Design and experimental evaluation of enhanced diffraction efficiency of lanthanum-based material coated laminar-type gratings in the boron K-emission region.

Numerical and experimental studies have been performed to evaluate the enhancement of diffraction efficiency of diffraction gratings around B $K$-emission by overcoating lanthanum series layers on conventional metal-coated laminar-type gratings. We propose an optical design method based on the concept of spectral flux given by collection efficiency and diffraction efficiency. A diffraction grating with a small angle of incidence provides an advantage to soft x-ray spectrographs because it collects the emission at a larger solid angle compared to that of conventional grazing incidence diffraction gratings. Numerical calculations indicated that La and ${\rm{La}}{{\rm{F}}_3}$ were promising as overcoating materials on a laminar-type Ni-coated diffraction grating, and we performed an experimental study using ${\rm{La}}{{\rm{F}}_3}$ and La/C overcoatings, considering their producibility and durability. The diffraction efficiencies were measured using a reflectometer at a synchrotron facility. The diffraction efficiencies observed at 183.4 eV were 29.4% and 34.3% at angles of incidence of 85.1° and 84.9° for ${\rm{Ni}}/{\rm{La}}{{\rm{F}}_3}$ and Ni/La/C gratings, respectively.

Soft x-ray laser beamline for surface processing and damage studies.

We have developed a soft x-ray laser (SXRL) beamline equipped with an intensity monitor dedicated to ablation study such as surface processing and damage formation. The SXRL beam having a wavelength of 13.9 nm, pulse width of 7 ps, and pulse energy of around 200 nJ is generated from Ag plasma mediums using an oscillator-amplifier configuration. The SXRL beam is focused onto the sample surface by the Mo/Si multilayer coated spherical mirror. To get the correct irradiation energy/fluence, an intensity monitor composed of a Mo/Si multilayer beam splitter and an x-ray charge-coupled device camera has been installed in the beamline. The Mo/Si multilayer beam splitter has a large polarization dependence in the reflectivity around the incident angle of 45°. However, by evaluating the relationship between reflectivity and transmittance of the beam splitter appropriately, the irradiation energy onto the sample surface can be derived from the energy acquired by the intensity monitor. This SXRL beamline is available to not only the ablation phenomena but also the performance evaluation of soft x-ray optics and resists.

Soft X-ray spectral analysis of laser produced molybdenum plasmas using the fundamental and second harmonics of a Nd:YAG laser.

Our measurement of the soft X-ray emission of Mo plasmas produced by picosecond Nd:YAG lasers emitting on the fundamental (1064 nm, 150 ps) and second (532 nm, 130 ps) harmonics is presented. The contrast in intensity between spectral peaks and the intensity outside them is lower for the second harmonic produced plasmas probably due to the presence more intense satellite emission and higher optical thickness. The measured spectra are absolutely calibrated and the observed output photon flux was (7 - 9) × 1013 photons/sr in the water-window (2.3 - 4.4 nm) spectral range for a laser energy of 160 mJ independent of laser wavelength. However, in the short wavelength range 1.5 - 2 nm, the emission using the second harmonic is strongly enhanced and is even higher than for the maximum energy of 220 mJ of the fundamental wavelength, so despite inevitable energy losses, laser wavelength conversion may lead to emission enhancement in certain spectral ranges. This enhancement is attributed to higher absorption of short wavelength laser light and higher charge state generation in denser plasmas.

Intense water-window soft x-ray emission by spectral control using dual laser pulses.

We demonstrate intense emission in the water-window soft x-ray spectral region by controlling the spectral behavior through changing the balance between emissivity and self-absorption in an expanding plasma. The number of photons obtained from a dual laser irradiated target with a 150-ps pre-pulse was maximized at 3.8 × 1014 photons/sr in λ = 2.34 - 4.38 nm at a pulse separation time of 7 - 10 ns. Enhancement of the number of photons is attributed to efficient coupling with the main laser pulse while maintaining a tiny source size.

