 5-year postoperative estimated glomerular filtration rate (eGFR) and the preoperative ERPF of the contralateral kidney (cERPF), ERPF of the diseased kidney (dERPF), total ERPF (tERPF), cERPF to dERPF ratio, serum creatinine (sCr) level, eGFR, as well as the influence of preoperative comorbidities (diabetes, hypertension) on the postoperative eGFR, were evaluated with both univariate and multivariate analyses. Multiple linear regression analysis showed that preoperative cERPF significantly correlated with postoperative eGFR. However, a much stronger correlation was observed between the preoperative and postoperative eGFR. Multiple logistic regression analysis showed that only preoperative eGFR was a significant predicator of the development of advanced-stage chronic kidney disease (CKD). Preoperative MAG3 renogram is not superior to eGFR measurement as a prognostic indicator of long-term renal function after unilateral nephrectomy. (author)

Trap-mediated electronic transport properties of gate-tunable pentacene/MoS2 p-n heterojunction diodes.

Science.gov (United States)

Kim, Jae-Keun; Cho, Kyungjune; Kim, Tae-Young; Pak, Jinsu; Jang, Jingon; Song, Younggul; Kim, Youngrok; Choi, Barbara Yuri; Chung, Seungjun; Hong, Woong-Ki; Lee, Takhee

2016-11-10

We investigated the trap-mediated electronic transport properties of pentacene/molybdenum disulphide (MoS 2 ) p-n heterojunction devices. We observed that the hybrid p-n heterojunctions were gate-tunable and were strongly affected by trap-assisted tunnelling through the van der Waals gap at the heterojunction interfaces between MoS 2 and pentacene. The pentacene/MoS 2 p-n heterojunction diodes had gate-tunable high ideality factor, which resulted from trap-mediated conduction nature of devices. From the temperature-variable current-voltage measurement, a space-charge-limited conduction and a variable range hopping conduction at a low temperature were suggested as the gate-tunable charge transport characteristics of these hybrid p-n heterojunctions. Our study provides a better understanding of the trap-mediated electronic transport properties in organic/2-dimensional material hybrid heterojunction devices.

Pn seismic wave travel time at the Semipalatinsk Test Site - Borovoe seismic station trace

International Nuclear Information System (INIS)

An, V.A.; Kaazik, P.B.; Ovchinnikov, V.M.

2001-01-01

This paper preparation involved 160 explosions at the Degelen Site conducted in 1961-1989 and 89 explosions at the Balapan Site conducted in 1968-1989. Pn wave travel time was tied to the sea level in accordance with velocity characteristics of the explosion hypocenter medium; and to average epicentral distance for every site basing on their local travel time curves of Pn wave relative to Borovoe station. Maximum amplitude of mean-year travel times variations is 0.3-0.5 s as at the Nevada Test Site - Borovoe trace and Mirniy (Antarctica). However, the linear trend in contrast to previous traces has negative sign (0.08 s for Degelen and 0.1 s for Balapan). Thus, Pn wave velocity increases with calendar time. (author)

Temperature-Dependent Asymmetry of Anisotropic Magnetoresistance in Silicon p-n Junctions.

Science.gov (United States)

Yang, D Z; Wang, T; Sui, W B; Si, M S; Guo, D W; Shi, Z; Wang, F C; Xue, D S

2015-09-01

We report a large but asymmetric magnetoresistance in silicon p-n junctions, which contrasts with the fact of magnetoresistance being symmetric in magnetic metals and semiconductors. With temperature decreasing from 293 K to 100 K, the magnetoresistance sharply increases from 50% to 150% under a magnetic field of 2 T. At the same time, an asymmetric magnetoresistance, which manifests itself as a magnetoresistance voltage offset with respect to the sign of magnetic field, occurs and linearly increases with magnetoresistance. More interestingly, in contrast with other materials, the lineshape of anisotropic magnetoresistance in silicon p-n junctions significantly depends on temperature. As temperature decreases from 293 K to 100 K, the width of peak shrinks from 90° to 70°. We ascribe these novel magnetoresistance to the asymmetric geometry of the space charge region in p-n junction induced by the magnetic field. In the vicinity of the space charge region the current paths are deflected, contributing the Hall field to the asymmetric magnetoresistance. Therefore, the observed temperature-dependent asymmetry of magnetoresistance is proved to be a direct consequence of the spatial configuration evolution of space charge region with temperature.

TORPEDO: Prospective, double blind, randomized clinical trial comparing the use of Ketorolac verse placebo during live donor nephrectomy for kidney transplant

Directory of Open Access Journals (Sweden)

Jeffrey Campsen

2017-06-01

Full Text Available The aim of this pilot study was to determine if the use of Ketorolac for donor nephrectomies could decrease the use of narcotics. Methods: This is a prospective, double blind, randomized trial involving patients undergoing nephrectomy for live donor kidney transplantation. Three arms: 1. Ketorolac 30 mg IV×1 in the OR, then ketorolac 15 mg IV every 6 h for 7 doses. 2. Ketorolac 30 mg IV×1 in the OR, then placebo IV every 6 h for 7 doses. 3. Placebo IV×1 in the OR, then placebo IV every 6 h for 7 doses. Outcomes: blood loss, mortality, renal function, cumulative narcotic use, length of hospital stay (LOS, and urinary retention. Results: There were no patient deaths, blood transfusions or renal dysfunction in any study arm. Arm 1 had less narcotic use, reduced length of stay, and reduced urinary retention than Arm 3. Conclusion: There was reduced LOS, less narcotic use and less urinary retention in the Ketorolac group (Arm 1 versus the placebo group (Arm 3. Based on these results we will proceed with a larger study to compare the use of non-opioid analgesics in donor nephrectomies.

High-resolution measurement of the {sup 16}O({gamma},pn) reaction

Energy Technology Data Exchange (ETDEWEB)

Isaksson, L.

1996-10-01

The {sup 16}O({gamma},pn) reaction has been measured with a resolution high enough to resolve individual low-lying states in the residual {sup 14}N nucleus. Partial cross-sections, available to the acceptance of the detector system, have been extracted for the individual states, and compared to a recent calculation based on absorption on one-pion exchange currents and the {Delta} resonance current. The experiment was performed at the Maxlab accelerator laboratory in Lund, Sweden, using tagged photons at an energy of 67 - 76 MeV. The proton detector angular range was 60 - 100 deg and the corresponding for the neutron detector 81 - 103 deg. A missing energy resolution of 1.5 MeV was obtained. The relative population of the states in the residual {sup 14}N nucleus indicates that the reaction takes place predominantly on proton-neutron pairs coupled to (J{sup {pi}},T) = (1{sup +},0). The cross-section for absorption on (0{sup +},1) pairs is strongly suppressed. Furthermore, the relative population of the states indicates that both L=0 and L=2 pairs participate in the reaction. 45 refs.

Theoretical study on pp → pnπ+ reaction at medium energies

International Nuclear Information System (INIS)

Ouyang, Zhen; Xie, Jujun; Zou, Bingsong; Xu, Hushan

2009-01-01

The pp → pnπ + reaction is a channel with the largest total cross section for pp collision in COSY/CSR energy region. In this work, we investigate individual contributions from various N* and Δ* resonances with mass up to about 2 GeV for the pp → pnπ + reaction. We extend a resonance model, which can reproduce the observed total cross section quite well, to give theoretical predictions of various differential cross sections for the present reaction at T p = 2.88 GeV. It could serve as a reference for identifying new physics in the future experiments at HIRFL-CSR. (author)

Axial p-n junction and space charge limited current in single GaN nanowire

Science.gov (United States)

Fang, Zhihua; Donatini, Fabrice; Daudin, Bruno; Pernot, Julien

2018-01-01

The electrical characterizations of individual basic GaN nanostructures, such as axial nanowire (NW) p-n junctions, are becoming indispensable and crucial for the fully controlled realization of GaN NW based devices. In this study, electron beam induced current (EBIC) measurements were performed on two single axial GaN p-n junction NWs grown by plasma-assisted molecular beam epitaxy. I-V characteristics revealed that both ohmic and space charge limited current (SCLC) regimes occur in GaN p-n junction NW. Thanks to an improved contact process, both the electric field induced by the p-n junction and the SCLC in the p-part of GaN NW were disclosed and delineated by EBIC signals under different biases. Analyzing the EBIC profiles in the vicinity of the p-n junction under 0 V and reverse bias, we deduced a depletion width in the range of 116-125 nm. Following our previous work, the acceptor N a doping level was estimated to be 2-3 × 1017 at cm-3 assuming a donor level N d of 2-3 × 1018 at cm-3. The hole diffusion length in n-GaN was determined to be 75 nm for NW #1 and 43 nm for NW #2, demonstrating a low surface recombination velocity at the m-plane facet of n-GaN NW. Under forward bias, EBIC imaging visualized the electric field induced by the SCLC close to p-side contact, in agreement with unusual SCLC previously reported in GaN NWs.

Axial p-n junction and space charge limited current in single GaN nanowire.

Science.gov (United States)

Fang, Zhihua; Donatini, Fabrice; Daudin, Bruno; Pernot, Julien

2018-01-05

The electrical characterizations of individual basic GaN nanostructures, such as axial nanowire (NW) p-n junctions, are becoming indispensable and crucial for the fully controlled realization of GaN NW based devices. In this study, electron beam induced current (EBIC) measurements were performed on two single axial GaN p-n junction NWs grown by plasma-assisted molecular beam epitaxy. I-V characteristics revealed that both ohmic and space charge limited current (SCLC) regimes occur in GaN p-n junction NW. Thanks to an improved contact process, both the electric field induced by the p-n junction and the SCLC in the p-part of GaN NW were disclosed and delineated by EBIC signals under different biases. Analyzing the EBIC profiles in the vicinity of the p-n junction under 0 V and reverse bias, we deduced a depletion width in the range of 116-125 nm. Following our previous work, the acceptor N a doping level was estimated to be 2-3 × 10 17 at cm -3 assuming a donor level N d of 2-3 × 10 18 at cm -3 . The hole diffusion length in n-GaN was determined to be 75 nm for NW #1 and 43 nm for NW #2, demonstrating a low surface recombination velocity at the m-plane facet of n-GaN NW. Under forward bias, EBIC imaging visualized the electric field induced by the SCLC close to p-side contact, in agreement with unusual SCLC previously reported in GaN NWs.

Photoeffect on the p-n silicon junction under conditions of interband heating of carriers by light

Energy Technology Data Exchange (ETDEWEB)

Andrianov, A V; Valov, P M; Sukhanov, V L; Tuchkevich, V V; Shmidt, N M [AN SSSR, Leningrad. Fiziko-Tekhnicheskij Inst.

1980-05-01

Photoeffect on the p-n silicon junction conditioned by interband heating of carriers by the CO/sub 2/-laser light has been studied experimentally at room temperature and under nonstationary conditions. Photoelectromotive force (p.e.m.f.) with the sign opposite to the value p.e.m.f. appears in the case of direct displacement of p-n structures. The p.e.m.f. value increases with the increase of direct desplacement. Photoelectrons are shown to make the main contribution into the mechanism of p.e.m.f. formation. Lateral p.e.m.f. connected with spreading currents in the direction parallel to the surface of the p-n junction appears in the p-n structure base. It has been found out that structures with highly alloyed emitter at reverse displacement operates under standard photodiod conditions, that is due to the semiconductor lattice heating by CO/sub 2/-laser irradiation.

Photoeffect on the p-n silicon junction under conditions of interband heating of carriers by light

International Nuclear Information System (INIS)

Andrianov, A.V.; Valov, P.M.; Sukhanov, V.L.; Tuchkevich, V.V.; Shmidt, N.M.

1980-01-01

Photoeffect on the p-n silicon junction conditioned by interband heating of carriers by the CO 2 -laser light has been studied experimentally at room temperature and under nonstationary conditions. Photoelectromotive force (p.e.m.f.) with the sign opposite to the value p.e.m.f. appears in the case of direct displacement of p-n structures. The p.e.m.f. value increases with the increase of direct desplacement. Photoelectrons are shown to make the main contribution into the mechanism of p.e.m.f. formation. Lateral p.e.m.f. connected with spreading currents in the direction parallel to the surface of the p-n junction appears in the p-n structure base. It has been found out that structures with highly alloyed emitter at reverse displacement operates under standard photodiod conditions, that is due to the semiconductor lattice heating by CO 2 -laser irradiation

Nitrogen atom transfer mediated by a new PN3P-pincer nickel core via a putative nitrido nickel intermediate

KAUST Repository

Yao, Changguang

2018-02-13

A 2nd generation PN3P-pincer azido nickel complex (PN3P)Ni(N3) reacts with isocyanides to afford monosubstituted carbodiimides under irradiation, presumably via a transient nitrido intermediate. The resulting species can further generate unsymmetrical carboddimides and the PN3P nickel halide complex, accomplishing a synthetic cycle for a complete nitrogen atom transfer reaction.

Nitrogen atom transfer mediated by a new PN3P-pincer nickel core via a putative nitrido nickel intermediate

KAUST Repository

Yao, Changguang; Wang, Xiufang; Huang, Kuo-Wei

2018-01-01

A 2nd generation PN3P-pincer azido nickel complex (PN3P)Ni(N3) reacts with isocyanides to afford monosubstituted carbodiimides under irradiation, presumably via a transient nitrido intermediate. The resulting species can further generate unsymmetrical carboddimides and the PN3P nickel halide complex, accomplishing a synthetic cycle for a complete nitrogen atom transfer reaction.

Effects of dissolved oxygen and pH on nitrous oxide production rates in autotrophic partial nitrification granules.

Science.gov (United States)

Rathnayake, Rathnayake M L D; Oshiki, Mamoru; Ishii, Satoshi; Segawa, Takahiro; Satoh, Hisashi; Okabe, Satoshi

2015-12-01

The effects of dissolved oxygen (DO) and pH on nitrous oxide (N2O) production rates and pathways in autotrophic partial nitrification (PN) granules were investigated at the granular level. N2O was primarily produced by betaproteobacterial ammonia-oxidizing bacteria, mainly Nitrosomonas europaea, in the oxic surface layer (production increased with increasing bulk DO concentration owing to activation of the ammonia (i.e., hydroxylamine) oxidation in this layer. The highest N2O emissions were observed at pH 7.5, although the ammonia oxidation rate was unchanged between pH 6.5 and 8.5. Overall, the results of this study suggest that in situ analyses of PN granules are essential to gaining insight into N2O emission mechanisms in a granule. Copyright © 2015 Elsevier Ltd. All rights reserved.

Naringenin (NAR) and 8-prenylnaringenin (8-PN) reduce the developmental competence of porcine oocytes in vitro

NARCIS (Netherlands)

Solak, Kamila A.; Santos, Regiane R.; van den Berg, Martin; Blaauboer, Bas J.; Roelen, Bernard A J; van Duursen, Majorie B M

2014-01-01

Flavanones such as naringenin (NAR) and 8-prenylnaringenin (8-PN) are increasingly used as dietary supplements despite scientific concern regarding adverse effects on female reproduction upon excessive intake. In the present study, NAR and 8-PN (0.3-1. μM) significantly affected porcine oocyte

Dynamic SPECT of the brain using a lipophilic technetium-99m complex, PnAO

DEFF Research Database (Denmark)

Holm, S; Andersen, A R; Vorstrup, S

1985-01-01

m PnAO was injected i.v. as a bolus of 15 to 25 mCi. The distribution was followed over 10-sec intervals using a highly sensitive, rapidly rotating SPECT (Tomomatic 64) and compared to 133Xe flow maps. Upon arrival of the PnAO bolus to the brain, a high uptake was found in brain tissue with high......The lipophilic 99mTc-labeled oxime propylene amine oxime (PnAO) should, according to recent reports behave like 133Xe in the human brain. This study compares SPECT images of the two tracers in six subjects: four stroke cases, one transitory ischemic attack case and one normal subject. Technetium-99......AO has a high yet incomplete brain extraction yielding a flow dominated initial distribution with limitations mentioned....

Visualizing the photovoltaic behavior of a type-II p-n heterojunction superstructure

Energy Technology Data Exchange (ETDEWEB)

Xing, Juanjuan, E-mail: xingjuanjuan@mail.sic.ac.cn [State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, 1295 Dingxi Road, Shanghai 200050 (China); Electron Microscopy Group, Surface Physics and Structure Unit, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Takeguchi, Masaki [Electron Microscopy Group, Surface Physics and Structure Unit, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Hashimoto, Ayako [Electron Microscopy Group, Surface Physics and Structure Unit, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Global Research Center for Environment and Energy Based on Nanomaterials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Cao, Junyu; Ye, Jinhua [International Center for Materials Nanoarchitectonics (WPI-MANA), 1-1 Namiki, Tsukuba, Ibaraki 305-0044 (Japan)

2014-04-21

Photovoltaic behavior of a CaFe{sub 2}O{sub 4}/ZnFe{sub 2}O{sub 4} p-n multi-junction was investigated with electron holography combined with an in situ light irradiation system. Potential profiles of the samples with and without light irradiation were extracted to measure the open circuit photovoltage generated either by the whole heterojunction superstructure or from each p-n junction. Investigation on the variation in the energy band configuration under light irradiation revealed the mechanism involved in the photoelectric effect, with respect to the properties of the heterojunction and its periodic quantum structure.

P-N semiconductor junctions used as X-ray detectors

International Nuclear Information System (INIS)

Pela, C.A.; Bruco, J.L.; Navas, E.A.; Paula, E. de; Guilardi Neto, T.

1987-01-01

The current response of some comercial P-N semiconductor junctions in function of X-ray incidency, in 40 to 140 KVp band used in diagnosis was characterized. Some junctions were also exposed to radiation of 80 to 250 KVp used in therapy. (C.G.C.) [pt

Peripheral pn production and decay angular distributions in the reaction pi /sup -/p to (pn)p at 12 GeV/c incident momentum

CERN Document Server

Ghidini, B; Cantore, A; Di Corato, M; Donald, R A; Eades, John; Edwards, D N; Edwards, M E; French, Bernard R; Fry, J R; Houlden, M A; Mandelli, L; Moebes, J P; Müller, K; Navach, F; Palano, A; Palazzi-Cerrina, C; Paul, E; Picciarelli, V; Renneberg, W; Rühmer, W; Smith, I; Zito, G

1978-01-01

The reaction pi /sup -/p to (pn)p/sub s/, where p/sub s/ is a slow proton, was measured at 12 GeV/c incident momentum with the CERN-OMEGA spectrometer. Both antiproton and proton were identified uniquely by electronics information. 1844 events with four-momentum transfer squared in the range 0.13pn) up to 2.5 GeV were obtained. The corresponding cross section in this t range is determined to be sigma =4+or-0.4 mu b. Extrapolating the differential cross section over the whole t range assuming d sigma /dt approximately exp(5.3 t) a cross section of sigma =9.3+or-2.0 mu b is estimated. Comparison is made with data on pi /sup -/p to (pp)n/sub s/ (where n/sub s/ is a slow neutron) in the same t range. (12 refs).

A Psychometric Evaluation of a Swedish Version of the Positive–Negative Sex-Role Inventory (PN-SRI

Directory of Open Access Journals (Sweden)

Therese Rydberg Sterner

2018-02-01

Full Text Available The Positive–Negative Sex-Role Inventory (PN-SRI assesses gender identity. The aim of this study was to evaluate the validity and reliability of a Swedish version of the PN-SRI in a population of 70-year-olds within the Gothenburg H70-study in Sweden. The overarching objective of testing the PN-SRI within the H70-study was to evaluate its usability to further study gender identity in large population-based samples of older adults. A total of 1124 individuals participated in the psychometric testing. A sub-sample of these (n = 406 provided a comprehensive survey regarding societal norms on femininity and masculinity. Reliability and validity tests were performed using Cronbach’s Alpha and factor analyses. The Cronbach’s α coefficients (0.734–0.787 indicated a satisfactory level of internal consistency, and the four-factor model (Model 2 fitted the data at an acceptable level (root-mean-square error of approximation, RMSEA = 0.068, standardized root-mean-square residual, SRMR = 0.07. This cross-cultural adaptation of the PN-SRI indicates that it may be applicable in a Swedish research setting comprising older adults. Future research is needed to further test the psychometric properties of this scale. Adding the PN-SRI to population-based studies will contribute to providing a nuanced way of analyzing differences and similarities among men and women.

Field-effect P-N junction

Science.gov (United States)

Regan, William; Zettl, Alexander

2015-05-05

This disclosure provides systems, methods, and apparatus related to field-effect p-n junctions. In one aspect, a device includes an ohmic contact, a semiconductor layer disposed on the ohmic contact, at least one rectifying contact disposed on the semiconductor layer, a gate including a layer disposed on the at least one rectifying contact and the semiconductor layer and a gate contact disposed on the layer. A lateral width of the rectifying contact is less than a semiconductor depletion width of the semiconductor layer. The gate contact is electrically connected to the ohmic contact to create a self-gating feedback loop that is configured to maintain a gate electric field of the gate.

Efficient transfer hydrogenation reaction Catalyzed by a dearomatized PN 3P ruthenium pincer complex under base-free Conditions

KAUST Repository

He, Lipeng

2012-03-01

A dearomatized complex [RuH(PN 3P)(CO)] (PN 3PN, N′-bis(di-tert-butylphosphino)-2,6-diaminopyridine) (3) was prepared by reaction of the aromatic complex [RuH(Cl)(PN 3P)(CO)] (2) with t-BuOK in THF. Further treatment of 3 with formic acid led to the formation of a rearomatized complex (4). These new complexes were fully characterized and the molecular structure of complex 4 was further confirmed by X-ray crystallography. In complex 4, a distorted square-pyramidal geometry around the ruthenium center was observed, with the CO ligand trans to the pyridinic nitrogen atom and the hydride located in the apical position. The dearomatized complex 3 displays efficient catalytic activity for hydrogen transfer of ketones in isopropanol. © 2011 Elsevier B.V. All rights reserved.

Optimization of Silicon parameters as a betavoltaic battery: Comparison of Si p-n and Ni/Si Schottky barrier

International Nuclear Information System (INIS)

Rahmani, Faezeh; Khosravinia, Hossein

2016-01-01

Theoretical studies on the optimization of Silicon (Si) parameters as the base of betavoltaic battery have been presented using Monte Carlo simulations and the state equations in semiconductor to obtain maximum power. Si with active area of 1 cm 2 has been considered in p-n junction and Schottky barrier structure to collect the radiation induced-charge from 10 mCi cm −2 of Nickle-63 ( 63 Ni) Source. The results show that the betavoltaic conversion efficiency in the Si p-n structure is about 2.7 times higher than that in the Ni/Si Schottky barrier structure. - Highlights: • Silicon parameters were studied in betavoltaic batteries. • Studied betavoltaic batteries include p-n and Schottky barrier structures. • The p-n structure has higher conversion efficiency.

Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial.

Science.gov (United States)

Nitz, Ulrike; Gluz, Oleg; Christgen, Matthias; Kates, Ronald E; Clemens, Michael; Malter, Wolfram; Nuding, Benno; Aktas, Bahriye; Kuemmel, Sherko; Reimer, Toralf; Stefek, Andrea; Lorenz-Salehi, Fatemeh; Krabisch, Petra; Just, Marianne; Augustin, Doris; Liedtke, Cornelia; Chao, Calvin; Shak, Steven; Wuerstlein, Rachel; Kreipe, Hans H; Harbeck, Nadia

2017-10-01

The prospective phase 3 PlanB trial used the Oncotype DX ® Recurrence Score ® (RS) to define a genomically low-risk subset of clinically high-risk pN0-1 early breast cancer (EBC) patients for treatment with adjuvant endocrine therapy (ET) alone. Here, we report five-year data evaluating the prognostic value of RS, Ki-67, and other traditional clinicopathological parameters. A central tumour bank was prospectively established within PlanB. Following an early amendment, hormone receptor (HR)+ , pN0-1 RS ≤ 11 patients were recommended to omit chemotherapy. Patients with RS ≥ 12, pN2-3, or HR-negative/HER2-negative disease were randomised to anthracycline-containing or anthracycline-free chemotherapy. Primary endpoint: disease-free survival (DFS). PlanB Clinicaltrials.gov identifier: NCT01049425. From 2009 to 2011, PlanB enrolled 3198 patients (central tumour bank, n = 3073) with the median age of 56 years, 41.1% pN+, and 32.5% grade 3 EBC. Chemotherapy was omitted in 348/404 (86.1%) eligible RS ≤ 11 patients. After 55 months of median follow-up, five-year DFS in ET-treated RS ≤ 11 patients was 94% (in both pN0 and pN1) versus 94% (RS 12-25) and 84% (RS > 25) in chemotherapy-treated patients (p 2 cm, and RS, but not IHC4 or Ki-67 were independent adverse factors. If RS was excluded, IHC4 or both Ki-67 and PR entered the model. The impact of RS was particularly pronounced in patients with intermediate Ki-67 (>10%, risk, genomically low-risk (RS ≤ 11) pN0-1 patients without adjuvant chemotherapy support using RS with standardised pathology for treatment decisions in HR+ HER2-negative EBC. Ki-67 has the potential to support patient selection for genomic testing.

Follow the light: projector-based augmented reality intracorporeal system for laparoscopic surgery.

Science.gov (United States)

Edgcumbe, Philip; Singla, Rohit; Pratt, Philip; Schneider, Caitlin; Nguan, Christopher; Rohling, Robert

2018-04-01

A projector-based augmented reality intracorporeal system (PARIS) is presented that includes a miniature tracked projector, tracked marker, and laparoscopic ultrasound (LUS) transducer. PARIS was developed to improve the efficacy and safety of laparoscopic partial nephrectomy (LPN). In particular, it has been demonstrated to effectively assist in the identification of tumor boundaries during surgery and to improve the surgeon's understanding of the underlying anatomy. PARIS achieves this by displaying the orthographic projection of the cancerous tumor on the kidney's surface. The performance of PARIS was evaluated in a user study with two surgeons who performed 32 simulated robot-assisted partial nephrectomies. They performed 16 simulated partial nephrectomies with PARIS for guidance and 16 simulated partial nephrectomies with only an LUS transducer for guidance. With PARIS, there was a significant reduction [30% ([Formula: see text])] in the amount of healthy tissue excised and a trend toward a more accurate dissection around the tumor and more negative margins. The combined point tracking and reprojection root-mean-square error of PARIS was 0.8 mm. PARIS' proven ability to improve key metrics of LPN surgery and qualitative feedback from surgeons about PARIS supports the hypothesis that it is an effective surgical navigation tool.

Two-dimensional dopant profiling of gallium nitride p-n junctions by scanning capacitance microscopy

Science.gov (United States)

Lamhamdi, M.; Cayrel, F.; Frayssinet, E.; Bazin, A. E.; Yvon, A.; Collard, E.; Cordier, Y.; Alquier, D.

2016-04-01

Two-dimensional imaging of dopant profiles for n and p-type regions are relevant for the development of new power semiconductors, especially for gallium nitride (GaN) for which classical profiling techniques are not adapted. This is a challenging task since it needs a technique with simultaneously good sensitivity, high spatial resolution and high dopant gradient resolution. To face these challenges, scanning capacitance microscopy combined with Atomic Force Microscopy is a good candidate, presenting reproducible results, as demonstrated in literature. In this work, we attempt to distinguish reliably and qualitatively the various doping concentrations and type at p-n and unipolar junctions. For both p-n and unipolar junctions three kinds of samples were prepared and measured separately. The space-charge region of the p-n metallurgical junction, giving rise to different contrasts under SCM imaging, is clearly observed, enlightening the interest of the SCM technique.

Horizontal Assembly of Single Nanowire Diode Fabricated by p-n Junction GaN NW Grown by MOCVD

Directory of Open Access Journals (Sweden)

Ji-Hyeon Park

2014-01-01

Full Text Available Uniaxially p-n junction gallium nitride nanowires have been synthesized via metal-organic chemical vapor deposition method. Nanowires prepared on Si(111 substrates were found to grow perpendicular to the substrate, and the transmission electron microscopy studies demonstrated that the nanowires had singlecrystalline structures with a growth axis. The parallel assembly of the p-n junction nanowire was prepared on a Si substrate with a thermally grown SiO2 layer. The transport studies of horizontal gallium nitride nanowire structures assembled from p- and n-type materials show that these junctions correspond to well-defined p-n junction diodes. The p-n junction devices based on GaN nanowires suspended over the electrodes were fabricated and their electrical properties were investigated. The horizontally assembled gallium nitride nanowire diodes suspended over the electrodes exhibited a substantial increase in conductance under UV light exposure. Apart from the selectivity to different light wavelengths, high responsivity and extremely short response time have also been obtained.

PN Sequence Preestimator Scheme for DS-SS Signal Acquisition Using Block Sequence Estimation

Directory of Open Access Journals (Sweden)

Sang Kyu Park

2005-03-01

Full Text Available An m-sequence (PN sequence preestimator scheme for direct-sequence spread spectrum (DS-SS signal acquisition by using block sequence estimation (BSE is proposed and analyzed. The proposed scheme consists of an estimator and a verifier which work according to the PN sequence chip clock, and provides not only the enhanced chip estimates with a threshold decision logic and one-chip error correction among the first m received chips, but also the reliability check of the estimates with additional decision logic. The probabilities of the estimator and verifier operations are calculated. With these results, the detection, the false alarm, and the missing probabilities of the proposed scheme are derived. In addition, using a signal flow graph, the average acquisition time is calculated. The proposed scheme can be used as a preestimator and easily implemented by changing the internal signal path of a generally used digital matched filter (DMF correlator or any other correlator that has a lot of sampling data memories for sampled PN sequence. The numerical results show rapid acquisition performance in a relatively good CNR.

pn junctions based on a single transparent perovskite semiconductor BaSnO3

Science.gov (United States)

Kim, Hoon Min; Kim, Useong; Park, Chulkwon; Kwon, Hyukwoo; Lee, Woongjae; Kim, Tai Hoon; Kim, Kee Hoon; Char, Kookrin; Mdpl, Department Of Physics; Astronomy Team; Censcmr, Department Of Physics; Astronomy Team

2014-03-01

Successful p doping of transparent oxide semiconductor will further increase its potential, especially in the area of optoelectronic applications. We will report our efforts to dope the BaSnO3 (BSO) with K by pulsed laser deposition. Although the K doped BSO exhibits rather high resistivity at room temperature, its conductivity increases dramatically at higher temperatures. Furthermore, the conductivity decreases when a small amount of oxygen was removed from the film, consistent with the behavior of p type doped oxides. We have fabricated pn junctions by using K doped BSO as a p type and La doped BSO as an n type material. I_V characteristics of these devices show the typical rectifying behavior of pn junctions. We will present the analysis of the junction properties from the temperature dependent measurement of their electrical properties, which shows that the I_V characteristics are consistent with the material parameters such as the carrier concentration, the mobility, and the bandgap. Our demonstration of pn junctions based on a single transparent perovskite semiconductor further enhances the potential of BSO system with high mobility and stability.

Total number of planetary nebulae in different galaxies and the PN distance scale.

Science.gov (United States)

Peimbert, M.

1990-12-01

RESUMEN A partir de una muestra de quince galaxias se encuentra que la tasa de natalidad de nebulosas planetarias por unidad de luminosidad, , disminuye al aumentar la luminosidad y al aumentar (B - V)0. Se discuten posibles explicaciones para estos resultados. Se estima el valor de para la Galaxia y a partir de el se encuentra que el numero total de nebulosas planetarias en nuestra galaxia con R de 7200 j 1800. El valor galactico de implica que la mayorfa de las estrellas de masa intermedia pasa por la etapa de nebulosa planetaria. El valor galactico de , la tasa de mortalidad estelar por unidad de luminosidad y la tasa de natalidad de enanas blancas favorecen escalas de distancias largas para nebulosas planetarias, como la de Cudworth (1974) y la de Mallik y Peimbert (1988). ABSTRACT From a sample of fifteen galaxies it is found that the birth rate of PN per unit luminosity, , decreases with increasing luminosity and with increasing (B - V)0 possible reasons for these relationships are discussed. The value for the Galaxy is estimated and, from it, a total number of PN of 7200 # 1800 wid R < 0.64 pc is obtained. The galactic value implies that most of the intermediate mass stars go through the PN stage. The galactic value, the stellar death rate per unit luminosity and the white dwarf birth rate are in favor of long distance scales to PN like those of Cudworth (1974) and Mallik and (1988). Key wonis: NEBULAE.PLANETARY - STARS-EVOLUTION - STARS-SThLIAR STA. S

Negative differential resistance observed from vertical p+-n+ junction device with two-dimensional black phosphorous

Science.gov (United States)

Lee, Daeyeong; Jang, Young Dae; Kweon, Jaehwan; Ryu, Jungjin; Hwang, Euyheon; Yoo, Won Jong; Samsung-SKKU Graphene/2D Center (SSGC) Collaboration

A vertical p+-n+ homojunction was fabricated by using black phosphorus (BP) as a van der Waals two-dimensional (2D) material. The top and bottom layers of the materials were doped by chemical dopants of gold chloride (AuCl3) for p-type doping and benzyl viologen (BV) for n-type doping. The negative differential resistance (NDR) effect was clearly observed from the output curves of the fabricated BP vertical devices. The thickness range of the 2D material showing NDR and the peak to valley current ratio of NDR are found to be strongly dependent on doping condition, gate voltage, and BP's degradation level. Furthermore, the carrier transport of the p+-n+ junction was simulated by using density functional theory (DFT) and non-equilibrium Green's function (NEGF). Both the experimental and simulation results confirmed that the NDR is attributed to the band-to-band tunneling (BTBT) across the 2D BP p+-n+ junction, and further quantitative details on the carrier transport in the vertical p+-n+ junction devices were explored, according to the analyses of the measured transfer curves and the DFT simulation results. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (2013R1A2A2A01015516).

Iodine (p,n) and (d,2n) excitation function measurements

International Nuclear Information System (INIS)

West, H.I. Jr.; Nuckolls, R.M.; Mustafa, M.G.; Lanier, R.G.

1991-01-01

We have measured the nuclear excitation functions for the reactions 127 I (p,n) 127 Xe and 127 I(d,2n) 127 Xe. These results are being used in the interpretation of data obtained from nuclear test diagnostics. 15 refs., 3 figs., 3 tabs

Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects.

Science.gov (United States)

Mota Filho, Francisco Hidelbrando Alves; Sávio, Luis Felipe; Sakata, Rafael Eiji; Ivanovic, Renato Fidelis; da Silva, Marco Antonio Nunes; Maia, Ronaldo; Passerotti, Carlo

2018-01-01

Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using na 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology. Copyright® by the International Brazilian Journal of Urology.

Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects

Directory of Open Access Journals (Sweden)

Francisco Hidelbrando Alves Mota Filho

Full Text Available ABSTRACT Introduction Robot-Assisted Single Site Radical Nephrectomy (RASS-RN has been reported by surgeons in Europe and United States (1–3. To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. Case A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Results Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3 cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Discussion Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2. Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. Conclusion RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.

The effect of PN-1, a Traditional Chinese Prescription, on the Learning and Memory in a Transgenic Mouse Model of Alzheimer’s Disease

Directory of Open Access Journals (Sweden)

Zhi-Gang Yao

2013-01-01

Full Text Available Traditional Chinese Medicine (TCM is a complete medical system that has been practiced for more than 3000 years. Prescription number 1 (PN-1 consists of several Chinese medicines and is designed according to TCM theories to treat patients with neuropsychiatric disorders. The evidence of clinical practice suggests the benefit effects of PN-1 on cognitive deficits of dementia patients. We try to prove and explain this by using contemporary methodology and transgenic animal models of Alzheimer’s disease (AD. The behavioral studies were developed to evaluate the memory of transgenic animals after intragastric administration of PN-1 for 3 months. Amyloid beta-protein (Aβ neuropathology was quantified using immunohistochemistry and ELISA. The western blotting was used to detect the levels of plasticity associated proteins. The safety of PN-1 on mice was also assessed through multiple parameters. Results showed that PN-1 could effectively relieve learning and memory impairment of transgenic animals. Possible mechanisms showed that PN-1 could significantly reduce plaque burden and Aβ levels and boost synaptic plasticity. Our observations showed that PN-1 could improve learning and memory ability through multiple mechanisms without detectable side effects on mice. We propose that PN-1 is a promising alternative treatment for AD in the future.

Laparoscopic nephrectomy for a single-system ectopic ureter draining a small, dysplastic and poorly functioning kidney in children

International Nuclear Information System (INIS)

Jeong, Byong-Chang; Lim, Dae-Jung; Lee, Sang-Chul; Choi, Hwang; Kim, Hyeon-Hoe

2007-01-01

The purpose of this study was to assess the efficacy of laparoscopic nephrectomy for a single-system ectopic ureter draining a dysplastic kidney in children. Between February 1999 and September 2005, 16 girls with a mean age of 6.2 years (range: 2-15 years) presented with urinary incontinence accompanied by regular voiding since birth (15 patients) and vaginitis (one patient). Ultrasonography, intravenous urography and a technetium-99m dimercaptosuccinic acid ( 99m Tc-DMSA) renal scan showed the presence of only a single kidney in all cases. Computed tomography (CT) showed a dysplastic kidney definitely in nine patients, structures suspicious of dysplastic kidney in three cases, and no dysplastic kidney in four cases. Magnetic resonance imaging was carried out in the four cases with non-visualized dysplastic kidneys by CT, and showed a suspicious lesion in only one case, and no lesion in the other three patients. All patients underwent transperitoneal laparoscopic nephrectomy for a dysplastic kidney. Laparoscopy identifies all dysplastic kidneys easily, even in those cases in which dystrophic kidney could not be identified by preoperative imaging. Dysplastic kidneys and ectopic ureters were removed successfully in all 16 patients. Mean operative time was 109 min (range: 40-155 min) with little intraoperative bleeding. Mean postoperative hospital stay was 2.6 days (range: 2-4 days). No intraoperative complication was encountered, except in one single case, in which a small bowel injury occurred during open Hasson's procedure. All patients became dry soon after the operation. Laparoscopic nephrectomy for an ectopic ureter draining into a dysplastic kidney is a safe and effective method, and can be carried out successfully, despite a failure by preoperative imaging studies to localize the dysplastic kidney. (author)

Oncological outcomes of laparoscopic radical nephrectomy for renal cancer Resultados oncológicos da nefrectomia radical laparoscópica no tratamento do carcinoma renal

Directory of Open Access Journals (Sweden)

Jose R. Colombo Jr.