Emission of water-window soft x-rays under optically thin conditions using low-density foam targets.

The effect of optical thickness in a bismuth water-window soft x-ray source is considered by comparing the emission from laser-produced plasmas of a 7.5% atomic density foam target and a solid-density target. The number of photons recorded in the 4 nm region was comparable for both targets at a plasma-initiating laser pulse duration of 6 ns. From experiments at different pulse durations of 150 ps and 6 ns, self-absorption (opacity) effects were found to be relatively small for bismuth plasmas as compared to those of tin, based on the same emission mechanism and which are used in 13.5 nm sources for extreme ultraviolet lithography.

Selection of target elements for laser-produced plasma soft x-ray sources.

We demonstrated the upper limitation to the number of shots, i.e., target lifetime, together with the number of photons emitted in the water-window soft x-ray spectral region from a number of targets used as sources in this spectral region, for multi-shot irradiation at the same position on the target surface. The spectra involved result from unresolved transition arrays originating from n=3-n=4 transitions in medium-Z element plasmas and from n=4-n=4 transitions originating in high-Z plasmas. The output flux was maintained for the highest number of shots in the case of the high melting point element molybdenum, and the total output in the water window was 7.7×1013 photons/sr at a laser power density of 1.2×1014 W/cm2.

[Two Cases of Transperineal Urethral Resection of the Prostate].

Two patients who could not take normal lithotomy position, one by fixation of the right hip joint due to coxitis, and the other by cerebral palsy, underwent transurethral resection of the prostate under perineal external urethrotomy. The perineal wound was closed and urethral catheter was inserted via the external urethral meatus. Postoperative course was uneventful for both patients.

Sonographic classification of testicular tumors by tissue harmonic imaging: experience of 58 cases.

PURPOSE: To evaluate the relationship between our proposed sonographic classification of testicular tumors by tissue harmonic imaging and histological type. METHODS: We retrospectively analyzed 58 testicular tumors and tumor-like lesions [seminomatous germ cell tumor (SGCT): 28; non-seminomatous germ cell tumor (NSGCT): 16; lymphoid and hematopoietic tumor (LHT): 7; Leydig cell tumor: 1; epidermal cyst: 2; and tumor of paratesticular structure (TPS): 4]. We divided a sonographic image into six types for morphological criteria and three types for color Doppler criteria. We examined the relationship between the sonographic classification and histological type. RESULTS: For morphological criteria, there were 21 cases of Type I (36%), 15 Type II (26%), 9 Type III (15%), five Type IV (9%), five Type V (9%), and three Type VI (5%). For color Doppler criteria, there were 47 cases classified as hypervascular (81%), eight as hypovascular (14%), and three as avascular (5%). Most of the SGCTs were divided into types I and II; the NSGCTs into types III, IV, and V; the LHTs into only type II; and the TPSs into type VI. CONCLUSION: We established a sonographic classification of testicular tumors with various histological types. This sonographic classification is potentially useful for estimating the histological type of testicular tumors.

Evaluation of a flat-field grazing incidence spectrometer for highly charged ion plasma emission in soft x-ray spectral region from 1 to 10 nm.

A flat-field grazing incidence spectrometer operating on the spectral region from 1 to 10 nm was built for research on physics of high temperature and high energy density plasmas. It consists of a flat-field grating with 2400 lines/mm as a dispersing element and an x-ray charged coupled device (CCD) camera as the detector. The diffraction efficiency of the grating and the sensitivity of the CCD camera were directly measured by use of synchrotron radiation at the BL-11D beamline of the Photon Factory (PF). The influence of contamination to the spectrometer also was characterized. This result enables us to evaluate the absolute number of photons in a wide range wavelength between 1 and 10 nm within an acquisition. We obtained absolutely calibrated spectra from highly charged ion plasmas of Gd, from which a maximum energy conversion efficiency of 0.26% was observed at a Nd:YAG laser intensity of 3 × 1012 W/cm2.