2007-01-01

Full Text Available PURPOSE: To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS: We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS: All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44, mean blood loss was 183 vs 461 mL (P = . 004, and mean operative time was 2.8 vs 3.7 hrs (P OBJETIVO: Relatar os resultados oncológicos após 5 anos de seguimento em pacientes submetidos a nefrectomia radical laparoscópica para tratamento do câncer renal, comparando esses com os resultados obtidos com um grupo de pacientes submetidos a nefrectomia radical aberta. MÉTODOS: Foram analisadas retrospectivamente as informações obtidas de 88 pacientes submetidos a nefrectomia radical para o tratamento do carcinoma renal realizadas previamente a Janeiro de 2000. Destes pacientes, 45 foram tratados com nefrectomia radical laparoscópica e 43 com nefrectomia radical aberta. Foram incluídos pacientes com tumores localizados com tamanho máximo de 15 cm, sem adenopatia ou sinal de envolvimento de veia renal na avaliação radiologica pré-operatória. As informações sobre o seguimento dos pacientes foram obtidas a partir de

Excitation functions of the (pn) and (p,2n) reactions on Cd isotopes. [(pn) and (p,2n) reactions on the sup(110-114,116)Cd

Energy Technology Data Exchange (ETDEWEB)

Skakun, E A; Klyucharev, A P; Rakivnenko, Yu N; Romanij, I A [AN Ukrainskoi SSR, Kiev. Fiziko-Tekhnicheskii Inst.

1975-01-01

Excitation functions of (pn)- and (p,2n)-reactions on /sup 110/-/sup 114/,/sup 116/Cd nuclei are measured in a range of incident proton energy up to 20 MeV. Experimental results are compared to calculated ones.

A fast and zero-biased photodetector based on GaTe-InSe vertical 2D p-n heterojunction

Science.gov (United States)

Feng, W.; Jin, Z.; Yuan, J.; Zhang, J.; Jia, S.; Dong, L.; Yoon, J.; Zhou, L.; Vajtai, R.; Tour, J. M.; Ajayan, P. M.; Hu, P.; Lou, J.

2018-04-01

p-n junctions serve as the building blocks for fundamental semiconductor devices, such as solar cells, light-emitting diodes (LEDs) and photodetectors. With recent studies unveiling the excellent optoelectronic properties of two-dimensional (2D) semiconductors, they are considered to be superb candidates for high performance p-n junctions. Here, we fabricate a vertical GaTe-InSe van der Waals (vdWs) p-n heterojunction by a PDMS-assisted transfer technique without etching. The fabricated p-n heterojunction shows gate-tunable current-rectifying behavior with a rectification factor reaching 1000. In addition, it features fast photodetection under zero bias as well as a high power conversion efficiency (PCE). Under 405 nm laser excitation, the zero-biased photodetector shows a high responsivity of 13.8 mA W-1 as well as a high external quantum efficiency (EQE) of 4.2%. Long-term stability is also observed and a response time of 20 µs is achieved due to stable and fast carrier transit through the built-in electric field in the depletion region. Fast and efficient charge separation in the vertical 2D p-n junction paves the way for developing 2D photodetectors with zero dark current, high speed and low power consumption.

New Circumstellar Sources of PO and PN: The Increasing Role of Phosphorus Chemistry in Oxygen-rich Stars

Science.gov (United States)

Ziurys, L. M.; Schmidt, D. R.; Bernal, J. J.

2018-04-01

PO and PN have been newly identified in several oxygen-rich circumstellar envelopes, using the Submillimeter Telescope of the Arizona Radio Observatory. The J = 5 → 4 and J = 6 → 5 transitions of PN near 235 and 282 GHz, and the lambda doublets originating in the J = 5.5 → 4.5 and J = 6.5 → 5.5 lines of PO at 240 and 284 GHz, have been detected toward the shells of asymptotic giant branch (AGB) stars TX Cam and R Cas. A similar set of lines has been observed toward the supergiant NML Cyg, and new transitions of these two molecules were also measured toward the AGB star IK Tau. Along with the previous data from VY Canis Majoris (VY CMa), these spectral lines were analyzed using the non-local thermodynamic equilibrium (non-LTE) circumstellar modeling code, ESCAPADE. For the AGB stars, peak abundances found for PN and PO were f ∼ (1–2) × 10‑8 and (0.5–1) × 10‑7, respectively, while those for the supergiants were f(PN) ∼ (0.3–0.7) × 10‑8 and f(PO) ∼ (5–7) × 10‑8. PN was well modeled with a spherical radial distribution, suggesting formation near the stellar photosphere, perhaps enhanced by shocks. PO was best reproduced by a shell model, indicating a photochemical origin, except for VY CMa. Overall, the abundance of PO is a factor of 5–20 greater than that of PN. This study suggests that phosphorus-bearing molecules are common in O-rich envelopes, and that a significant amount of phosphorus (>20%) remains in the gas phase.

Array analysis of regional Pn and Pg wavefields from the Nevada Test Site

International Nuclear Information System (INIS)

Leonard, M.A.

1991-06-01

Small-aperture high-frequency seismic arrays with dimensions of a few kilometers or less, can improve our ability to seismically monitor compliance with a low-yield Threshold Test Ban Treaty. This work studies the characteristics and effectiveness of array processing of the regional Pn and Pg wavefields generated by underground nuclear explosions at the Nevada Test Site. Waveform data from the explosion HARDIN (m b = 5.5) is recorded at a temporary 12-element, 3-component, 1.5 km-aperture array sited in an area of northern Nevada. The explosions VILLE (m b = 4.4) and SALUT (m b = 5.5) are recorded at two arrays sited in the Mojave desert, one a 96-element vertical-component 7 km-aperture array and the other a 155-element vertical-component 4 km-aperture array. Among the mean spectra for the m b = 5.5 events there are significant differences in low-frequency spectral amplitudes between array sites. The spectra become nearly identical beyond about 6 Hz. Spectral ratios are used to examine seismic source properties and the partitioning of energy between Pn and Pg. Frequency-wavenumber analysis at the 12-element array is used to obtain estimates of signal gain, phase velocity, and source azimuth. This analysis reveals frequency-dependent biases in velocity and azimuth of the coherent Pn and Pg arrivals. Signal correlation, the principal factor governing array performance, is examined in terms of spatial coherence estimates. The coherence is found to vary between the three sites. In all cases the coherence of Pn is greater than that for Pg. 81 refs., 92 figs., 5 tabs

Array analysis of regional Pn and Pg wavefields from the Nevada Test Site

Energy Technology Data Exchange (ETDEWEB)

Leonard, M.A. (California Univ., Berkeley, CA (United States). Dept. of Geology and Geophysics Lawrence Berkeley Lab., CA (United States))

1991-06-01

Small-aperture high-frequency seismic arrays with dimensions of a few kilometers or less, can improve our ability to seismically monitor compliance with a low-yield Threshold Test Ban Treaty. This work studies the characteristics and effectiveness of array processing of the regional Pn and Pg wavefields generated by underground nuclear explosions at the Nevada Test Site. Waveform data from the explosion HARDIN (m{sub b} = 5.5) is recorded at a temporary 12-element, 3-component, 1.5 km-aperture array sited in an area of northern Nevada. The explosions VILLE (m{sub b} = 4.4) and SALUT (m{sub b} = 5.5) are recorded at two arrays sited in the Mojave desert, one a 96-element vertical-component 7 km-aperture array and the other a 155-element vertical-component 4 km-aperture array. Among the mean spectra for the m{sub b} = 5.5 events there are significant differences in low-frequency spectral amplitudes between array sites. The spectra become nearly identical beyond about 6 Hz. Spectral ratios are used to examine seismic source properties and the partitioning of energy between Pn and Pg. Frequency-wavenumber analysis at the 12-element array is used to obtain estimates of signal gain, phase velocity, and source azimuth. This analysis reveals frequency-dependent biases in velocity and azimuth of the coherent Pn and Pg arrivals. Signal correlation, the principal factor governing array performance, is examined in terms of spatial coherence estimates. The coherence is found to vary between the three sites. In all cases the coherence of Pn is greater than that for Pg. 81 refs., 92 figs., 5 tabs.

Transparent CH{sub 3}NH{sub 3}SnCl{sub 3}/Al-ZnO p-n heterojunction diode

Energy Technology Data Exchange (ETDEWEB)

Kumar, Sunil, E-mail: skbgudha@gmail.com; Ansari, Mohd Zubair; Khare, Neeraj [Department of Physics, Indian Institute of Technology, Hauz Khas, New Delhi, Delhi-110016 (India)

2016-05-23

A p-type Organic inorganic tin chloride (CH{sub 3}NH{sub 3}SnCl{sub 3}) perovskite thin film has been synthesized by solution method. An n-type 1% Al doped ZnO (AZO) film has been deposited on FTO substrate by ultrasonic assisted chemical vapor deposition technique. A transparent CH{sub 3}NH{sub 3}SnCl{sub 3}/AZO p-n heterojunction diode has been fabricated by spin coating technique. CH{sub 3}NH{sub 3}SnCl{sub 3}/AZO p-n heterojunction shows 75% transparency in the visible region. I-V characteristic of CH{sub 3}NH{sub 3}SnCl{sub 3}/AZO p-n heterojunction shows rectifying behavior of the diode. The diode parameters calculated as ideality factor η=2.754 and barrier height Φ= 0.76 eV. The result demonstrates the potentiality of CH{sub 3}NH{sub 3}SnCl{sub 3}/AZO p-n heterojunction for transparent electronics.

Melanotic Xp11 Translocation Renal Cancer Managed With Radical Nephrectomy and IVC Tumor Thrombectomy

Directory of Open Access Journals (Sweden)

Iyad S. Khourdaji

2017-01-01

Full Text Available Melanotic Xp11 translocation renal cancer is a rarely observed neoplasm primarily affecting adolescents and young adults. Given the paucity of data describing this malignancy, its natural history and subsequent long-term management are not well understood. We report a case of melanotic Xp11 translocation with tumor thrombus extension managed with radical nephrectomy and inferior vena cava (IVC tumor thrombectomy. To our knowledge, this is the first case report to describe use of conventional tumor thrombectomy techniques in a patient with melanotic Xp11 translocation renal cancer.

PnET-BGC: Modeling Biogeochemical Processes in a Northern Hardwood Forest Ecosystem

Data.gov (United States)

National Aeronautics and Space Administration — ABSTRACT: This archived model product contains the directions, executables, and procedures for running PnET-BGC to recreate the results of: Gbondo-Tugbawa, S.S.,...

Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses.

Science.gov (United States)

Bagrodia, Aditya; Harrow, Brian; Liu, Zhuo-Wei; Olweny, Ephrem O; Faddegon, Stephen; Yin, Gang; Tan, Yung Khan; Han, Woong Kyu; Lotan, Yair; Margulis, Vitaly; Cadeddu, Jeffrey A

2014-01-01

To evaluate a nomogram using the RENAL Nephrometry Score (RENAL-NS) that was developed to characterize masses as benign vs. malignant and high vs. low grade in our patients with small renal masses treated with partial nephrectomy (PN). The nomogram was previously developed and validated in patients with widely variable tumor sizes. Retrospective review of PN performed between 1/2003 and 7/2011. Imaging was reviewed by a urologic surgeon for RENAL-NS. Final pathology was used to classify tumors as benign or malignant and low (I/II) or high (III/IV) Fuhrman grade. Patient age, gender, and RENAL score were entered into the nomogram described by Kutikov et al. to determine probabilities of cancer and high-grade disease. Area under the curve was determined to assess agreement between observed and expected outcomes for prediction of benign vs. malignant disease and for prediction of high- vs. low-grade or benign disease. A total of 250 patients with 252 masses underwent PN during the study period; 179/250 (71.6%) had preoperative imaging available. RENAL-NS was assigned to 181 masses. Twenty-two percent of tumors were benign. Eighteen percent of tumors were high grade. Area under the curve was 0.648 for predicting benign vs. malignant disease and 0.955 for predicting low-grade or benign vs. high-grade disease. The RENAL-NS score nomogram by Kutikov does not discriminate well between benign and malignant disease for small renal masses. The nomogram may potentially be useful in identifying high-grade tumors. Further validation is required where the nomogram probability and final pathologic specimen are available. Copyright © 2014 Elsevier Inc. All rights reserved.

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

Science.gov (United States)

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Effect of deep dislocation levels in silicon on the properties of p-n junctions

Energy Technology Data Exchange (ETDEWEB)

Zakharov, A.G.; Dudko, V.G.; Nabokov, G.M.; Sechenov, D.A.

1988-07-01

We present the results of studies on the influence of deep levels, due to dislocations in electronic-grade silicon, on the lifetime of minority carriers and on the current-voltage and capacitance-voltage characteristics of p-n junctions. The parameters of the deep levels were determined by means of dynamic spectroscopy. The carrier lifetime in the high-resistance region of the p-n junction correlates well with the dislocation density and varies from 10/sup /minus/7/ sec to 3 /centered dot/10/sup /minus/6/ sec when the dislocation density N/sub d/ varies from 10/sup 7/ cm/sup /minus/2/ to 5 /centered dot/10/sup 3/ cm/sup /minus/2/. The voltage across the p-n junction at a high level of injection varies 1.6 to 6.2 v as a function of N/sub d/. The ionization energy of deep levels associated with dislocation in silicon is 0.44 and 0.57 eV, measured from the bottom of the conduction band.

Sequences of measures on atomic subalgebras of P(N) | Aizpuru ...

African Journals Online (AJOL)

Sequences of measures on atomic subalgebras of P(N). Antonio Aizpuru, Antonio Gutierrez-D´avila. Abstract. A vector form of Phillips' theorem, for atomic Boolean algebras with countably many atoms, is given. As a consequence we obtain a new characterization of weak compact sets of σ-additive measures. Quaestiones ...

Comparative Study of the Effect of Intravenous Paracetamol and Tramadol in Relieving of Postoperative Pain after General Anesthesia in Nephrectomy Patients.

Science.gov (United States)

Manne, Venkata Sesha Sai Krishna; Gondi, Srinivasa Rao

2017-01-01

The aim of this study was to compare the effect of intravenous paracetamol and tramadol in relieving of postoperative pain after general anesthesia for nephrectomy in prospective donor patients for kidney transplantation. A randomized study was conducted on 100 adult patients scheduled for nephrectomy aged from 35 to 55 years of both sexes and divided into two groups and were administered intravenous paracetamol and tramadol for postoperative pain relief and assessed with visual analog scale score and variations in vital parameters to assess extent of pain relief. After statistical interpretation of collected data, the observations were extrapolated. There was a statistically significant difference in the pain intensity scores obtained between the paracetamol and tramadol groups. On the basis of the present study, it is concluded that tramadol due to its lesser onset of action time was superior to paracetamol in providing acute postoperative pain relief.

Cost effectiveness of open versus laparoscopic living-donor nephrectomy

DEFF Research Database (Denmark)

Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole

2009-01-01

, and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery...... (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated...... into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0...

GaAsPN-based PIN solar cells MBE-grown on GaP substrates: toward the III-V/Si tandem solar cell

Science.gov (United States)

Da Silva, M.; Almosni, S.; Cornet, C.; Létoublon, A.; Levallois, C.; Rale, P.; Lombez, L.; Guillemoles, J.-F.; Durand, O.

2015-03-01

GaAsPN semiconductors are promising material for the elaboration of high efficiencies tandem solar cells on silicon substrates. GaAsPN diluted nitride alloy is studied as the top junction material due to its perfect lattice matching with the Si substrate and its ideal bandgap energy allowing a perfect current matching with the Si bottom cell. We review our recent progress in materials development of the GaAsPN alloy and our recent studies of some of the different building blocks toward the elaboration of a PIN solar cell. A lattice matched (with a GaP(001) substrate, as a first step toward the elaboration on a Si substrate) 1μm-thick GaAsPN alloy has been grown by MBE. After a post-growth annealing step, this alloy displays a strong absorption around 1.8-1.9 eV, and efficient photoluminescence at room temperature suitable for the elaboration of the targeted solar cell top junction. Early stage GaAsPN PIN solar cells prototypes have been grown on GaP (001) substrates, with 2 different absorber thicknesses (1μm and 0.3μm). The external quantum efficiencies and the I-V curves show that carriers have been extracted from the GaAsPN alloy absorbers, with an open-circuit voltage of 1.18 V, while displaying low short circuit currents meaning that the GaAsPN structural properties needs a further optimization. A better carrier extraction has been observed with the absorber displaying the smallest thickness, which is coherent with a low carriers diffusion length in our GaAsPN compound. Considering all the pathways for improvement, the efficiency obtained under AM1.5G is however promising.

Physical Properties of the Very Young PN Hen3-1357 (Stingray Nebula) Based on Multiwavelength Observations

Energy Technology Data Exchange (ETDEWEB)

Otsuka, Masaaki [Institute of Astronomy and Astrophysics Academia Sinica, 11F of Astronomy-Mathematics Building, AS/NTU. No.1, Sec. 4, Roosevelt Road, Taipei 10617, Taiwan, R.O.C. (China); Parthasarathy, M. [Indian Institute of Astrophysics, II B lock Koramangala, Bangalore 560034, Karnataka (India); Tajitsu, A. [Subaru Telescope, National Astronomical Observatory of Japan, 650 N Aohoku Place, Hilo, HI 96720 (United States); Hubrig, S., E-mail: otsuka@asiaa.sinica.edu.tw [Leibniz-Institut fuer Astrophysik Potsdam (AIP) An der Sternwarte 12, D-14482 Potsdam (Germany)

2017-03-20

We carried out a detailed analysis of the interesting and important very young planetary nebula (PN) Hen3-1357 (Stingray Nebula) based on a unique data set of optical to far-IR spectra and photometric images. We calculated the abundances of nine elements using collisionally excited lines (CELs) and recombination lines (RLs). The RL C/O ratio indicates that this PN is O-rich, which is also supported by the detection of the broad 9/18 μ m bands from amorphous silicate grains. The observed elemental abundances can be explained by asymptotic giant branch (AGB) nucleosynthesis models for initially 1–1.5 M {sub ⊙} stars with Z = 0.008. The Ne overabundance might be due to the enhancement of {sup 22}Ne isotope in the He-rich intershell. Using the spectrum of the central star synthesized by Tlusty as the ionization/heating source of the PN, we constructed the self-consistent photoionization model with Cloudy to the observed quantities and derived the gas and dust masses, dust-to-gas mass ratio, and core mass of the central star. About 80% of the total dust mass is from warm–cold dust component beyond ionization front. Comparison with other Galactic PNe indicates that Hen3-1357 is an ordinary amorphous silicate-rich and O-rich gas PN. Among other studied PNe, IC4846 shows many similarities in properties of the PN to Hen3-1357, although their post-AGB evolution is quite different from each other. Further monitoring of observations and comparisons with other PNe such as IC4846 are necessary to understand the evolution of Hen3-1357.

Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer.

Science.gov (United States)

Tan, Hung-Jui; Meyer, Anne-Marie; Kuo, Tzy-Mey; Smith, Angela B; Wheeler, Stephanie B; Carpenter, William R; Nielsen, Matthew E

2015-03-15

Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers. With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation. During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care. © 2014 American Cancer Society.

PnET-BGC: Modeling Biogeochemical Processes in a Northern Hardwood Forest Ecosystem

Data.gov (United States)

National Aeronautics and Space Administration — This archived model product contains the directions, executables, and procedures for running PnET-BGC to recreate the results of: Gbondo-Tugbawa, S.S., C.T. Driscoll...

MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

International Nuclear Information System (INIS)

Ghonge, Nitin P; Gadanayak, Satyabrat; Rajakumari, Vijaya

2014-01-01

As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know

The PR in PN for Education Associations. PR Bookshelf, No. 3.

Science.gov (United States)

National Education Association, Washington, DC.

This booklet presents suggestions and guidelines for the effective use of public relations (PR) techniques during professional negotiations (PN) among teachers, administrators, and boards of education. Introductory sections present the National Education Association (NEA) position regarding professional negotiation and grievance procedures and…

Synthesis, crystal structure, and magnetic properties of quaternary iron selenides: Ba{sub 2}FePnSe{sub 5} (Pn=Sb, Bi)

Energy Technology Data Exchange (ETDEWEB)

Wang, Jian; Greenfield, Joshua T.; Kovnir, Kirill

2016-10-15

Two new barium iron pnictide–selenides, Ba{sub 2}FeSbSe{sub 5} and Ba{sub 2}FeBiSe{sub 5}, were synthesized by a high-temperature solid-state route and their crystal structures were determined using single crystal X-ray diffraction. Both compounds are isomorphic to the high pressure phase Ba{sub 3}FeS{sub 5} and crystallize in the orthorhombic space group Pnma (No. 62) with cell parameters of a=12.603(2)/12.619(2) Å, b=9.106(1)/9.183(1) Å, c=9.145(1)/9.123(1) Å and Z=4 for Ba{sub 2}FeSbSe{sub 5} and Ba{sub 2}FeBiSe{sub 5}, respectively. According to differential scanning calorimetry, Ba{sub 2}FePnSe{sub 5} compounds exhibit high thermal stability and melt congruently at 1055(5) K (Pn=Sb) and 1105(5) K (Pn=Bi). Magnetic characterizations reveal strong antiferromagnetic nearest-neighbor interactions in both compounds resulting in an antiferromagnetic ordering at 58(1) K for Ba{sub 2}FeSbSe{sub 5} and 79(2) K for Ba{sub 2}FeBiSe{sub 5}. The magnetic interactions between Fe{sup 3+} centers, which are at least 6 Å apart from each other, are mediated by superexchange interactions. - Graphical abstract: In Ba{sub 2}FeSbSe{sub 5} and Ba{sub 2}FeBiSe{sub 5} the magnetic interactions between Fe{sup 3+} centers, which are at least 6 Å apart from each other, are mediated by superexchange interactions. - Highlights: • New compounds Ba{sub 2}FeSbSe{sub 5} and Ba{sub 2}FeBiSe{sub 5} have been synthesized. • The crystal structure was determined by single crystal X-ray diffraction. • Both compounds melt congruently at temperatures above 1000 K. • Ba{sub 2}FeSbSe{sub 5} and Ba{sub 2}FeBiSe{sub 5} exhibit AFM ordering at 58 K (Sb) and 70 K (Bi). • Magnetic exchange between Fe{sup 3+} is mediated by either Se–Sb(Bi)–Se or Se–Ba–Se bridges.

Laparoscopic resection of tumor recurrence after radical nephrectomy for localized renal cell carcinoma.

Science.gov (United States)

Curcio, Lessandro; Cunha, Antonio Claudio; Renteria, Juan; Presto, Daniel

2014-01-01

Local recurrence of Renal Cell Carcinoma (RCC) after radical nephrectomy is a rare event. Some known risk factors are: clinical/pathological stage, locorregional disease and lyimph node positivity. Since up to 30-40% of patients can achieve a disease-free status, we show a case (video) in which we performed a laparoscopic excision of a local RCC, taking advantage of all the well-known benefits of laparoscopy. A 56 years old female with a history of open radical nephrectomy two years before was diagnosed with a mass at the time of surveillance CT imaging during follow-up. The suspected local recurrence was 12 cm, and vascularized predominantly by tributaries originating from the iliac vessels. There was no other site of disease (i.e. brain, lung, liver, bones) and laboratory tests were normal. Laparoscopic approach was approached, by inserting 4 trocars (2 of 10 and 2 of 5mm) with the patient in the lateral position. The procedure lasted 130 minutes, with 220 mL of estimated bleeding; the larger vessels were ligated with polymer clips (Hem-o-lok) and the smaller handled by ultrasonic clamp. The specimen was removed by a small incision below the umbilicus in an appropriate bag. The patient was feed in the first postoperative day and discharged on the third day. Histopathology revealed sarcoma, with a high degree of mitosis, and negative surgical margins. She was referred to medical oncology for adjuvant therapy consideration. The laparoscopic resection of recurrent tumor should be encouraged in highly selected cases. The minimally invasive method, with its known advantages, especially for more debilitated patients, can be advantageous when applied to suitable cases.

The effect of dephasing on edge state transport through p-n junctions in HgTe/CdTe quantum wells.

Science.gov (United States)

Zhang, Ying-Tao; Song, Juntao; Sun, Qing-Feng

2014-02-26

Using the Landauer-Büttiker formula, we study the effect of dephasing on the transport properties of the HgTe/CdTe p-n junction. It is found that in the HgTe/CdTe p-n junction the topologically protected gapless helical edge states manifest a quantized 2e²/h plateau robust against dephasing, in sharp contrast to the case for the normal HgTe/CdTe quantum well. This robustness of the transport properties of the edge states against dephasing should be attributed to the special construction of the HgTe/CdTe p-n junction, which limits the gapless helical edge states to a very narrow region and thus weakens the influence of the dephasing on the gapless edge states to a large extent. Our results demonstrate that the p-n junction could be a substitute device for use in experimentally observing the robust edge states and quantized plateau. Finally, we present a feasible scheme based on current experimental methods.

Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy.

Science.gov (United States)

Ravaud, Alain; Motzer, Robert J; Pandha, Hardev S; George, Daniel J; Pantuck, Allan J; Patel, Anup; Chang, Yen-Hwa; Escudier, Bernard; Donskov, Frede; Magheli, Ahmed; Carteni, Giacomo; Laguerre, Brigitte; Tomczak, Piotr; Breza, Jan; Gerletti, Paola; Lechuga, Mariajose; Lin, Xun; Martini, Jean-Francois; Ramaswamy, Krishnan; Casey, Michelle; Staehler, Michael; Patard, Jean-Jacques

2016-12-08

Sunitinib, a vascular endothelial growth factor pathway inhibitor, is an effective treatment for metastatic renal-cell carcinoma. We sought to determine the efficacy and safety of sunitinib in patients with locoregional renal-cell carcinoma at high risk for tumor recurrence after nephrectomy. In this randomized, double-blind, phase 3 trial, we assigned 615 patients with locoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib (50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year or until disease recurrence, unacceptable toxicity, or consent withdrawal. The primary end point was disease-free survival, according to blinded independent central review. Secondary end points included investigator-assessed disease-free survival, overall survival, and safety. The median duration of disease-free survival was 6.8 years (95% confidence interval [CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to 6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overall survival data were not mature at the time of data cutoff. Dose reductions because of adverse events were more frequent in the sunitinib group than in the placebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) and discontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequent in the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events) than in the placebo group (15.8% and 3.6%, respectively). There was a similar incidence of serious adverse events in the two groups (21.9% for sunitinib vs. 17.1% for placebo); no deaths were attributed to toxic effects. Among patients with locoregional clear-cell renal-cell carcinoma at high risk for tumor recurrence after nephrectomy, the median duration of disease-free survival was significantly longer in the sunitinib group than in the placebo group, at a cost of a higher rate of toxic events. (Funded by Pfizer; S-TRAC Clinical

Anaesthetic management of a patient with deep brain stimulation implant for radical nephrectomy

Directory of Open Access Journals (Sweden)

Monica Khetarpal

2014-01-01

Full Text Available A 63-year-old man with severe Parkinson′s disease (PD who had been implanted with deep brain stimulators into both sides underwent radical nephrectomy under general anaesthesia with standard monitoring. Deep brain stimulation (DBS is an alternative and effective treatment option for severe and refractory PD and other illnesses such as essential tremor and intractable epilepsy. Anaesthesia in the patients with implanted neurostimulator requires special consideration because of the interaction between neurostimulator and the diathermy. The diathermy can damage the brain tissue at the site of electrode. There are no standard guidelines for the anaesthetic management of a patient with DBS electrode in situ posted for surgery.

Uppermost mantle seismic velocity and anisotropy in the Euro-Mediterranean region from Pn and Sn tomography

Science.gov (United States)

Díaz, J.; Gil, A.; Gallart, J.

2013-01-01

In the last 10-15 years, the number of high quality seismic stations monitoring the Euro-Mediterranean region has increased significantly, allowing a corresponding improvement in structural constraints. We present here new images of the seismic velocity and anisotropy variations in the uppermost mantle beneath this complex area, compiled from inversion of Pn and Sn phases sampling the whole region. The method of Hearn has been applied to the traveltime arrivals of the International Seismological Center catalogue for the time period 1990-2010. A total of 579 753 Pn arrivals coming from 12 377 events recorded at 1 408 stations with epicentral distances between 220 km and 1 400 km have been retained after applying standard quality criteria (maximum depth, minimum number of recordings, maximum residual values …). Our results show significant features well correlated with surface geology and evidence the heterogeneous character of the Euro-Mediterranean lithosphere. The station terms reflect the existence of marked variations in crustal thickness, consistent with available Moho depths inferred from active seismic experiments. The highest Pn velocities are observed along a continuous band from the Po Basin to the northern Ionian Sea. Other high velocity zones include the Ligurian Basin, the Valencia Trough, the southern Alboran Sea and central part of the Algerian margin. Most significant low-velocity values are associated to orogenic belts (Betics, Pyrenees, Alps, Apennines and Calabrian Arc, Dinarides-Hellenides), and low-velocity zones are also identified beneath Sardinia and the Balearic Islands. The introduction of an anisotropic term enhances significantly the lateral continuity of the anomalies, in particular in the most active tectonic areas. Pn anisotropy shows consistent orientations subparallel to major orogenic structures, such as Betics, Apennines, Calabrian Arc and Alps. The Sn tomographic image has lower resolution but confirms independently most of the

Gamow-Teller matrix elements from 00 ( p,n) cross section

International Nuclear Information System (INIS)

Goodman, C.D.; Goulding, C.A.; Greenfield, M.B.; Rapaport, J.; Bainum, D.E.; Foster, C.C.; Love, W.G.; Petrovich, F.

1980-01-01

After simple corrections for distortion effects, 120-MeV, 0 0 (p,n) cross sections are found to be proportional to the squares of the corresponding Fermi and Gamow-Teller matrix elements extracted from β-decay measurements. It is suggested that this proportionality can be used to extract Gamow-Teller matrix elements for transitions inaccessible to β decay

Pre- and post-operative evaluations of eight dogs following right nephrectomy due to Dioctophyma renale.

Science.gov (United States)

Mesquita, L R; Rahal, S C; Faria, L G; Takahira, R K; Rocha, N S; Mamprim, M J; Oliveira, H S

2014-01-01

Dioctophyma renale is a large nematode distributed worldwide that may cause progressive and severe destruction of renal parenchyma. The present study aimed to evaluate pre- and post-operatively dogs submitted to right nephrectomy due to D. renale and to assess the histopathological damage of the removed kidney. Eight crossbred dogs, aged from 12 to 48 months that were unilaterally nephrectomized due to the presence of D. renale were evaluated. Physical examination, urinalysis, complete blood count, serum biochemistry, and abdominal ultrasound were performed immediately before and one month after nephrectomy. The nephrectomized right kidneys were submitted to macroscopic and microscopic evaluations. Urinalysis preoperatively detected occult blood in all dogs and D. renale eggs in five cases. Complete blood count showed all parameters within the reference range, except one dog post-operatively. Serum biochemistry performed before and after surgery verified that urea, creatinine and sodium were within the reference range values in all dogs. Other findings varied among the dogs. The length and arterial resistive index mean values of the left kidney were similar pre- and post-operatively. Thus, the inconsiderable change in laboratory findings pre- and post-operatively was attributable to compensation by left kidney function for the removed abnormal right kidney. Right kidney histology revealed chronic nephropathy due to D. renale. Imaging diagnosis should be performed on dogs suspected as carrying the disease or on those from an enzootic area since the laboratory findings are not specific except eggs in the urine.

C-H and H-H Bond Activation via Ligand Dearomatization/Rearomatization of a PN3P-Rhodium(I) Complex

KAUST Repository

Huang, Kuo-Wei; Wang, Yuan; Zheng, Bin; Pan, Yupeng; Pan, Chengling; He, Lipeng

2015-01-01

A neutral complex PN3P-Rh(I)Cl (2) was prepared from a reaction of the PN3P pincer ligand (1) with [Rh(COD)Cl]2 (COD = 1,5-cyclooctadiene). Upon treatment with a suitable base, H–H and Csp2–H activation reactions can be achieved through

P-N defect in GaNP studied by optically detected magnetic resonance

International Nuclear Information System (INIS)

Chen, W.M.; Thinh, N.Q.; Vorona, I.P.; Buyanova, I.A.; Xin, H.P.; Tu, C.W.

2003-01-01

We provide experimental evidence for an intrinsic defect in GaNP from optically detected magnetic resonance (ODMR). This defect is identified as a P-N complex, exhibiting hyperfine structure due to interactions with a nuclear spin I=((1)/(2)) of one P atom and also a nuclear spin I=1 due to one N atom. The introduction of the defect is assisted by the incorporation of N within the studied N composition range of up to 3.1%, under non-equilibrium growth conditions during gas-source molecular beam epitaxy. The corresponding ODMR spectrum was found to be isotropic, suggesting an A 1 symmetry of the defect state. The localization of the electron wave function at the P-N defect in GaNP is found to be even stronger than that for the isolated P Ga antisite in its parent binary compound GaP

Renal artery stenosis and hypertension after abdominal irradiation for Hodgkin disease. Successful treatment with nephrectomy

International Nuclear Information System (INIS)

Salvi, S.; Green, D.M.; Brecher, M.L.; Magoos, I.; Gamboa, L.N.; Fisher, J.E.; Baliah, T.; Afshani, E.

1983-01-01

Hypertension secondary to stenosis of the left renal artery developed in a thirteen-year-old male six years after completion of inverted Y irradiation (3,600 rad) for abdominal Hodgkin disease. Surgical treatment with nephrectomy resulted in control of the hypertension without the use of antihypertensive agents. We review the literature for this unusual complication of abdominal irradiation, and recommend that a 99mTc-DMSA renal scan, selective renal vein sampling for renin determinations, and renal arteriography be performed on any patient in whom hypertension develops following abdominal irradiation in childhood

Steady-state characteristics of lateral p-n junction vertical-cavity surface-emitting lasers

Science.gov (United States)

Ryzhii, V.; Tsutsui, N.; Khmyrova, I.; Ikegami, T.; Vaccaro, P. O.; Taniyama, H.; Aida, T.

2001-09-01

We developed an analytical device model for lateral p-n junction vertical-cavity surface-emitting lasers (LJVCSELs) with a quantum well active region. The model takes into account the features of the carrier injection, transport, and recombination in LJVCSELs as well as the features of the photon propagation in the cavity. This model is used for the calculation and analysis of the LJVCSEL steady-state characteristics. It is shown that the localization of the injected electrons primarily near the p-n junction and the reabsorption of lateral propagating photons significantly effects the LJVCSELs performance, in particular, the LJVCSEL threshold current and power-current characteristics. The reincarnation of electrons and holes due to the reabsorption of lateral propagating photons can substantially decrease the threshold current.

Effects of electron and proton irradiations on n/p and p/n GaAs cells grown by MOCVD

International Nuclear Information System (INIS)

Weinberg, I.; Swartz, C.K.; Hart, R.E. Jr.

1987-01-01

State-of-the-art n/p and p/n heteroface GaAs cells, processed by metal organic chemical vapor deposition, were irradiated by 1 MeV electrons and 37 MeV protons and their performance determined as a function of fluence. It was found that the p/n cells were more radiation resistant than the n/p cells. The increased loss in the n/p cells was attributed to increases in series resistance and losses in the p-region resulting from the irradiation. The greater loss in fill factor observed for the n/p cells introduces the possibility that the presently observed superiority of the p/n cells may not be an intrinsic property of this configuration in GaAs

Potential profile and photovoltaic effect in nanoscale lateral pn junction observed by Kelvin probe force microscopy

International Nuclear Information System (INIS)

Nowak, Roland; Moraru, Daniel; Mizuno, Takeshi; Jablonski, Ryszard; Tabe, Michiharu

2014-01-01

Nanoscale pn junctions have been investigated by Kelvin probe force microscopy and several particular features were found. Within the depletion region, a localized noise area is observed, induced by temporal fluctuations of dopant states. Electronic potential landscape is significantly affected by dopants with ground-state energies deeper than in bulk. Finally, the effects of light illumination were studied and it was found that the depletion region shifts its position as a function of light intensity. This is ascribed to charge redistribution within the pn junction as a result of photovoltaic effect and due to the impact of deepened-level dopants. - Highlights: • In pn nano-junctions, temporal potential fluctuations are found in depletion layer. • Fluctuations are due to frequent capture and emission of free carriers by dopants. • Depletion layer position shifts as a function of the intensity of irradiated light. • The depletion layer shifts are due to changes of deep-level dopants' charge states

Single Atomically Sharp Lateral Monolayer p-n Heterojunction Solar Cells with Extraordinarily High Power Conversion Efficiency

KAUST Repository

Tsai, Meng-Lin

2017-06-26

The recent development of 2D monolayer lateral semiconductor has created new paradigm to develop p-n heterojunctions. Albeit, the growth methods of these heterostructures typically result in alloy structures at the interface, limiting the development for high-efficiency photovoltaic (PV) devices. Here, the PV properties of sequentially grown alloy-free 2D monolayer WSe-MoS lateral p-n heterojunction are explores. The PV devices show an extraordinary power conversion efficiency of 2.56% under AM 1.5G illumination. The large surface active area enables the full exposure of the depletion region, leading to excellent omnidirectional light harvesting characteristic with only 5% reduction of efficiency at incident angles up to 75°. Modeling studies demonstrate the PV devices comply with typical principles, increasing the feasibility for further development. Furthermore, the appropriate electrode-spacing design can lead to environment-independent PV properties. These robust PV properties deriving from the atomically sharp lateral p-n interface can help develop the next-generation photovoltaics.

Improved measurement of the glomerular filtration rate from Tc-99m DTPA scintigraphy in patients following nephrectomy

Energy Technology Data Exchange (ETDEWEB)

Kim, Yong-il; Ha, Seunggyun [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seongnam-si, Gyeonggi-do (Korea, Republic of); So, Young [Konkuk University School of Medicine, Department of Nuclear Medicine, Chungju (Korea, Republic of); Lee, Won Woo [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of); Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seongnam-si, Gyeonggi-do (Korea, Republic of); Byun, Seok-Soo [Seoul National University College of Medicine, Department of Urology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kim, Sang Eun [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of)

2014-02-15

We aimed to improve Tc-99m DTPA glomerular filtration rate (GFR) scintigraphy (Gates' method) in a prospective study using Cr-51 EDTA GFR test as a gold standard. Fifty-seven Tc-99m DTPA GFR scintigrams in 45 subjects (male/female = 33:12, age = 45.9 ± 17.6 years, 14 healthy volunteers and 31 nephrectomised patients) were compared using Cr-51 EDTA GFR tests. Using the %renal uptake of Tc-99m DTPA and Cr-51 EDTA GFR, a revised equation for GFR was established through linear regression analysis. The revised equation for improved GFR was GFR(mL/min) = (%renal uptake x 11.7773) - 0.7354. Gates' original GFRs (70.1 ± 20.5 mL/min/1.73 m{sup 2}) were significantly lower than Cr-51 EDTA GFRs (97.0 ± 31.9 mL/min/1.73 m{sup 2}; P < 0.0001), but the improved GFRs (98.0 ± 26.3 mL/min/1.73 m{sup 2}) were not different from (P = 0.7360) and had a significant correlation with (r = 0.73, P < 0.0001) the Cr-51 EDTA GFRs. The revised GFR equation effectively demonstrated perioperative GFR changes in kidneys that were operated on and the contralateral kidneys at 3 and 6 months post-partial nephrectomy (n = 25). GFR measurement using Tc-99m DTPA scintigraphy could be significantly improved by a revised equation derived from the comparison with Cr-51 EDTA GFR. (orig.)