Clinical variables for predicting metastatic renal cell carcinoma patients who might not benefit from cytoreductive nephrectomy: neutrophil-to-lymphocyte ratio and performance status.

BACKGROUND: Cytoreductive nephrectomy (CN) plays an important role in the multimodal treatment of metastatic renal cell carcinoma (RCC). However, certain patients experience rapid progression of the carcinoma following CN. This study aimed to investigate the value of neutrophil-to-lymphocyte ratio (NLR) in the selection of patients for CN. METHODS: Records corresponding to 73 patients with metastatic RCC were retrospectively reviewed. Forty-eight patients underwent CN, and their overall survival (OS) and preoperative variables were analyzed. The OS of patients who did not undergo CN was used as a reference. RESULTS: Univariate analysis showed that symptomatic tumors, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≥ 1, hemoglobin level <12 g/dl, neutrophil count ≥ 5500/µL, C-reactive protein level ≥ 2.0 mg/dl, and NLR ≥ 4.0 were significantly associated with poor outcomes in patients who underwent cytoreductive nephrectomy. The median OS of patients with NLR ≥ 4.0 was 10.2 months, which was significantly shorter than that of patients with NLR <4.0 (36.5 months) (P = 0.0020). Multivariate analysis showed that NLR and ECOG-PS were independent predictors of OS in patients treated with CN. The OS of CN patients with NLR ≥ 4.0 and ECOG-PS ≥1 was similar to that of patients who did not undergo CN (8.4 vs. 6.1 months, P = 0.939). CONCLUSIONS: Preoperative NLR elevation is significantly associated with poor outcomes in patients with metastatic RCC who underwent CN. Patients with NLR ≥4.0 and ECOG-PS ≥ 1 might not benefit from immediate CN after initial diagnosis.

Clinical implications of preoperative serum total cholesterol in patients with clear cell renal cell carcinoma.

OBJECTIVE: To investigate the clinical implication of preoperative serum total cholesterol (TC) level in patients with clear cell renal cell carcinoma (RCC). METHODS: The records of 364 patients with clear cell RCC who had undergone nephrectomy were retrospectively reviewed. The association among preoperative TC level, clinicopathologic factors, and oncological outcome in terms of cancer-specific survival (CSS) and recurrence-free survival period was analyzed by univariate and multivariate analyses. RESULTS: As a continuous variable, lower serum TC level was found to be significantly associated with male sex, symptomatic tumor, advanced TNM stage, higher nuclear grade, microscopic venous invasion, poor Eastern Cooperative Oncology Group Performance Status, larger tumor size, elevated C-reactive protein level, and lower hemoglobin level. Univariate analysis showed that relatively lower preoperative serum TC level was associated with lower recurrence-free survival (P = .040) and CSS (P <.001) rates. Multivariate analysis indicated that in addition to pT stage, M stage, nuclear grade, and Eastern Cooperative Oncology Group Performance Status, serum TC level (hazard ratio, 0.988 per mg/dL; 95% confidence interval, 0.980-0.998; P = .019) was an independent predictor of CSS. CONCLUSION: Low preoperative serum TC level is associated with worse prognosis in patients with clear cell RCC. Consideration of preoperative serum TC level might thus provide additional prognostic information for patients with clear cell RCC.

[Urinary incontinence in early experience with robot-assisted laparoscopic prostatectomy-comparison with radical retropubic prostatectomy].