End Stage and Chronic Kidney Disease:Associations with Renal Cancer

Directory of Open Access Journals (Sweden)

Paul eRusso

2012-04-01

Full Text Available There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephro pathological changes are commonly observed in the non tumor bearing portions of kidney resected at the time of partial and radical nephrectomy. In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with radical nephrectomy. Despite emerging evidence that partial nephrectomy provides equivalent local tumor control to radical nephrectomy while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

Laparoscopic resection of tumor recurrence after radical nephrectomy for localized renal cell carcinoma

Directory of Open Access Journals (Sweden)

Lessandro Curcio

2014-06-01

Full Text Available Introduction Local recurrence of Renal Cell Carcinoma (RCC after radical nephrectomy is a rare event. Some known risk factors are: clinical/pathological stage, locorregional disease and lyimph node positivity. Since up to 30-40% of patients can achieve a disease-free status, we show a case (video in which we performed a laparoscopic excision of a local RCC, taking advantage of all the well-known benefits of laparoscopy.Case report A 56 years old female with a history of open radical nephrectomy two years before was diagnosed with a mass at the time of surveillance CT imaging during follow-up. The suspected local recurrence was 12cm, and vascularized predominantly by tributaries originating from the iliac vessels. There was no other site of disease (i.e. brain, lung, liver, bones and laboratory tests were normal. Laparoscopic approach was approached, by inserting 4 trocars (2 of 10 and 2 of 5mm with the patient in the lateral position.Result The procedure lasted 130 minutes, with 220mL of estimated bleeding; the larger vessels were ligated with polymer clips (Hem-o-lok and the smaller handled by ultrasonic clamp. The specimen was removed by a small incision below the umbilicus in an appropriate bag. The patient was feed in the first postoperative day and discharged on the third day. Histopathology revealed sarcoma, with a high degree of mitosis, and negative surgical margins. She was referred to medical oncology for adjuvant therapy consideration.Conclusion The laparoscopic resection of recurrent tumor should be encouraged in highly selected cases. The minimally invasive method, with its known advantages, especially for more debilitated patients, can be advantageous when applied to suitable cases.

Adjuvant Sunitinib for High-risk Renal Cell Carcinoma After Nephrectomy: Subgroup Analyses and Updated Overall Survival Results.

Science.gov (United States)

Motzer, Robert J; Ravaud, Alain; Patard, Jean-Jacques; Pandha, Hardev S; George, Daniel J; Patel, Anup; Chang, Yen-Hwa; Escudier, Bernard; Donskov, Frede; Magheli, Ahmed; Carteni, Giacomo; Laguerre, Brigitte; Tomczak, Piotr; Breza, Jan; Gerletti, Paola; Lechuga, Mariajose; Lin, Xun; Casey, Michelle; Serfass, Lucile; Pantuck, Allan J; Staehler, Michael

2018-01-01

Adjuvant sunitinib significantly improved disease-free survival (DFS) versus placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence after nephrectomy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59-0.98; p=0.03). To report the relationship between baseline factors and DFS, pattern of recurrence, and updated overall survival (OS). Data for 615 patients randomized to sunitinib (n=309) or placebo (n=306) in the S-TRAC trial. Subgroup DFS analyses by baseline risk factors were conducted using a Cox proportional hazards model. Baseline risk factors included: modified University of California Los Angeles integrated staging system criteria, age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS), weight, neutrophil-to-lymphocyte ratio (NLR), and Fuhrman grade. Of 615 patients, 97 and 122 in the sunitinib and placebo arms developed metastatic disease, with the most common sites of distant recurrence being lung (40 and 49), lymph node (21 and 26), and liver (11 and 14), respectively. A benefit of adjuvant sunitinib over placebo was observed across subgroups, including: higher risk (T3, no or undetermined nodal involvement, Fuhrman grade ≥2, ECOG PS ≥1, T4 and/or nodal involvement; hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55-0.99; p=0.04), NLR ≤3 (HR 0.72, 95% CI 0.54-0.95; p=0.02), and Fuhrman grade 3/4 (HR 0.73, 95% CI 0.55-0.98; p=0.04). All subgroup analyses were exploratory, and no adjustments for multiplicity were made. Median OS was not reached in either arm (HR 0.92, 95% CI 0.66-1.28; p=0.6); 67 and 74 patients died in the sunitinib and placebo arms, respectively. A benefit of adjuvant sunitinib over placebo was observed across subgroups. The results are consistent with the primary analysis, which showed a benefit for adjuvant sunitinib in patients at high risk of recurrent RCC after nephrectomy. Most subgroups of patients at high risk of recurrent renal cell carcinoma after

Modeling pN2 through Geological Time: Implications for Planetary Climates and Atmospheric Biosignatures.

Science.gov (United States)

Stüeken, E E; Kipp, M A; Koehler, M C; Schwieterman, E W; Johnson, B; Buick, R

2016-12-01

Nitrogen is a major nutrient for all life on Earth and could plausibly play a similar role in extraterrestrial biospheres. The major reservoir of nitrogen at Earth's surface is atmospheric N 2 , but recent studies have proposed that the size of this reservoir may have fluctuated significantly over the course of Earth's history with particularly low levels in the Neoarchean-presumably as a result of biological activity. We used a biogeochemical box model to test which conditions are necessary to cause large swings in atmospheric N 2 pressure. Parameters for our model are constrained by observations of modern Earth and reconstructions of biomass burial and oxidative weathering in deep time. A 1-D climate model was used to model potential effects on atmospheric climate. In a second set of tests, we perturbed our box model to investigate which parameters have the greatest impact on the evolution of atmospheric pN 2 and consider possible implications for nitrogen cycling on other planets. Our results suggest that (a) a high rate of biomass burial would have been needed in the Archean to draw down atmospheric pN 2 to less than half modern levels, (b) the resulting effect on temperature could probably have been compensated by increasing solar luminosity and a mild increase in pCO 2 , and (c) atmospheric oxygenation could have initiated a stepwise pN 2 rebound through oxidative weathering. In general, life appears to be necessary for significant atmospheric pN 2 swings on Earth-like planets. Our results further support the idea that an exoplanetary atmosphere rich in both N 2 and O 2 is a signature of an oxygen-producing biosphere. Key Words: Biosignatures-Early Earth-Planetary atmospheres. Astrobiology 16, 949-963.

MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

Directory of Open Access Journals (Sweden)

Nitin P Ghonge

2014-01-01

Full Text Available As Laparoscopic Donor Nephrectomy (LDN offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.

Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

Directory of Open Access Journals (Sweden)

Budrikis Algimantas

2012-08-01

Full Text Available Abstract Background The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. Clinical case A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. Diagnosis Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. Treatment We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

Gamma rays from the 31P(n, γ)32P reaction

NARCIS (Netherlands)

Middelkoop, G. van

1967-01-01

The 31P(n, γ)32P reaction is studied with a 5 cm3 Ge(Li) counter. Altogether, 54 γ-rays are detected with experimental energy errors between 0.4 and 3.0 keV. The Q-value of the reaction is determined as Q = 7936.8±0.8 keV.

Pharmacological characterisation of the highly NaV1.7 selective spider venom peptide Pn3a

OpenAIRE

Jennifer R. Deuis; Zoltan Dekan; Joshua S. Wingerd; Jennifer J. Smith; Nehan R. Munasinghe; Rebecca F. Bhola; Wendy L. Imlach; Volker Herzig; David A. Armstrong; K. Johan Rosengren; Frank Bosmans; Stephen G. Waxman; Sulayman D. Dib-Hajj; Pierre Escoubas; Michael S. Minett

2017-01-01

Human genetic studies have implicated the voltage-gated sodium channel NaV1.7 as a therapeutic target for the treatment of pain. A novel peptide, ?-theraphotoxin-Pn3a, isolated from venom of the tarantula Pamphobeteus nigricolor, potently inhibits NaV1.7 (IC50 0.9?nM) with at least 40?1000-fold selectivity over all other NaV subtypes. Despite on-target activity in small-diameter dorsal root ganglia, spinal slices, and in a mouse model of pain induced by NaV1.7 activation, Pn3a alone displayed...

Do the different types of renal surgery impact the quality of life in the postoperative period?

DEFF Research Database (Denmark)

Azawi, Nessn H.; Tesfalem, H; Dahl, C

2015-01-01

was associated with a significant decrease in emotional functioning and role functioning compared with never thinking about one's cancer. CONCLUSION: Total nephrectomy was a negative predictor of overall global health status. There is a demand for a reasonable follow-up program with an individual control......PURPOSE: Because more than 70 % of patients with localized tumors experience 10 years of cancer-specific survival, their quality of life (QoL) after surgery is important. The aim of this study was to explore the impact of the type of surgery (partial vs. total nephrectomy) and the postoperative...... outcome on the QoL of patients with renal cancer. METHODS: A total of 205 patients underwent partial or total nephrectomy at the Department of Urology, Roskilde Hospital, between February 2008 and June 2013 and survived until the time of the survey. The European Organization for Research and Treatment...

Randomized clinical trial of transversus abdominis plane block versus placebo control in live-donor nephrectomy.

Science.gov (United States)

Hosgood, Sarah A; Thiyagarajan, Umasanker M; Nicholson, Harriet F L; Jeyapalan, Inthira; Nicholson, Michael L

2012-09-15

Laparoscopic surgery reduces pain after donor nephrectomy; however, most patients still require a significant amount of postoperative parenteral opiate analgesia. Therefore, there is a need to investigate techniques that might further reduce postoperative pain. This study assessed the safety and efficacy of using a transversus abdominis plane (TAP) block in a randomized, double-blind, placebo-controlled trial. Forty-six patients were analyzed in the trial and were randomized to undergo the TAP block procedure with either bupivacaine (n=24) or saline placebo (Control n=22) injected into the muscle plane. Prefilled syringes were dispensed with the group allocation concealed to maintain blinding. After surgery, the amount of morphine, level of pain, and measures of recovery were recorded. The amount of morphine used 6 hr after surgery was significantly lower in patients receiving TAP block with bupivacaine compared with the control (presented as mean [SD], 12.4 [8.4] vs. 21.2 [14.0] mg; P=0.015). However, the total amount of morphine used was similar in both groups 45.6 [31.4] vs. 52.7 [28.8] mg; P=0.771. Patients in the bupivacaine group experienced significantly less pain on postoperative days 1 (score, 19 [15] vs. 37 [20]; P=0.003) and 2 (score, 11 [10] vs. 19 [13]; P=0.031). Recovery and postoperative hospital stay were similar in both groups. There were no complications associated with the procedure. The TAP block procedure is beneficial in reducing postoperative pain and early morphine requirements in laparoscopic live-donor nephrectomy.

Ozone Therapy on Rats Submitted to Subtotal Nephrectomy: Role of Antioxidant System

Directory of Open Access Journals (Sweden)

José Luis Calunga

2005-01-01

Full Text Available Chronic renal failure (CRF represents a world health problem. Ozone increases the endogenous antioxidant defense system, preserving the cell redox state. The aim of this study is to evaluate the effect of ozone/oxygen mixture in the renal function, morphology, and biochemical parameters, in an experimental model of CRF (subtotal nephrectomy. Ozone/oxygen mixture was applied daily, by rectal insufflation (0.5 mg/kg for 15 sessions after the nephrectomy. Renal function was evaluated, as well as different biochemical parameters, at the beginning and at the end of the study (10 weeks. Renal plasmatic flow (RPF, glomerular filtration rate (GFR, the urine excretion index, and the sodium and potassium excretions (as a measurement of tubular function in the ozone group were similar to those in Sham group. Nevertheless, nephrectomized rats without ozone (positive control group showed the lowest RPF, GFR, and urine excretion figures, as well as tubular function. Animals treated with ozone showed systolic arterial pressure (SAP figures lower than those in the positive control group, but higher values compared to Sham group. Serum creatinine values and protein excretion in 24 hours in the ozone group were decreased compared with nephrectomized rats, but were still higher than normal values. Histological study demonstrated that animals treated with ozone showed less number of lesions in comparison with nephrectomized rats. Thiobarbituric acid reactive substances were significantly increased in nephrectomized and ozone-treated nephrectomized rats in comparison with Sham group. In the positive control group, superoxide dismutase (SOD and catalase (CAT showed the lowest figures in comparison with the other groups. However, ozone/oxygen mixture induced a significant stimulation in the enzymatic activity of CAT, SOD, and glutathione peroxidase, as well as reduced glutathione in relation with Sham and positive control groups. In this animal model of CRF, ozone

Isospin excitation of nucleus in 42,44,48Ca (p,n)42,44,48Sc

International Nuclear Information System (INIS)

Suzuki, Keiji

2002-01-01

To obtain information of (p,n) reaction of heavy nucleus in 100 MeV or less, 42,44,48 Ca(p,n) 42,44,48 Sc was observed on the Cyclotron Radio Isotope Center in Tohoku University. The experimental results showed that 7, 8 and 10 spin parities were determined for 42 Sc, 44 Sc and 48 SC, respectively. It was the first determination of one and two negative parity transition of 42 Sc and 48 Sc,respectively, by (p,n) reaction. The full space wave function made by 0f1p shell effective interaction by Richter,et al is good accuracy and reliability. On the (p,n) reaction at E p =35 MeV, the transition matrix elements of 42 Ca, 44 Ca and 48 Ca were derived. On the experiment of 42 Ca(p,n) 42 Sc at E p 2 on energy was agreed with the calculation results by Franey and Love. The nuclear structure of 42 Ca was thought to show more stronger U(4) symmetry, because strong GT transition at T=1 was not observed, which was expected by j-j bonding shell model calculation. (S.Y.)

Characteristics of electroplated Ni thick film on the PN junction semiconductor for beta-voltaic battery

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin Joo; Uhm, Young Rang; Park, Keun Young; Son, Kwang Jae [Radioisotope Research Division, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2014-12-15

Nickel (Ni) electroplating was implemented by using a metal Ni powder in order to establish a {sup 63}Ni plating condition on the PN junction semiconductor needed for production of betavoltaic battery. PN junction semiconductors with a Ni seed layer of 500 and 1000 Å were coated with Ni at current density from 10 to 50 mA cm{sup -2}. The surface roughness and average grain size of Ni deposits were investigated by XRD and SEM techniques. The roughness of Ni deposit was increased as the current density was increased, and decreased as the thickness of Ni seed layer was increased. The results showed that the optimum surface shape was obtained at a current density of 10 mA cm{sup -2} in seed layer with thickness of 500 Å, 20 mA cm{sup -2} of 1000 Å. Also, pure Ni deposit was well coated on a PN junction semiconductor without any oxide forms. Using the line width of (111) in XRD peak, the average grain size of the Ni thick firm was measured. The results showed that the average grain size was increased as the thickness of seed layer was increased.

Characteristics of electroplated Ni thick film on the PN junction semiconductor for beta-voltaic battery

International Nuclear Information System (INIS)

Kim, Jin Joo; Uhm, Young Rang; Park, Keun Young; Son, Kwang Jae

2014-01-01

Nickel (Ni) electroplating was implemented by using a metal Ni powder in order to establish a 63 Ni plating condition on the PN junction semiconductor needed for production of betavoltaic battery. PN junction semiconductors with a Ni seed layer of 500 and 1000 Å were coated with Ni at current density from 10 to 50 mA cm -2 . The surface roughness and average grain size of Ni deposits were investigated by XRD and SEM techniques. The roughness of Ni deposit was increased as the current density was increased, and decreased as the thickness of Ni seed layer was increased. The results showed that the optimum surface shape was obtained at a current density of 10 mA cm -2 in seed layer with thickness of 500 Å, 20 mA cm -2 of 1000 Å. Also, pure Ni deposit was well coated on a PN junction semiconductor without any oxide forms. Using the line width of (111) in XRD peak, the average grain size of the Ni thick firm was measured. The results showed that the average grain size was increased as the thickness of seed layer was increased

High-efficiency p-n junction oxide photoelectrodes for photoelectrochemical water splitting.

Science.gov (United States)

Liu, Zhifeng; Yan, Lu

2016-11-16

Development of all oxide p-n junctions makes a significant advancement in photoelectrode catalysis functional materials. In this article, we report the preparation of TiO 2 nanorod (NR)/Cu 2 O photoanodes via a simple hydrothermal method followed by an electrochemical deposition process. This facile synthesis route can simultaneously achieve uniform TiO 2 NR/Cu 2 O composite nanostructures and obtain varied amounts of Cu 2 O by controlling the deposition time. The photocurrent density of TiO 2 NR/Cu 2 O heterojunction photoanodes enhanced the photocatalytic activity with a photocurrent density of 5.25 mA cm -2 at 1.23 V versus RHE compared to pristine TiO 2 NR photoanodes under the same conditions. It is demonstrated that the presence of Cu 2 O has played an important role in expanding the spectral response region and reducing the photogenerated charge recombination rate. More importantly, the results provide new insights into the performance of all oxide p-n junctions as photoanodes for PEC water splitting.

The problem of crowd crimes: the approach of P.N. Obninskiy

Directory of Open Access Journals (Sweden)

Gorbatov D.S.

2014-09-01

Full Text Available We describe the specific approach to crowd crimes proposed by prominent Russian lawyer and public figure of the XIX century P.N. Obninskiy. We clarify its fundamental differences from other concepts of Russian and foreign psychologists and lawyers. Particular attention is paid to the P.N. Obninskiy treatment of possible sanity and responsibility of participants of mass cholera riots of the late XIX century in various regions of the Russian Empire. We reveal the moral potential of his views. Crowd as a social associations, the personality changes in the crowd, the crowd propensity to violate the law, the issue of punishment for crimes committed by it – these are some of the questions that interested the public opinion of the time. The article emphasizes that the lack of trust and lack of equal dialogue between representatives of different social groups have played a negative role in the development of «contagion morale», and later became reasons for the even more tragic events of Russian history.

Direct assessment of p-n junctions in single GaN nanowires by Kelvin probe force microscopy

Science.gov (United States)

Minj, Albert; Cros, Ana; Auzelle, Thomas; Pernot, Julien; Daudin, Bruno

2016-09-01

Making use of Kelvin probe force microscopy, in dark and under ultraviolet illumination, we study the characteristics of p-n junctions formed along the axis of self-organized GaN nanowires (NWs). We map the contact potential difference of the single NW p-n junctions to locate the space charge region and directly measure the depletion width and the junction voltage. Simulations indicate a shrinkage of the built-in potential for NWs with small diameter due to surface band bending, in qualitative agreement with the measurements. The photovoltage of the NW/substrate contact is studied by analyzing the response of NW segments with p- and n-type doping under illumination. Our results show that the shifts of the Fermi levels, and not the changes in surface band bending, are the most important effects under above band-gap illumination. The quantitative electrical information obtained here is important for the use of NW p-n junctions as photovoltaic or rectifying devices at the nanoscale, and is especially relevant since the technique does not require the formation of ohmic contacts to the NW junction.