To compare the results of urinary incontinence in patients with clinically localized prostate cancer, T1a- 3aN0M0, treated by robot-assisted laparoscopic prostatectomy (RALP) or open radical retropubic prostatectomy (RRP), we studied 44 patients treated with RALP and 60 who received RRP by one surgeon between March 2004 and January 2011. The pad-free and safety-pad (1 pad a day) rates after surgery were calculated with Kaplan-Meyer method. All preoperative and postoperative factors were not significantly different between the two groups. Overall, 88% of the patients in the RRP group were pad-free with a mean follow-up of 54 months and 93% of the patients in the RALP group were pad-free with a mean follow up of 22.1 months. However, the pad-free rates at 3, 6 and 12 months after surgery were 33, 58.6 and 75.8%, respectively, in the RRP group compared to 44, 72 and 89.5% in the RALP group, respectively (p = 0.0393). Similarly, 97% of the patients in the RRP group and 98% of the patients in the RALP group used a safety-pad during the observation period. The rates of safety-pad at 3, 6 and 12 months after surgery were 52.7, 71.6 and 81%, respectively, in the RRP group compared to 78.9,92 and 94.7% in the RALP group, respectively (p = 0.002). In conclusion, while the follow-period is short and the number of patients is small, RALP may provide a better functional outcome after surgery in terms of early recovery of urinary incontinence than RRP. This may be one of the reasons to justify the use of robotic surgery as an alternative to the traditional RRP.

Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy.

OBJECTIVE: Preoperative prognostic factors in bladder cancer patients have not been fully established. This study was undertaken to investigate preoperative prognostic factors, including neutrophil-to-lymphocyte ratio (NLR), and to develop a novel prognostic factors-based risk stratification model for disease-specific survival (DSS) in bladder cancer patients treated with radical cystectomy (RC). METHODS: We performed a retrospective analysis of 189 consecutive bladder cancer patients treated with RC at our institution. Prognostic value of the preoperative clinical and laboratory parameters were evaluated by univariate and multivariate Cox proportional hazard model analyses, and patients were stratified according to relative risks (RRs) for DSS. RESULTS: One-, 3-, and 5-year DSS rates were 86.8%, 70.8%, and 61.7%, respectively. In univariate analysis, tumor size, clinical T stage, hydronephrosis, concomitance of carcinoma in situ, and some laboratory findings (hemoglobin [Hb] level, platelet count, C-reactive protein, neutrophil count, lymphocyte count, and NLR) were significantly associated with poor prognosis. In multivariate analysis, tumor size, hydronephrosis, Hb level, and NLR were independent factors for predicting poor prognosis. Patients were stratified into 3 risk groups: low (RR = 1.000-3.717), intermediate (RR = 4.149-9.315), and high (RR = 10.397-38.646). The differences among the groups were significant. CONCLUSIONS: NLR was an independent prognostic factor, as were tumor size, hydronephrosis, and Hb levels, and the combination of these factors can stratify DSS risks in bladder cancer patients treated with RC. This information may be useful for identifying patients who might be candidates for clinical trials of multimodal treatment strategies, including innovative neoadjuvant treatments.

Risk stratification of survival by lymphovascular invasion, pathological stage, and surgical margin in patients with bladder cancer treated with radical cystectomy.

BACKGROUND: The aim of this study was to investigate prognostic factors and develop a prognostic factor-based risk stratification model for disease-specific survival (DSS) in a radical cystectomy (RC) series. METHODS: The patient cohort comprised 194 consecutive patients with bladder cancer treated with RC. Univariate and multivariate Cox proportional hazard model analyses were performed to identify significant prognostic factors for DSS. A risk stratification model was developed based on the relative risks (RRs) of DSS. RESULTS: Median follow-up period was 26.8 months. The 1-, 3-, and 5-year DSS were 88.0, 74.0, and 64.9%, respectively. In the univariate analysis, pathological T (pT) (≥ pT2), lymphovascular invasion (LVI), non-urothelial carcinoma component, surgical margin (SM), and lymph node metastases (pN) were significantly associated with poor prognosis. In the multivariate analysis, pT (≥ pT2), LVI, and SM were independent factors for predicting poor prognosis. Based on these results, patients were stratified into three risk groups: low (RR = 1.00-3.626), intermediate (5.860-9.826), and high (21.24). The 1-, 3-, and 5-year survival rates were 96.9, 85.1, and 85.1% in the low-risk group, 83.0, 63.4, and 43.8% in the intermediate group, and 51.0, 19.4, and 19.4% in the high-risk group, respectively. The differences among these groups were significant. CONCLUSIONS: In our RC series, pT (≥ pT2), LVI, and SM were independent prognostic factors. This information may be useful to identify patients with poor prognosis, who might be good candidates for innovative treatment.