Relativistic pn-QRPA to the double beta decay

International Nuclear Information System (INIS)

Conti, Claudio de; Krmpotic, F.; Carlson, Brett Vern

2010-01-01

Full text: In nature there are about 50 nuclear systems where the single beta-decay is energetically forbidden, and double- beta decay turns out to be only possible mode of disintegration. It is the nuclear pairing force which causes such an 'anomaly', by making the mass of the odd-odd isobar, (N - 1;Z + 1), to be greater than the masses of its even-even neighbors, (N;Z) and (N - 2;Z +2). The modes by which the double-beta decay can take place are connected with the neutrino and antineutrino distinction. In case the lepton number is strictly conserved the neutrino is a Dirac fermion and the two-neutrino mode is the only possible mode of disintegration. On the other hand, if this conservation is violated, the neutrino is a Majorana particle and neutrinoless double-beta decay also can occur. Both two-neutrino and neutrinoless double-beta decay processes have attracted much attention, because a comparison between experiment and theory for the first, provides a measure of confidence one may have in the nuclear wave function employed for extracting the unknown parameters from neutrinoless lifetime measurements. The proton-neutron (pn) quasiparticle random phase approximation (QRPA) has turned out be the most simple model for calculating the nuclear wave function involved in the double-beta decay transitions. In this work the transition matrix elements for 0 + -> 0 + double-beta decay are calculated for 48 Ca, 76 Ge, 82 Se, 100 Mo, 128 Te and 130 Te nuclei, using a relativistic pn-QRPA based on Hartree-Bogoliubov approximation to the single-particle motion. (author)

Positive Temperature Coefficient of Breakdown Voltage in 4H-SiC PN Junction Rectifiers

National Research Council Canada - National Science Library

Neudeck, Philip

1998-01-01

...-suited SiC polytype for power device implementation. This paper reports the first experimental measurements of stable positive temperature coefficient behavior observed in 4H-SiC pn junction rectifiers...

Narrow-band light emission from a single carbon nanotube p-n diode

Science.gov (United States)

Kinoshita, Megumi; Mueller, Thomas; Steiner, Mathias; Perebeinos, Vasili; Bol, Ageeth; Farmer, Damon; Avouris, Phaedon

2010-03-01

We present the first observation of electroluminescence from electrostatically-generated carbon nanotube (CNT) p-n junctions[1]. While CNT optoelectronics has made much progress in recent years, observations of emission from electrically excited CNT devices have been limited to the high-bias regime and with low efficiency. Furthermore, the resulting broad linewidths are broad, making it difficult to investigate electronic levels and carrier dynamics. We find that p-n junctions allow for better carrier control at lower power inputs, resulting in emission with near-zero threshold, low self-heating and efficiency two to three orders of magnitude greater compared to previous device configurations. This yields higher signal-to-noise ratio and narrower linewidths (down to ˜35 meV) that allows us to identify localized excitonic transitions that have previously been observed only in photoluminescent studies. [1] T. Mueller, M. Kinoshita, M. Steiner, V. Perebeinos, A. Bol, D. Farmer, and Ph. Avouris, Nature Nanotech., web publication, November 15 2009.

Changes in glomerular filtration rate, lithium clearance and plasma protein clearances in the early phase after unilateral nephrectomy in living healthy renal transplant donors

DEFF Research Database (Denmark)

Strandgaard, S; Kamper, A; Skaarup, P

1988-01-01

1. Glomerular and tubular function was studied before and 2 months after unilateral nephrectomy in 14 healthy kidney donors by measurement of the clearances of 51Cr-labelled ethylenediaminetetra-acetate, lithium, beta 2-microglobulin, albumin and immunoglobulin G. 2. The glomerular filtration rat...

Tuning of optical and electrical properties of wide band gap Fe:SnO{sub 2}/Li:NiO p-n junctions using 80 MeV oxygen ion beam

Energy Technology Data Exchange (ETDEWEB)

Mistry, Bhaumik V.; Joshi, U.S. [Gujarat University, Department of Physics, School of Sciences, Ahmedabad (India); Avasthi, D.K. [Inter University Accelerator Centre, New Delhi (India)

2016-12-15

Electrical and optical properties of pristine and swift heavy ion (SHI) irradiated p-n junction diode have been investigated for advanced electronics application. Fe:SnO{sub 2}/Li:NiO p-n junction was fabricated by using pulsed laser deposition on c-sapphire substrate. The optical band gaps of Fe:SnO{sub 2} and Li:NiO films were obtained to be 3.88 and 3.37 eV, respectively. The current-voltage characteristics of the oxide-based p-n junction showed a rectifying behaviour with turn-on voltage of 0.95 V. The oxide-based p-n junction diode was irradiated to 80 MeV O{sup +6} ions with 1 x 10{sup 12} ions/cm{sup 2} fluence. Decrease in grain size due to SHI irradiation is confirmed by the grazing angle X-ray diffraction and atomic force microscopy. In comparison with the pristine p-n junction diode, O{sup +6} ion irradiated p-n junction diode shows the increase of surface roughness and decrease of percentage transmittance in visible region. For irradiated p-n junction diode, current-voltage curve has still rectifying behaviour but exhibits lower turn-on voltage than that of virgin p-n junction diode. (orig.)

Effect of Free Ammonia, Free Nitrous Acid, and Alkalinity on the Partial Nitrification of Pretreated Pig Slurry, Using an Alternating Oxic/Anoxic SBR

Directory of Open Access Journals (Sweden)

Marisol Belmonte

2017-01-01

Full Text Available The effect of free ammonia (NH3 or FA, free nitrous acid (HNO2 or FNA, and total alkalinity (TA on the performance of a partial nitrification (PN sequencing batch reactor (SBR treating anaerobically pretreated pig slurry was studied. The SBR was operated under alternating oxic/anoxic (O/A conditions and was fed during anoxic phases. This strategy allowed using organic matter to partially remove nitrite (NO2- and nitrate (NO3- generated during oxic phases. The desired NH4+ to NO2- ratio of 1.3 g N/g N was obtained when an Ammonium Loading Rate (ALR of 0.09 g NH4+-N/L·d was applied. The system was operated at a solid retention time (SRT of 15–20 d and dissolved oxygen (DO levels higher than 3 mg O2/L during the whole operational period. PN mainly occurred caused by the inhibitory effect of FNA on nitrite oxidizing bacteria (NOB. Once HNO2 concentration was negligible, NH4+ was fully oxidized to NO3- in spite of the presence of FA. The use of biomass acclimated to ammonium as inoculum avoided a possible effect of FA on NOB activity.

Pharmacological characterisation of the highly NaV1.7 selective spider venom peptide Pn3a

OpenAIRE

Deuis, J. R.; Dekan, Z.; Wingerd, J. S.; Smith, J. J.; Munasinghe, N. R.; Bhola, R. F.; Imlach, W. L.; Herzig, V.; Armstrong, D. A.; Rosengren, K. J.; Bosmans, F.; Waxman, S. G.; Dib-Hajj, S. D.; Escoubas, P.; Minett, M. S.

2017-01-01

Human genetic studies have implicated the voltage-gated sodium channel NaV1.7 as a therapeutic target for the treatment of pain. A novel peptide, μ-theraphotoxin-Pn3a, isolated from venom of the tarantula Pamphobeteus nigricolor, potently inhibits NaV1.7 (IC50 0.9 nM) with at least 40-1000-fold selectivity over all other NaV subtypes. Despite on-target activity in small-diameter dorsal root ganglia, spinal slices, and in a mouse model of pain induced by NaV1.7 activation, Pn3a alone displayed...

Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules.

Science.gov (United States)

Mouraviev, Vladimir; Klein, Martina; Schommer, Eric; Thiel, David D; Samavedi, Srinivas; Kumar, Anup; Leveillee, Raymond J; Thomas, Raju; Pow-Sang, Julio M; Su, Li-Ming; Mui, Engy; Smith, Roger; Patel, Vipul

2016-03-01

In pursuit of improving the quality of residents' education, the Southeastern Section of the American Urological Association (SES AUA) hosts an annual robotic training course for its residents. The workshop involves performing a robotic live porcine nephrectomy as well as virtual reality robotic training modules. The aim of this study was to evaluate workload levels of urology residents when performing a live porcine nephrectomy and the virtual reality robotic surgery training modules employed during this workshop. Twenty-one residents from 14 SES AUA programs participated in 2015. On the first-day residents were taught with didactic lectures by faculty. On the second day, trainees were divided into two groups. Half were asked to perform training modules of the Mimic da Vinci-Trainer (MdVT, Mimic Technologies, Inc., Seattle, WA, USA) for 4 h, while the other half performed nephrectomy procedures on a live porcine model using the da Vinci Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA). After the first 4 h the groups changed places for another 4-h session. All trainees were asked to complete the NASA-TLX 1-page questionnaire following both the MdVT simulation and live animal model sessions. A significant interface and TLX interaction was observed. The interface by TLX interaction was further analyzed to determine whether the scores of each of the six TLX scales varied across the two interfaces. The means of the TLX scores observed at the two interfaces were similar. The only significant difference was observed for frustration, which was significantly higher at the simulation than the animal model, t (20) = 4.12, p = 0.001. This could be due to trainees' familiarity with live anatomical structures over skill set simulations which remain a real challenge to novice surgeons. Another reason might be that the simulator provides performance metrics for specific performance traits as well as composite scores for entire exercises. Novice trainees experienced

Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

Science.gov (United States)

Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

2013-01-01

Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. © 2013 John Wiley & Sons A/S.

A p-n heterojunction of CuI/TiO2 with enhanced photoelectrocatalytic activity for methanol electro-oxidation

International Nuclear Information System (INIS)

Sun, Mingjuan; Hu, Jiayue; Zhai, Chunyang; Zhu, Mingshan; Pan, Jianguo

2017-01-01

Highlights: •A p-n heterojunction of CuI/TiO 2 is constructed. •CuI/TiO 2 is used as the support for depositing Pt nanoparticles. •Enhanced catalytic activity of MOR by using Pt-CuI/TiO 2 under light irradiation. •Improved charger separation contributes to enhanced photoelectrocatalytic activity. -- Abstract: In this paper, a p-n heterojunction including p-type CuI and n-type TiO 2 is first time constructed to be the support for the deposition of Pt. The as-prepared Pt-CuI/TiO 2 modified electrode is studied for the electrocatalytic oxidation of methanol both in dark and under light illumination. Compare to traditional electrocatalytic oxidation, the electrocatalytic activity of Pt-CuI/TiO 2 for methanol oxidation is improved with 4.0 times upon light illumination. Moreover, compare to bare CuI and TiO 2 upon light illumination, the heterostructure of CuI/TiO 2 displays 4.3 and 9.1 times enhanced electrocatalytic activity for methanol oxidation, respectively. The synergistic effects of photocatalysis and electrocatalysis as well as the effective charge transport in the p-n heterojunction of Pt-CuI/TiO 2 contribute such big enhancement. The present studies indicate that the constructing of p-n heterojunction provides more insights in the fields of photoelectrochemical and photo–assisted fuel cell system.

Neutron fragmentation in the reaction pn to pX at 19 GeV/c

CERN Document Server

Bakken, V; Lundborg, P; Makela, J; Pimiä, M; Selldén, B; Sundell, E; Tuominiemi, J

1979-01-01

Data on the reaction pn to pX are extracted from a pd experiment in the CERN 2 m DBC at 10 GeV/c. The cross-section for neutron fragmentation events with mod t mod <1 (GeV/c)/sup 2/ determined and compared with data at high energies at fixed M/sub x//sup 2//s and t. The cross-section can be described with the triple-Regge formula taking into account only the pion exchange contributions, i.e. the pi pi P and pi pi R terms. A leading-particle effect consistent with the pion exchange model is observed in the longitudinal-momentum distribution of the negative pions in the final state of the reaction pn to pX, when transformed to the rest frame of the recoiling system X. (10 refs).

Preparation of TNAs/NiO p-n heterojunction and their applications in UV photosensor

Science.gov (United States)

Yusoff, M. M.; Mamat, M. H.; Malek, M. F.; Abdullah, M. A. R.; Ismail, A. S.; Saidi, S. A.; Mohamed, R.; Suriani, A. B.; Khusaimi, Z.; Rusop, M.

2018-05-01

A nanocomposite consisted of n-type titanium dioxide (TiO2) nanorod arrays (TNAs) and p-type nickel oxide (NiO) were deposited using a novel facile low-temperature aqueous chemical route (ACR) in a Schott bottle with cap clamps and sol-gel spin coating method, respectively on a transparent conductive oxide (TCO) glass substrate for the application of ultraviolet (UV) photosensor. The p-n heterojunction photosensor exhibited an increase in photocurrent under UV light (365 nm, 750 µW/cm2) at applied reverse bias. The measured UV response also revealed an increase in photocurrent, and dark current with increasing applied reverse bias on the p-n heterojunction. In this study, the fabricated TNAs/NiO composite nanostructures showed potential applications for photosensor based on the steady photocurrent results obtained under UV irradiation

First tests with fully depleted PN-CCD's

International Nuclear Information System (INIS)

Strueder, L.; Lutz, G.; Sterzik, M.; Holl, P.; Kemmer, J.; Prechtel, U.; Ziemann, T.; Rehak, P.

1987-01-01

We have fabricated 280 μm thick fully depletable pn CCD's on high resistivity silicon (/rho/ ∼ 2.5 kΩcm). Its operation is based on the semiconductor drift chamber principle proposed by Gatti and Rheak. They are designed as energy and position sensitive radiation detector for (minimum) ionizing particles and X-ray imaging. Two dimensional semiconductor device modeling demonstrates the basic charge transer mechanisms. Prototypes of the detectors have been tested in static and dynamic conditions. A preliminary charge transfer inefficiency was determined to 6 x 10/sup/minus/3/. The charge loss during the transfer is discussed and as a consequence we have developed an improved design for a second fabrication iteration which is now being produced. 4 refs., 15 figs

Medline Plus

Full Text Available ... Mission Medical Center, Merriam, KS, 05/04/2012) Kidney Cancer Robot Assisted Partial Nephrectomy Using Fluorescence (Shawnee ... Medical Center, Winston-Salem, NC, 09/17/2015) Kidneys and Urinary System Kidney Cancer Robot Assisted Partial ...

Relativistic pn-QRPA to the double beta decay

International Nuclear Information System (INIS)

Conti, Claudio de; Krmpotic, Francisco; Carlson, Brett Vern

2011-01-01

Full text: In nature there are about 50 nuclear systems where the single beta-decay is energetically forbidden, and double-beta decay turns out to be only possible mode of disintegration. It is the nuclear pairing force which causes such an 'anomaly', by making the mass of the odd-odd isobar, (N - 1;Z + 1), to be greater than the masses of its even-even neighbors, (N;Z) and (N - 2;Z +2). The modes by which the double-beta decay can take place are connected with the neutrino and antineutrino distinction. In case the lepton number is strictly conserved the neutrino is a Dirac fermion and the two-neutrino mode is the only possible mode of disintegration. On the other hand, if this conservation is violated, the neutrino is a Majorana particle and neutrinoless double-beta decay also can occur. Both two-neutrino and neutrinoless double-beta decay processes have attracted much attention, because a comparison between experiment and theory for the first, provides a measure of confidence one may have in the nuclear wave function employed for extracting the unknown parameters from neutrinoless lifetime measurements. The proton-neutron (pn) quasiparticle random phase approximation (QRPA) has turned out be the most simple model for calculating the nuclear wave function involved in the double-beta decay transitions. In this work the transition matrix elements for 0 + → 0 + double-beta decay are calculated for 48 Ca, 76 Ge, 82 Se, 100 Mo, 128 Te and 130 Te nuclei, using a relativistic pn-QRPA based on Hartree-Bogoliubov approximation to the single-particle motion. (author)

Bio-inspired nanostructures for implementing vertical pn-junctions

KAUST Repository

Saffih, Faycal

2011-08-04

An apparatus, system, and method having a 3D pn-junction structure are presented. One embodiment of an apparatus includes a substrate, a first doped structure, and a second doped structure. In one embodiment, the first doped structure has a first doping type. The first doped structure may be formed above the substrate and extend outwardly from an upper surface of the substrate. In one embodiment, the second doped structure has a second doping type. The second doped structure may be formed above the substrate and in contact with the first doped structure. Additionally, the second doped structure may extend outwardly from the upper surface of the substrate.

Bio-inspired nanostructures for implementing vertical pn-junctions

KAUST Repository

Saffih, Faycal

2011-01-01

An apparatus, system, and method having a 3D pn-junction structure are presented. One embodiment of an apparatus includes a substrate, a first doped structure, and a second doped structure. In one embodiment, the first doped structure has a first doping type. The first doped structure may be formed above the substrate and extend outwardly from an upper surface of the substrate. In one embodiment, the second doped structure has a second doping type. The second doped structure may be formed above the substrate and in contact with the first doped structure. Additionally, the second doped structure may extend outwardly from the upper surface of the substrate.

Electronic transmission through p-n and n-p-n junctions of graphene

Energy Technology Data Exchange (ETDEWEB)

Setare, M R [Department of Science of Bijar, University of Kurdistan, Bijar (Iran, Islamic Republic of); Jahani, D, E-mail: rezakord@ipm.co, E-mail: Dariush110@gmail.co [Department of Physics, Razi University, Kermanshah (Iran, Islamic Republic of)

2010-06-23

In this paper, we first evaluate the electronic transmission of Dirac fermions into a p-n junction of gapped graphene and show that the final result depends on the sign of the refractive index, n. We also, by considering the appropriate wavefunctions in the region of the electrostatic potential, show that both transmission and the reflection probability turn out to be positive and less than unity instead of the negative transmission and higher than unity reflection coefficient commonly referred to as the Klein paradox. We then obtain the transmission probability corresponding to a special p-n junction for which there exists a region in which the low energy excitations of graphene acquire a finite mass and, interestingly, find that in this case the transmission is independent of the index of refraction, in contrast with the corresponding result for gapped graphene. We then discuss the validity of the solutions reported in some of the papers cited in this work which, considering the Buettiker formula, turn out to lead to the wrong results for conductivity.

The X-ray mirror telescope and the pn-CCD detector of CAST

CERN Document Server

Kuster, M; Englhauser, J; Franz, J; Friedrich, P; Hartmann, R; Kang, D; Kotthaus, R; Lutz, Gerhard; Moralez, J; Serber, W; Strüder, L

2004-01-01

The Cern Axion Solar Telescope - CAST - uses a prototype 9 Tesla LHC superconducting dipole magnet to search for a hypothetical pseudoscalar particle, the axion, which was proposed by theory in the 1980s to solve the strong CP problem and which could be a dark matter candidate. In CAST a strong magnetic field is used to convert the solar axions to detectable photons via inverse Primakoff effect. The resulting X-rays are thermally distributed in the energy range of 1-7 keV and can be observed with conventional X-ray detectors. The most sensitive detector system of CAST is a pn-CCD detector originally developed for XMM-Newton combined with a Wolter I type X-ray mirror system. The combination of a focusing X-ray optics and a state of the art pn-CCD detector which combines high quantum efficiency, good spacial and energy resolution, and low background improves the sensitivity of the CAST experiment such that for the first time the axion photon coupling constant can be probed beyond the best astrophysical constrai...

Effect of parenteral nutrition on the bone marrow recovery under exsperimental conditions of uneven irradiation

International Nuclear Information System (INIS)

Moroz, B.B.; Fedorovskij, L.L.; Deshevoj, Yu.B.