Followup of neutrophil-to-lymphocyte ratio and recurrence of clear cell renal cell carcinoma.

PURPOSE: An increase in the pretreatment neutrophil-to-lymphocyte ratio is associated with poor prognosis for various cancers, including renal cell carcinoma. However, the clinical implication of a posttreatment change in the neutrophil-to-lymphocyte ratio in patients with cancer remains unclear. MATERIALS AND METHODS: We reviewed the records of 250 patients with nonmetastatic clear cell renal cell carcinoma and analyzed associations among clinicopathological variables, the preoperative and postoperative neutrophil-to-lymphocyte ratio, and recurrence-free survival. RESULTS: The 10-year recurrence-free survival rate for patients with a preoperative neutrophil-to-lymphocyte ratio of 2.7 or greater was significantly lower than that for those with a ratio of less than 2.7 (64.4% vs 83.7%, p = 0.0004). When combined with the postoperative ratio, patients with a preoperative ratio of 2.7 or greater could be further divided into 2 groups with a significantly different prognosis. The 10-year recurrence-free survival rate for patients with a preoperative neutrophil-to-lymphocyte ratio of 2.7 or greater and postoperative ratio of less than 2.7 was significantly lower than that for those with a preoperative and postoperative ratio of 2.7 or greater (52.0% vs 83.5%, p = 0.0487). The latter was similar to the 83.7% for patients with a preoperative ratio of less than 2.7. In patients with recurrence the ratio at recurrence was significantly increased compared with the postoperative ratio (mean ± SD 2.82 ± 1.63 vs 2.00 ± 0.90, p = 0.0090). Multivariate analysis showed that tumor size, pathological tumor stage and the neutrophil-to-lymphocyte ratio change (a combination of the preoperative and postoperative ratios) were independent predictors of recurrence. Using these 3 significant variables patients were stratified into low, intermediate and high risk groups, among which the recurrence-free survival rate significantly differed. CONCLUSIONS: The posttreatment neutrophil-to-lymphocyte ratio change was a significant prognostic factor for recurrence as well as tumor size and pathological tumor stage in patients with clear cell renal cell carcinoma.

Impact of tumor size on renal function and prediction of renal insufficiency after radical nephrectomy in patients with renal cell carcinoma.

PURPOSE: From the perspective of oncological and functional outcomes partial nephrectomy is considered standard surgery for small renal tumors 4 cm or less. However, radical nephrectomy is commonly done for small tumors. It is important to predict postoperative renal function in patients to choose the most optimal surgical procedure. MATERIALS AND METHODS: We retrospectively reviewed the records of 271 patients treated with radical nephrectomy for renal cell carcinoma. Associations of tumor size and clinical variables with renal function were analyzed. RESULTS: Preoperatively the mean ± SD glomerular filtration rate was 74.38 ± 17.70 ml per minute/1.73 m(2) and 56 patients (20%) had renal insufficiency (glomerular filtration rate less than 60 ml per minute/1.73 m(2)). The mean decrease in the glomerular filtration rate after radical nephrectomy was 24.2 ± 12.40 ml per minute/1.73 m(2) (31.5% ± 15%). Of 215 patients with a preoperative glomerular filtration rate of 60 ml per minute/1.73 m(2) or greater 165 (77%) had new onset renal insufficiency. Age, tumor size, preoperative glomerular filtration rate and hypertension were significantly associated with new onset renal insufficiency. Multivariate analysis revealed that age 60 years or greater, tumor size 7 cm or less and the preoperative glomerular filtration rate were independent risk factors for new onset renal insufficiency (p <0.05). Finally, we developed a predictive model for new onset renal insufficiency after radical nephrectomy. CONCLUSIONS: Tumor size 7 cm or less, age 60 years or greater and a decreased preoperative glomerular filtration rate were significant risk factors for new onset renal insufficiency in patients treated with radical nephrectomy. Partial nephrectomy might be considered an option according to the risk of postoperative renal insufficiency, especially in elderly patients with a tumor of 7 cm or less.