1986-01-01

Using white rats-males the effect of parenteral nutrition (PN) on blood formation (hemopoiesis) recovery under the conditions of total (control), subtotal (shielding of animal hind limb) with 7.5 Gy and X-ray partial irradiation of abdomen region with the 13.5 Gy has been studied. It has been found that bone marrow recovery increases either at subtotal or partial irradiation under the conditions of PN. Mechanisms of PN favourable effect are discussed. The advisability of using PN under uneven irradiations of organism is indicated

An experimental study of 99Tcm-PnAO-nitroimidazole and 99Tcm-HL91 in detection of myocardial hypoxia

International Nuclear Information System (INIS)

Yao Zhiming; Liu Xiujie; Shi Rongfang; Guo Feng; Liu Yunzhong; Wang Qi; Wei Hongxing; Zhu Lin

1999-01-01

Objective: To investigate the biological characteristics of two hypoxic-avid imaging agents, 99 Tc m -PnAO-nitroimidazole and 99 Tc m -HL91, and the experimental myocardial hypoxia, low perfusion and ischemic reperfusion were performed. Methods: Isolated rat hearts were retrograde perfused with Kerbs-Henscleit buffer (KH) in four phantoms: control, low perfusion, ischemic reperfusion and hypoxia. Control hearts were perfused with 95% O 2 and 5% CO 2 balanced KH at 9∼10 mL/min rate. Low perfusion hearts were perfused with the same KH at 1 mL/min rate, and ischemic reperfusion rat hearts were discontinued perfusion for 20 min then reperfused with the same KH. Hypoxic hearts were perfused with 100% N 2 balanced KH. Results: 1) At 30 and 60 min, the radioactivity ratio of liver to heart (L/H) was 11.6 and 6.9 ( 99 Tc m -PnAO-nitroimidazole), and 5.7 and 6.2 ( 99 Tc m -HL91), respectively. The lung to heart ratios at 60 min of 99 Tc m -PnAO-nitroimidazole and 99 Tc m -HL91 were 1.8 and 2.1, respectively 2) The accumulation of 99 Tc m -PnAo-nitroimidazole in the hypoxic, low perfusion and ischemic hearts was 4.8, 3.7 and 2.8 times that in the control hearts. At 60 min after starting washout, the retentions of 99 Tc m -PnAO-nitroimidazole in hypoxic, low flow and ischemic reperfusion myocardium were much higher than that of control hearts [(23.7 +- 9.1)%]. The accumulation of 99 Tc m -HL91 in the hypoxic and low perfusion hearts was also significantly higher than that in the control and ischemic reperfusion hearts, P 99 Tc m -HL91 in the low perfusion heart was 5.34, 3.43 and 1.23 times those of control, ischemic reperfusion and hypoxic hearts, respectively. Conclusions: 99 Tc m -PnAO-nitroimidazole can be accumulated in low perfusion, ischemic reperfusion and hypoxic hearts, while 99 Tc m -HL91 is mainly accumulated in hypoxic, specially low perfusion hearts. Since there is a high L/H in perfusions with either agent, the detecting of inferoposterior wall may be

Enhanced Photoelectrocatalytic Activity of BiOI Nanoplate-Zinc Oxide Nanorod p-n Heterojunction.

Science.gov (United States)

Kuang, Pan-Yong; Ran, Jing-Run; Liu, Zhao-Qing; Wang, Hong-Juan; Li, Nan; Su, Yu-Zhi; Jin, Yong-Gang; Qiao, Shi-Zhang

2015-10-19

The development of highly efficient and robust photocatalysts has attracted great attention for solving the global energy crisis and environmental problems. Herein, we describe the synthesis of a p-n heterostructured photocatalyst, consisting of ZnO nanorod arrays (NRAs) decorated with BiOI nanoplates (NPs), by a facile solvothermal method. The product thus obtained shows high photoelectrochemical water splitting performance and enhanced photoelectrocatalytic activity for pollutant degradation under visible light irradiation. The p-type BiOI NPs, with a narrow band gap, not only act as a sensitizer to absorb visible light and promote electron transfer to the n-type ZnO NRAs, but also increase the contact area with organic pollutants. Meanwhile, ZnO NRAs provide a fast electron-transfer channel, thus resulting in efficient separation of photoinduced electron-hole pairs. Such a p-n heterojunction nanocomposite could serve as a novel and promising catalyst in energy and environmental applications. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

C-H and H-H Bond Activation via Ligand Dearomatization/Rearomatization of a PN3P-Rhodium(I) Complex

KAUST Repository

Huang, Kuo-Wei

2015-04-13

A neutral complex PN3P-Rh(I)Cl (2) was prepared from a reaction of the PN3P pincer ligand (1) with [Rh(COD)Cl]2 (COD = 1,5-cyclooctadiene). Upon treatment with a suitable base, H–H and Csp2–H activation reactions can be achieved through the deprotonation/reprotonation of one of the N–H arms and dearomatization/rearomatization of the central pyridine ring with the oxidation state of Rh remaining I.

The 2H(e, e' p)n reaction at large energy transfers

NARCIS (Netherlands)

Willering, Hendrik Willem

2003-01-01

At the ELSA accelerator facillity in Bonn, Germany, we have measured the deutron "breakup" reaction 2H(e,e' p)n at four-momentum transfers around Q2 = -0 .20(GeV/c)2 with an electron beam energy of E0 = 1.6 GeV. The cross section has been determined for energy transfers extending from the

Characteristic features of silicon multijunction solar cells with vertical p-n junctions

International Nuclear Information System (INIS)

Guk, E.G.; Nalet, T.A.; Shvarts, M.Z.; Shuman, V.B.

1997-01-01

A relatively simple technology (without photolithography) based on diffusion welding and ion-plasma deposition of an insulating coating has been developed for fabricating multijunction silicon solar cells with vertical p-n junctions. The effective collection factor for such structures is independent of the wavelength of the incident light in the wavelength range λ=340-1080 nm

Measurement of rvec at signggd→pnπ0 at large nucleon momenta

International Nuclear Information System (INIS)

Adams, G.S.; Baghaei, H.; Caracappa, A.; Clayton, W.; D'Angelo, A.; Hoblit, S.; Khandaker, M.; Kistner, O.C.; Kobayashi, T.; Lindgren, R.; Miceli, L.; Ruth, C.; Sandorfi, A.M.; Schaerf, C.; Sealock, R.M.; Smith, L.C.; Stoler, P.; Tedeschi, D.J.; Thorn, C.E.; Thornton, S.T.; Vaziri, K.; Whisnant, C.S.; Winhold, E.J.

1995-01-01

Coincident protons and neutrons from the reaction rvec at signggd→pnπ 0 were measured at a photon energy of 290 MeV. Cross sections and beam asymmetries were extracted for nucleon momenta above the quasifree region for the first time. The measured cross sections are compared with the results of a cascade Monte Carlo calculation

Facile fabrication of p-n heterojunctions for Cu2O submicroparticles deposited on anatase TiO2 nanobelts

International Nuclear Information System (INIS)

Li, Li; Lei, Jingguo; Ji, Tianhao

2011-01-01

Graphical abstract: Cu 2 O particle-deposited TiO 2 nanobelts with p-n semiconductor heterojunction structure were successfully prepared via two-step preparation process, and their visible-light photodegradation activities of Rhodamine B were investigated in detail. Highlights: → Cu 2 O particle-deposited TiO 2 nanobelts mainly with diameters in a range of 200-400 nm were successfully prepared. → The amount of Cu 2 O particles deposited on TiO 2 nanobelts can be tuned. → The composite structure with Cu 2 O particles and TiO 2 nanobelts exhibits p-n semiconductor heterojunction performance. → Photocatalytic properties of such composites. -- Abstract: In this paper, Cu 2 O particle-deposited TiO 2 nanobelts with p-n semiconductor heterojunction structure were successfully prepared via a two-step preparation process to investigate electron-transfer performance between p-type Cu 2 O and n-type TiO 2 . Various measurement results confirm that the amount of pure Cu 2 O submicroparticles, with diameters within the range of 200-400 nm and deposited on the surface of TiO 2 nanobelts, can be controlled, and that the purity of Cu 2 O is heavily affected by reaction time. Visible-light photodegradation activities of Rhodamine B show that photocatalysts have little or no photocatalytic activities mainly due to their p-n heterojunction structure, indicating that there hardly appears any electron-transfer from Cu 2 O to TiO 2 .

Effect of Regional Hospital Competition and Hospital Financial Status on the Use of Robotic-Assisted Surgery.

Science.gov (United States)

Wright, Jason D; Tergas, Ana I; Hou, June Y; Burke, William M; Chen, Ling; Hu, Jim C; Neugut, Alfred I; Ananth, Cande V; Hershman, Dawn L

2016-07-01

Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. To examine the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. A cohort study of 221 637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The association between hospital competition, hospital financial status, and performance of robotic-assisted surgery was examined. The association between hospital competition was measured with the Herfindahl-Hirschman Index (HHI), hospital financial status was estimated as operating margin, and performance of robotic-assisted surgery was examined using multivariate mixed-effects regression models. We identified 221 637 patients who underwent one of the procedures of interest. The cohort included 30 345 patients who underwent radical prostatectomy; 20 802, total nephrectomy; 8060, partial nephrectomy; 134 985, hysterectomy; and 27 445, oophorectomy. Robotic-assisted operations were performed for 20 500 (67.6%) radical prostatectomies, 1405 (6.8%) total nephrectomies, 2759 (34.2%) partial nephrectomies, 14 047 (10.4%) hysterectomies, and 1782 (6.5%) oophorectomies. Use of robotic-assisted surgery increased for each procedure from January 2010 through December 2011. For all 5 operations, increased market competition (as measured by the HHI) was associated with increased use of robotic-assisted surgery. For prostatectomy, the risk ratios (95% CIs) for undergoing a robotic-assisted procedure were 2.20 (1.50-3.24) at hospitals in moderately competitive markets and 2.64 (1.84-3.78) for highly competitive markets

Photovoltaic characteristics of diffused P/+N bulk GaAs solar cells

Science.gov (United States)

Borrego, J. M.; Keeney, R. P.; Bhat, I. B.; Bhat, K. N.; Sundaram, L. G.; Ghandhi, S. K.

1982-01-01

The photovoltaic characteristics of P(+)N junction solar cells fabricated on bulk GaAs by an open tube diffusion technique are described in this paper.Spectral response measurements were analyzed in detail and compared to a computer simulation in order to determine important material parameters. It is projected that proper optimization of the cell parameters can increase the efficiency of the cells from 12.2 percent to close to 20 percent.

Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours.

Science.gov (United States)

Venkatramani, Vivek; Swain, Sanjaya; Satyanarayana, Ramgopal; Parekh, Dipen J

2017-06-01

Nephron-sparing surgery has emerged as the surgical treatment of choice for small renal masses over the past two decades, replacing the traditional teaching of radical nephrectomy for renal cell carcinoma. With time, there has been an evolution in the techniques and indications for partial nephrectomy. This review summarizes the current status of nephron-sparing surgery for renal carcinoma and also deals with the future of this procedure.

Tunnel currents produced by defects in p-n junctions of GaAs grown on vapor phase

International Nuclear Information System (INIS)

Barrales Guadarrama, V R; Rodríguez Rodriguez, E M; Barrales Guadarrama, R; Reyes Ayala, N

2017-01-01

With the purpose of assessing if the epitaxy on vapor phase technique “Close Space Vapor Deposition (CSVT)” is capable of produce thin films with adequate properties in order to manufacture p-n junctions, a study of invert and direct current was developed, in a temperature range of 94K to 293K, to junctions p-n of GaAs grown through the technique CSVT. It is shown that the dominant current, within the range 10 -7 to 10 -2 A, is consistent with a currents model of the type of internal emission form field, which shows these currents are due to the presence of localized states in the band gap. (paper)

Morphometric scores for renal tumors: What does the radiologist need to know?

Energy Technology Data Exchange (ETDEWEB)

Millet, Ingrid; Doyon, Fernanda Curros; Pages, Emma [Department of Imaging, CHU Montpellier (France); Thuret, Rodolphe [Department of Urology, CHU Montpellier (France); Taourel, Patrice, E-mail: p-taourel@chu-montpellier.fr [Department of Imaging, CHU Montpellier (France)

2014-08-15

Numerous therapeutic options are possible in the treatment of renal carcinomas including radical nephrectomy, partial nephrectomy, cryoablation, radiofrequency, active follow-up and among surgical treatments, different approaches may be used such as laparotomy, laparoscopy, robotic-assisted intervention. The choice between these different procedures is partially based on the anatomic conditions of the tumors. Different anatomic scores determined from cross-sectional imaging have been built to predict the complexity of the surgical procedure. The goals of this article are to review the relevant morphologic pattern for management of patients with renal tumors, to know how to calculate these different scores and to understand the clinical applications of these scores.

Morphometric scores for renal tumors: What does the radiologist need to know?

International Nuclear Information System (INIS)

Millet, Ingrid; Doyon, Fernanda Curros; Pages, Emma; Thuret, Rodolphe; Taourel, Patrice

2014-01-01

Numerous therapeutic options are possible in the treatment of renal carcinomas including radical nephrectomy, partial nephrectomy, cryoablation, radiofrequency, active follow-up and among surgical treatments, different approaches may be used such as laparotomy, laparoscopy, robotic-assisted intervention. The choice between these different procedures is partially based on the anatomic conditions of the tumors. Different anatomic scores determined from cross-sectional imaging have been built to predict the complexity of the surgical procedure. The goals of this article are to review the relevant morphologic pattern for management of patients with renal tumors, to know how to calculate these different scores and to understand the clinical applications of these scores

Chemically fixed p-n heterojunctions for polymer electronics by means of covalent B-F bond formation

Science.gov (United States)

Hoven, Corey V.; Wang, Huiping; Elbing, Mark; Garner, Logan; Winkelhaus, Daniel; Bazan, Guillermo C.

2010-03-01

Widely used solid-state devices fabricated with inorganic semiconductors, including light-emitting diodes and solar cells, derive much of their function from the p-n junction. Such junctions lead to diode characteristics and are attained when p-doped and n-doped materials come into contact with each other. Achieving bilayer p-n junctions with semiconducting polymers has been hindered by difficulties in the deposition of thin films with independent p-doped and n-doped layers. Here we report on how to achieve permanently fixed organic p-n heterojunctions by using a cationic conjugated polyelectrolyte with fluoride counteranions and an underlayer composed of a neutral conjugated polymer bearing anion-trapping functional groups. Application of a bias leads to charge injection and fluoride migration into the neutral layer, where irreversible covalent bond formation takes place. After the initial charging and doping, one obtains devices with no delay in the turn on of light-emitting electrochemical behaviour and excellent current rectification. Such devices highlight how mobile ions in organic media can open opportunities to realize device structures in ways that do not have analogies in the world of silicon and promise new opportunities for integrating organic materials within technologies now dominated by inorganic semiconductors.

Enhancement of breakdown voltage for fully-vertical GaN-on-Si p-n diode by using strained layer superlattice as drift layer

Science.gov (United States)

Mase, Suguru; Hamada, Takeaki; Freedsman, Joseph J.; Egawa, Takashi

2018-06-01

We have demonstrated a vertical GaN-on-Si p-n diode with breakdown voltage (BV) as high as 839 V by using a low Si-doped strained layer superlattice (SLS). The p-n vertical diode fabricated by using the n‑-SLS layer as a part of the drift layer showed a remarkable enhancement in BV, when compared with the conventional n‑-GaN drift layer of similar thickness. The vertical GaN-on-Si p-n diodes with 2.3 μm-thick n‑-GaN drift layer and 3.0 μm-thick n‑-SLS layer exhibited a differential on-resistance of 4.0 Ω · cm2 and a BV of 839 V.

Prevention of disease progression in a patient with a gastric cancer-re-recurrence. Outcome after intravenous treatment with the novel antineoplastic agent taurolidine. Report of a case

Directory of Open Access Journals (Sweden)

Menenakos Charalambos

2006-06-01

Full Text Available Abstract Background Taurolidine (TRD is a novel agent with multimodal antineoplastic effects. We present the case of a tumor remission after intravenous administration of taurolidine in a patient with gastric cancer re-recurrence. Case presentation A 58 years old male patient suffering from a gastric adenocarcinoma was submitted to partial gastrectomy and partial liver resection (pT2, pN1, pM1L (liver segment 2, N0, V0. 24 months later a local recurrence was diagnosed and the patient was reoperated. Postoperatively the patient underwent a palliative chemotherapy with eloxatin, FU, and leucovorin. A subsequent CT-revealed a liver metastasis and a recurrence adjacent to the hepatic artery. After successful radiofrequency ablation of the liver metastasis the patient was intravenously treated with 2% taurolidine. The patient endured the therapy well and no toxicity was observed. CT-scans revealed a stable disease without a tumor progression or metastatic spread. After 39 cycles the patient was submitted to left nephrectomy due to primary urothelial carcinoma and died 2 days later due to myocardial infarction. Postmortem histology of the esophageal-jejunal anastomosis and liver revealed complete remission of the known metastasized gastric adenocarcinoma. Conclusion The intravenous treatment with 2% taurolidine led to a histological remission of the tumor growth without any toxicity for the patient.

Inclusive production of. delta. /sup + +/(1232) in pn interactions at 19 GeV/c

Energy Technology Data Exchange (ETDEWEB)

Bakken, V.; Breivik, F.O.; Jacobsen, T.; Rudjord, A.L. (Oslo Univ. (Norway) Fysisk Inst.)

1982-12-21

We present a study of ..delta../sup + +/ production in pn interactions at 19 GeV/c, where the ..delta../sup + +/ is emitted in the protonlike (..delta..sub(F)/sup + +/) and neutron-like (..delta..sub(B)/sup + +/) c.m. hemispheres. The cross-section sigma(pn->..delta..sub(F)/sup + +/+X)=(3.09+-0.43) mb is about three times larger than sigma(pn->..delta..sub(B)/sup + +/+X)=(0.94+-0.34) mb. About 2/3 of ..delta..sub(F)/sup + +/ is peripherally produced with vertical stroketsub(p,..delta..)vertical stroke<1 (GeV/c)/sup 2/, while the cross-section for ..delta..sub(B)/sup + +/ production is nearly zero for vertical stroketsub(n,..delta..)vertical stroke<1 (GeV/c)/sup 2/. We have made a detailed study of the energy dependence of the reaction ap->..delta../sup + +/+X (a=p, anti p, n, ..pi..sup(+-), Ksup(+-)) for vertical stroketsub(p,..delta..)vertical stroke<1 (GeV/c)/sup 2/, by applying the same fitting procedure to extract the ..delta../sup + +/ cross-section to all available mass spectra. All the normalized cross-sections R=sigma(..delta../sup + +/)/sigmasub(inel) can be well described by R=R/sub 0/+R/sub 1/sup(a)psup(-..cap alpha..)sub(lab), where R/sub 0/ and ..cap alpha.. are the same for all reactions, while R/sub 1/sup(a) varies with the beam type a. The value of ..cap alpha.. is slightly below unity. The differential cross section of pn->..delta..sub(F)/sup + +/+X has been determined as a function of the variables t, t', x, y, psub(T)/sup 2/ and Msub(X)/sup 2/ both in the whole kinematical region and for vertical stroketsub(p,..delta..)vertical stroke<1 (GeV/c)/sup 2/. We show that the peripherally produced ..delta..sub(F)/sup + +/ is consistent with the dominance of the one-pion exchange mechanism. This follows from a study of the density matrix elements, the comparison of some properties of the system X with real ..pi../sup +/p data and from the results of a triple-Regge analysis.

Competition of the Peierls relief and structural defects in damping the domain walls in [Mn left brace (R/S)-pn right brace]2[Mn left brace(R/S)-pn right brace2(H2O)][Cr(CN)6]2 ferrimagnet

International Nuclear Information System (INIS)

Talantsev, A.D.; Kollak, O.V.; Kirman, M.V.; Morgunov, R.B.

2015-01-01

The [ [Mn left brace (R/S)-pn right brace] 2 [Mn left brace(R/S)-pn right brace 2 (H 2 O)][Cr(CN) 6 ] 2 molecular ferrimagnet exhibits an inverse sequence of changes in the domain wall motion regimes with increasing temperature in alternative magnetic field of 0.04-1400 Hz frequency. Initiation of the relaxation regime on the background of creep indicates that there are two different systems of the domain walls damping. The threshold amplitude of the alternative magnetic field corresponds to the Peierls relief contribution to the domain wall dynamics as well as the defect contribution usually considered.

Draft User Functionalities and Interfaces of PN Services (Low-Fi Prototyping)

DEFF Research Database (Denmark)

Karamolegkos, P.; Larsen, J. E.; Larsen, Lars Bo

2006-01-01

Internal report of WP1 Task 4 activities from January 2006 to August 2006. This report describes the draft user functionalities and coming user interfaces for PN services. It is a working document to be handed over to WP1 Task1 and Task3 for guidelines on specification. State of the art usability...... and user experience, conceptual design work on the two pilot services, MAGNET.CARE and Nomadic@Work, is described....

Oscillating Magnetoresistance in Graphene p-n Junctions at Intermediate Magnetic Fields.

Science.gov (United States)

Overweg, Hiske; Eggimann, Hannah; Liu, Ming-Hao; Varlet, Anastasia; Eich, Marius; Simonet, Pauline; Lee, Yongjin; Watanabe, Kenji; Taniguchi, Takashi; Richter, Klaus; Fal'ko, Vladimir I; Ensslin, Klaus; Ihn, Thomas

2017-05-10

We report on the observation of magnetoresistance oscillations in graphene p-n junctions. The oscillations have been observed for six samples, consisting of single-layer and bilayer graphene, and persist up to temperatures of 30 K, where standard Shubnikov-de Haas oscillations are no longer discernible. The oscillatory magnetoresistance can be reproduced by tight-binding simulations. We attribute this phenomenon to the modulated densities of states in the n- and p-regions.

Semiconducting ZnSnN{sub 2} thin films for Si/ZnSnN{sub 2} p-n junctions

Energy Technology Data Exchange (ETDEWEB)

Qin, Ruifeng [Hebei Engineering Laboratory of Photoelectronic Functional Crystals, Hebei University of Technology (HEBUT), Tianjin 300401 (China); Ningbo Institute of Material Technology and Engineering, Chinese Academy of Sciences, and Key Laboratory of Additive Manufacturing Materials of Zhejiang Province, Ningbo 315201 (China); Cao, Hongtao; Liang, Lingyan, E-mail: lly@nimte.ac.cn, E-mail: swz@hebut.edu.cn; Xie, Yufang; Zhuge, Fei; Zhang, Hongliang; Gao, Junhua; Javaid, Kashif [Ningbo Institute of Material Technology and Engineering, Chinese Academy of Sciences, and Key Laboratory of Additive Manufacturing Materials of Zhejiang Province, Ningbo 315201 (China); Liu, Caichi; Sun, Weizhong, E-mail: lly@nimte.ac.cn, E-mail: swz@hebut.edu.cn [Hebei Engineering Laboratory of Photoelectronic Functional Crystals, Hebei University of Technology (HEBUT), Tianjin 300401 (China)

2016-04-04

ZnSnN{sub 2} is regarded as a promising photovoltaic absorber candidate due to earth-abundance, non-toxicity, and high absorption coefficient. However, it is still a great challenge to synthesize ZnSnN{sub 2} films with a low electron concentration, in order to promote the applications of ZnSnN{sub 2} as the core active layer in optoelectronic devices. In this work, polycrystalline and high resistance ZnSnN{sub 2} films were fabricated by magnetron sputtering technique, then semiconducting films were achieved after post-annealing, and finally Si/ZnSnN{sub 2} p-n junctions were constructed. The electron concentration and Hall mobility were enhanced from 2.77 × 10{sup 17} to 6.78 × 10{sup 17 }cm{sup −3} and from 0.37 to 2.07 cm{sup 2} V{sup −1} s{sup −1}, corresponding to the annealing temperature from 200 to 350 °C. After annealing at 300 °C, the p-n junction exhibited the optimum rectifying characteristics, with a forward-to-reverse ratio over 10{sup 3}. The achievement of this ZnSnN{sub 2}-based p-n junction makes an opening step forward to realize the practical application of the ZnSnN{sub 2} material. In addition, the nonideal behaviors of the p-n junctions under both positive and negative voltages are discussed, in hope of suggesting some ideas to further improve the rectifying characteristics.

On the strong metric dimension of generalized butterfly graph, starbarbell graph, and {C}_{m}\\odot {P}_{n} graph

Science.gov (United States)

Yunia Mayasari, Ratih; Atmojo Kusmayadi, Tri

2018-04-01

Let G be a connected graph with vertex set V(G) and edge set E(G). For every pair of vertices u,v\\in V(G), the interval I[u, v] between u and v to be the collection of all vertices that belong to some shortest u ‑ v path. A vertex s\\in V(G) strongly resolves two vertices u and v if u belongs to a shortest v ‑ s path or v belongs to a shortest u ‑ s path. A vertex set S of G is a strong resolving set of G if every two distinct vertices of G are strongly resolved by some vertex of S. The strong metric basis of G is a strong resolving set with minimal cardinality. The strong metric dimension sdim(G) of a graph G is defined as the cardinality of strong metric basis. In this paper we determine the strong metric dimension of a generalized butterfly graph, starbarbell graph, and {C}mȯ {P}n graph. We obtain the strong metric dimension of generalized butterfly graph is sdim(BFn ) = 2n ‑ 2. The strong metric dimension of starbarbell graph is sdim(S{B}{m1,{m}2,\\ldots,{m}n})={\\sum }i=1n({m}i-1)-1. The strong metric dimension of {C}mȯ {P}n graph are sdim({C}mȯ {P}n)=2m-1 for m > 3 and n = 2, and sdim({C}mȯ {P}n)=2m-2 for m > 3 and n > 2.

Direct and indirect signal detection of 122 keV photons with a novel detector combining a pnCCD and a CsI(Tl) scintillator

Energy Technology Data Exchange (ETDEWEB)

Schlosser, D.M., E-mail: dieter.schlosser@pnsensor.de [PNSensor GmbH, Sckellstraße 3, 81667 München (Germany); Huth, M.; Hartmann, R. [PNSensor GmbH, Sckellstraße 3, 81667 München (Germany); Abboud, A.; Send, S. [Universität Siegen, Walter-Flex-Straße 3, 57072 Siegen (Germany); Conka-Nurdan, T. [Türkisch-Deutsche Universität, Sakinkaya Cad. 86, Beykoz, 34820 Istanbul (Turkey); Shokr, M.; Pietsch, U. [Universität Siegen, Walter-Flex-Straße 3, 57072 Siegen (Germany); Strüder, L. [PNSensor GmbH, Sckellstraße 3, 81667 München (Germany); Universität Siegen, Walter-Flex-Straße 3, 57072 Siegen (Germany)

2016-01-01

By combining a low noise fully depleted pnCCD detector with a CsI(Tl) scintillator, an energy-dispersive area detector can be realized with a high quantum efficiency (QE) in the range from below 1 keV to above 100 keV. In direct detection mode the pnCCD exhibits a relative energy resolution of 1% at 122 keV and spatial resolution of less than 75 µm, the pixel size of the pnCCD. In the indirect detection mode, i.e. conversion of the incoming X-rays in the scintillator, the measured energy resolution was about 9–13% at 122 keV, depending on the depth of interaction in the scintillator, while the position resolution, extracted with the help of simulations, was 30 µm only. We show simulated data for incident photons of 122 keV and compare the various interaction processes and relevant physical parameters to experimental results obtained with a radioactive {sup 57}Co source. - Highlights: • Position and energy resolving pnCCD+CsI(Tl) detector for energies from 1-150 keV • Detection in the pnCCD (122keV): 1% energy and <75µm spatial resolution • Detection in the scintillator (122keV): 9-12% energy and ~30µm spatial resolution.

The nonideality coefficient of current-voltage characteristics for p-n junctions in a high ultrahigh-frequency (microwave) field

International Nuclear Information System (INIS)

Shamirzaev, S. H.; Gulyamov, G.; Dadamirzaev, M. G.; Gulyamov, A. G.

2009-01-01

The effect of heating of electrons and holes on the nonideality coefficient of the current-voltage characteristic for a p-n junction in a high microwave field is studied. It is established that the nonideality coefficient for a diode depends on the type of charge carriers that make the major contribution to the current in the p-n junction. It is shown that, in some cases in silicon samples, the nonideality coefficient for the diode is governed by the temperature for holes in spite of the fact that the temperature for electrons is higher than the temperature for holes.

Relative cross-sections of In isomer production in the (pn) and (p,2n) reactions on Cd isotopes

Energy Technology Data Exchange (ETDEWEB)

Skakun, E A; Klyucharev, A P; Rakivnenko, Yu N; Romanij, I A [AN Ukrainskoi SSR, Kiev. Fiziko-Tekhnicheskii Inst.

1975-01-01

Ratios of excitation cross-sections for isomeric pairs are measured in a range of incident proton energy up to 20 MeV in the following reactions: sup(110)Cd(pn)sup(110*,g)In, sup(112)Cd(pn)sup(112*,g)In, sup(110)Cd(p,2n)sup(109*,g)In, sup(111)Cd(p,2n)sup(110*,g)In, and sup(113)Cd(p,2n)sup(112*,g)In. Calculations in terms of the equilibrium statistical theory have been performed for the same reactions. Comparison of the experiment with the theory yields better values for theoretical parameters.

5.0 kV breakdown-voltage vertical GaN p-n junction diodes

Science.gov (United States)

Ohta, Hiroshi; Hayashi, Kentaro; Horikiri, Fumimasa; Yoshino, Michitaka; Nakamura, Tohru; Mishima, Tomoyoshi

2018-04-01

A high breakdown voltage of 5.0 kV has been achieved for the first time in vertical GaN p-n junction diodes by using our newly developed guard-ring structures. A resistance device was inserted between the main diode portion and the guard-ring portion in a ring-shaped p-n diode to generate a voltage drop over the resistance device by leakage current flowing through the guard-ring portion under negatively biased conditions before breakdown. The voltage at the outer mesa edge of the guard-ring portion, where the electric field intensity is highest and the destructive breakdown usually occurs, is decreased by the voltage drop, so the electric field concentration in the portion is reduced. By adopting this structure, the breakdown voltage (V B) is raised by about 200 V. Combined with a low measured on-resistance (R on) of 1.25 mΩ cm2, Baliga’s figure of merit (V\\text{B}2/R\\text{on}) was as high as 20 GW/cm2.

Recent developments of the MARC/PN transport theory code including a treatment of anisotropic scatter

International Nuclear Information System (INIS)

Fletcher, J.K.

1987-12-01

The computer code MARC/PN provides a solution of the multigroup transport equation by expanding the flux in spherical harmonics. The coefficients of the series so obtained satisfy linked first order differential equations, and on eliminating terms associated with odd parity harmonics a second order system results which can be solved by established finite difference or finite element techniques. This report describes modifications incorporated in MARC/PN to allow for anisotropic scattering, and the modelling of irregular exterior boundaries in the finite element option. The latter development leads to substantial reductions in problem size, particularly for three dimensions. Also, links to an interactive graphics mesh generator (SUPERTAB) have been added. The final section of the report contains results from problems showing the effects of anisotropic scatter and the ability of the code to model irregular geometries. (author)

Atomistic nature in band-to-band tunneling in two-dimensional silicon pn tunnel diodes

International Nuclear Information System (INIS)

Tabe, Michiharu; Tan, Hoang Nhat; Mizuno, Takeshi; Muruganathan, Manoharan; Anh, Le The; Mizuta, Hiroshi; Nuryadi, Ratno; Moraru, Daniel

2016-01-01

We study low-temperature transport properties of two-dimensional (2D) Si tunnel diodes, or Si Esaki diodes, with a lateral layout. In ordinary Si Esaki diodes, interband tunneling current is severely limited because of the law of momentum conservation, while nanoscale Esaki diodes may behave differently due to the dopants in the narrow depletion region, by atomistic effects which release such current limitation. In thin-Si lateral highly doped pn diodes, we find clear signatures of interband tunneling between 2D-subbands involving phonon assistance. More importantly, the tunneling current is sharply enhanced in a narrow voltage range by resonance via a pair of a donor- and an acceptor-atom in the pn junction region. Such atomistic behavior is recognized as a general feature showing up only in nanoscale tunnel diodes. In particular, a donor-acceptor pair with deeper ground-state energies is likely to be responsible for such a sharply enhanced current peak, tunable by external biases.

Nitrous Oxide Production in a Granule-based Partial Nitritation Reactor: A Model-based Evaluation.

Science.gov (United States)

Peng, Lai; Sun, Jing; Liu, Yiwen; Dai, Xiaohu; Ni, Bing-Jie

2017-04-03

Sustainable wastewater treatment has been attracting increasing attentions over the past decades. However, the production of nitrous oxide (N 2 O), a potent GHG, from the energy-efficient granule-based autotrophic nitrogen removal is largely unknown. This study applied a previously established N 2 O model, which incorporated two N 2 O production pathways by ammonia-oxidizing bacteria (AOB) (AOB denitrification and the hydroxylamine (NH 2 OH) oxidation). The two-pathway model was used to describe N 2 O production from a granule-based partial nitritation (PN) reactor and provide insights into the N 2 O distribution inside granules. The model was evaluated by comparing simulation results with N 2 O monitoring profiles as well as isotopic measurement data from the PN reactor. The model demonstrated its good predictive ability against N 2 O dynamics and provided useful information about the shift of N 2 O production pathways inside granules for the first time. The simulation results indicated that the increase of oxygen concentration and granule size would significantly enhance N 2 O production. The results further revealed a linear relationship between N 2 O production and ammonia oxidation rate (AOR) (R 2  = 0.99) under the conditions of varying oxygen levels and granule diameters, suggesting that bulk oxygen and granule size may exert an indirect effect on N 2 O production by causing a change in AOR.

InGaN pn-junctions grown by PA-MBE: Material characterization and fabrication of nanocolumn electroluminescent devices

Science.gov (United States)

Gherasoiu, I.; Yu, K. M.; Reichertz, L.; Walukiewicz, W.

2015-09-01

PN junctions are basic building blocks of many electronic devices and their performance depends on the structural properties of the component layers and on the type and the amount of the doping impurities incorporated. Magnesium is the common p-type dopant for nitride semiconductors while silicon and more recently germanium are the n-dopants of choice. In this paper, therefore we analyze the quantitative limits for Mg and Ge incorporation on GaN and InGaN with high In content. We also discuss the challenges posed by the growth and characterization of InGaN pn-junctions and we discuss the properties of large area, long wavelength nanocolumn LEDs grown on silicon (1 1 1) by PA-MBE.

Separation of flip and non-flip parts of np → pn charge exchange at energies Tn = 0,5-2,0 GeV

International Nuclear Information System (INIS)

Shindin, R.A.; Gur'ev, D.K.; Morozov, A.A.; Nomofilov, A.A.; Strunov, L.N.

2011-01-01

The new 'Delta-Sigma' experimental data on the ratio R dp allowed separating the Flip and Non-Flip parts of the differential cross section of np → pn charge exchange process at the zero angle by the Dean formula. The PSA solutions for the np → np elastic scattering are transformed to the np → pn charge exchange representation using unitary transition, and good agreement is obtained

[Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study].

Science.gov (United States)

Araújo, Ana M; Guimarães, Joana; Nunes, Catarina S; Couto, Paula S; Amadeu, Eduarda

Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS>30mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24h after surgery. Student's t-test and Chi-square test, and linear regression models. A p-value0.05). VAS at rest (TAP vs. TSI groups) was: T1=33±29 vs. 39±32, T2=10±9 vs. 17±18 and T3=7±12 vs. 10±18. VAS with cough (TAP vs. TSI groups) was: T1=51±34 vs. 45±32, T2=24±24 vs. 33±23 and T3=20±23 vs. 23±23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3=21±27 vs. 21±25. Intraoperative remifentanil consumption was similar between TAP (0.16±0.07mcg.kg -1 .min -1 ) and TSI (0.18±0.9mcg.kg -1 .min -1 ) groups. There were no differences in opioid consumption between TAP (4.4±3.49mg) and TSI (6.87±4.83mg) groups during recovery. Functional recovery parameters were not statistically different between groups. Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study

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Ana M. Araújo

Full Text Available Abstract Background Transversus abdominis plane (TAP block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI in this surgery. Methods A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100 mm at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge and 24 h after surgery (T3. Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS > 30 mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24 h after surgery. Statistical analysis: Student's t-test and Chi-square test, and linear regression models. A p-value 0.05. VAS at rest (TAP vs. TSI groups was: T1 = 33 ± 29 vs. 39 ± 32, T2 = 10 ± 9 vs. 17 ± 18 and T3 = 7 ± 12 vs. 10 ± 18. VAS with cough (TAP vs. TSI groups was: T1 = 51 ± 34 vs. 45 ± 32, T2 = 24 ± 24 vs. 33 ± 23 and T3 = 20 ± 23 vs. 23 ± 23. VAS with incentive spirometer (TAP vs. TSI groups was: T3 = 21 ± 27 vs. 21 ± 25. Intraoperative remifentanil consumption was similar between TAP (0.16 ± 0.07 mcg.kg-1.min-1 and TSI (0.18 ± 0.9 mcg.kg-1.min-1 groups. There were no differences in opioid consumption between TAP (4.4 ± 3.49 mg and TSI (6.87 ± 4.83 mg groups during recovery. Functional recovery parameters were not statistically different between groups. Conclusions Multimodal

Significant Prognostic Factors for Completely Resected pN2 Non-small Cell Lung Cancer without Neoadjuvant Therapy

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Nakao, Masayuki; Mun, Mingyon; Nakagawa, Ken; Nishio, Makoto; Ishikawa, Yuichi; Okumura, Sakae

2015-01-01

Purpose: To identify prognostic factors for pathologic N2 (pN2) non-small cell lung cancer (NSCLC) treated by surgical resection. Methods: Between 1990 and 2009, 287 patients with pN2 NSCLC underwent curative resection at the Cancer Institute Hospital without preoperative treatment. Results: The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) rates were 46%, 55% and 24%, respectively. The median follow-up time was 80 months. Multivariate analysis identified four independent predictors for poor OS: multiple-zone mediastinal lymph node metastasis (hazard ratio [HR], 1.616; p = 0.003); ipsilateral intrapulmonary metastasis (HR, 1.042; p = 0.002); tumor size >30 mm (HR, 1.013; p = 0.002); and clinical stage N1 or N2 (HR, 1.051; p = 0.030). Multivariate analysis identified three independent predictors for poor RFS: multiple-zone mediastinal lymph node metastasis (HR, 1.457; p = 0.011); ipsilateral intrapulmonary metastasis (HR, 1.040; p = 0.002); and tumor size >30 mm (HR, 1.008; p = 0.032). Conclusion: Multiple-zone mediastinal lymph node metastasis, ipsilateral intrapulmonary metastasis, and tumor size >30 mm were common independent prognostic factors of OS, CSS, and RFS in pN2 NSCLC. PMID:25740454