The efficacy and safety of gemcitabine plus cisplatin regimen for patients with advanced urothelial carcinoma after failure of M-VAC regimen.

BACKGROUND: Our aim was to study the efficacy and safety of combination chemotherapy with gemcitabine plus cisplatin (GC) for patients with advanced urothelial carcinoma (UC) after failure of methotrexate, vinblastin, adriamycin, and cisplatin (M-VAC) chemotherapy. METHODS: We studied a total of 33 patients with advanced UC. All patients were treated with M-VAC with a mean of 3.2 courses per patient and had showed disease progression or no response. Clinical and pathological features were correlated to survival rates, and the incidence and degree of toxicities were also retrospectively reviewed. RESULTS: A total of 132 courses of GC with a mean of 4.0 courses per patients were undergone. Two (6.0%) complete responses and 11 (33.3%) partial responses produced an overall response rate of 39.4%. In 55 assessable lesions, there were 2 (4%) complete responses, 13 (23%) partial responses, 31 (55%) with stable disease, and 10 (18%) with progressive disease. Overall, mean of survival time after GC chemotherapy was 10.5 months (range, 3.0-22.9 months). In univariate analysis, the patients with higher serum hemoglobin or single metastasis or no liver metastasis tended to survive longer than those with lower hemoglobin or multiple metastases or existence of liver metastasis. Although grade 3-4 neutropenia was seen in 22 patients (66.7%) and grade 3-4 thrombocytopenia was seen in 10 patients (30.3%), fatal side effects were not observed. CONCLUSIONS: The combination chemotherapy with GC seems feasible with no severe side effects and may provide a survival benefit for patients with advanced UC after failure of M-VAC chemotherapy.

Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma.

PURPOSE: We investigated the prognostic significance of the neutrophil-to-lymphocyte ratio to predict recurrence in patients with nonmetastatic renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 192 patients with nonmetastatic renal cell carcinoma (T1-4N0M0) who underwent nephrectomy between 1986 and 2000. Mean followup was 93 months (range 6 to 232) months. We assessed the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio, and other clinical and laboratory parameters on univariate and multivariate analysis. RESULTS: Presentation mode, tumor stage, C-reactive protein, lymphocyte count and the neutrophil-to-lymphocyte ratio significantly correlated with recurrence-free survival on univariate analysis. The recurrence-free survival rate in patients with a neutrophil-to-lymphocyte ratio of less than 2.7 was 93.7% at 5 years and 79.8% at 10 years, significantly higher than the 77.9% and 58.4%, respectively, in patients with a ratio of 2.7 or greater (p = 0.0205). Multivariate analysis revealed that T stage and the neutrophil-to-lymphocyte ratio were independent predictors of recurrence. The 10-year survival rate in patients at low risk (T2 or less and neutrophil-to-lymphocyte ratio less than 2.7), intermediate risk (T2 or less and ratio 2.7 or greater, or T3 or greater and ratio less than 2.7) and high risk (T3 or greater and ratio 2.7 or greater) was 82.0%, 63.6% and 33.0%, respectively, which were significantly different. CONCLUSIONS: An increased pretreatment neutrophil-to-lymphocyte ratio is an independent predictor of recurrence. The combination of T stage and the neutrophil-to-lymphocyte ratio can be used to stratify recurrence risk in patients with nonmetastatic renal cell carcinoma.