Thulium fiber laser vs Ho:YAG in RIRS: a prospective randomized clinical trial assessing the efficacy of lasers and different fiber diameters (150 µm and 200 µm).

INTRODUCTION: The aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium-aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 µm and 200 µm). METHODS: A prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 µm; (2) SP TFL with 200-µm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-µm fiber. RESULTS: Ninety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-µm fiber (34 patients) and a 200-µm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-µm SP TFL group was 9.2 (6.2-14.6) min, in 150-µm SP TFL-11.4 (7.7-14.9) min (p = 0.390), in Ho:YAG-14.1 (10.8-18.1) min (p = 0.021). The total energy consumed in 200-µm SP TFL was 8.4 (5.8-15.2) kJ; 150-µm SP TFL - 10.8 (7.3-13.5) kJ (p = 0.626) and in Ho:YAG-15.2 (11.1-25.3) kJ (p = 0.005). CONCLUSIONS: Irrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.

Prospective Single-Center Study of SuperPulsed Thulium Fiber Laser in Retrograde Intrarenal Surgery: Initial Clinical Data.

INTRODUCTION: The objective of this study was to present our clinical experience of using the thulium fiber laser in retrograde intrarenal surgery (RIRS). METHODS: A prospective clinical study performed after the IRB approval (Sechenov University, Russia). Patients with stones <30 mm were treated with SuperPulsed thulium fiber laser (SP TFL) (NTO IRE-Polus, Russia) through a 200-µm-diameter fiber. Stone size, density, the duration of the operation, and laser on time (LOT) were measured. Based on the surgeon's feedback, retropulsion and intraoperative visibility were also assessed (Likert scale). Stone-free rates (SFRs) were assessed with a low-dose CT scan 90 days after the operation. RESULTS: Between January 2018 and December 2019, 153 patients (mean age 54 ± 2.8 years) underwent RIRS with SP TFL (mean stone density 1,020 ± 382 HU). Median stone volume was 279.6 (139.4-615.8) mm3. Median LOT was 2.8 (IQR 1.6-6.6) min with median total energy for stone ablation 4.0 (IQR 2.1-7.17) kJ, median ablation speed was 1.7 (1.0-2.8) mm3/s, median ablation efficacy was 13.3 (7.3-20.9) J/mm3, and energy consumption was 170.3 (59.7-743.3) J/s. Overall, the SFR (at 3 months) was 89%. The overall complication rate was 8.4%. Retropulsion was present in 23 (15.1%) patients. Visibility was estimated as optimal in most patients, with poor visibility reported in only 13 (8.5%) patients. CONCLUSION: The SP TFL is a safe and efficient tool in lithotripsy, irrespective of the stone type and density. Retropulsion is minimal and visibility is maintained with SP TFL. Nonetheless, further clinical studies are needed to ensure optimal comparison with conventional holmium:YAG lithotripsy.

Theranostic Platforms Based on Silica and Magnetic Nanoparticles Containing Quinacrine, Chitosan, Fluorophores, and Quantum Dots.

In this paper, we describe the synthesis of multilayer nanoparticles as a platform for the diagnosis and treatment of ischemic injuries. The platform is based on magnetite (MNP) and silica (SNP) nanoparticles, while quinacrine is used as an anti-ischemic agent. The synthesis includes the surface modification of nanoparticles with (3-glycidyloxypropyl)trimethoxysilane (GPMS), the immobilization of quinacrine, and the formation of a chitosan coating, which is used to fix the fluorophore indocyanine green (ICG) and colloidal quantum dots AgInS2/ZnS (CQDs), which serve as secondary radiation sources. The potential theranostic platform was studied in laboratory animals.

The impact of the laser fiber-tissue distance on histological parameters in a porcine kidney model.

PURPOSE: To evaluate the impact of the fiber-tissue distance on histological parameters in a porcine kidney model. METHODS: Four lasers were tested at 60 W using a 600-µm bare-ended fiber: a continuous wave (cw) thulium fiber laser (TFL), a super pulsed (SP) TFL, a Ho:YAG laser, and a blue diode laser (BDL). All tissue samples were mounted on a motorized XY-translation stage. The fiber-tissue distance was changed within a range from 0to 6 mm. Ten incisions were made with each laser at each distance. Afterwards, the tissue samples were sliced with a microtome for lactate dehydrogenase staining to determine zones of thermal damage. RESULTS: In contact mode, the largest incision depth was found for the cw TFL (1.7 ± 0.1 mm) compared to the SP TFL (1.0 ± 0.1 mm), BDL (0.9 ± 0.1 mm) and HoYAG laser (1.1 ± 0.1 mm), respectively. With regard to the coagulative properties, the SP TFL and the Ho:YAG laser showed comparable coagulation depths with 0.7 ± 0.1 and 0.6 ± 0.1 mm, respectively. At 2 mm fiber-tissue distance, the Ho:YAG laser was the only laser that vaporized tissue (incision depth: 0.2 ± 0.1 mm). The BDL was the only laser that caused coagulation at a distance of 3-5 mm. CONCLUSION: Our results support the clinical observation that cw TFL must be defocused for best coagulation, while the coagulation depth of the SP TFL remains nearly constant within the range of 0-3 mm. Increasing the distance of the laser fiber to the tissue up to 5 mm did not cause significant differences with regard to coagulation depth using the BDL.

Stochastic Memristive Interface for Neural Signal Processing.

We propose a memristive interface consisting of two FitzHugh-Nagumo electronic neurons connected via a metal-oxide (Au/Zr/ZrO2(Y)/TiN/Ti) memristive synaptic device. We create a hardware-software complex based on a commercial data acquisition system, which records a signal generated by a presynaptic electronic neuron and transmits it to a postsynaptic neuron through the memristive device. We demonstrate, numerically and experimentally, complex dynamics, including chaos and different types of neural synchronization. The main advantages of our system over similar devices are its simplicity and real-time performance. A change in the amplitude of the presynaptic neurogenerator leads to the potentiation of the memristive device due to the self-tuning of its parameters. This provides an adaptive modulation of the postsynaptic neuron output. The developed memristive interface, due to its stochastic nature, simulates a real synaptic connection, which is very promising for neuroprosthetic applications.

Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy.

PURPOSE: To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL). METHODS: Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire. RESULTS: A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases. CONCLUSIONS: TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.

The Role of Cysteine Cathepsins in Cancer Progression and Drug Resistance.

Cysteine cathepsins are lysosomal enzymes belonging to the papain family. Their expression is misregulated in a wide variety of tumors, and ample data prove their involvement in cancer progression, angiogenesis, metastasis, and in the occurrence of drug resistance. However, while their overexpression is usually associated with highly aggressive tumor phenotypes, their mechanistic role in cancer progression is still to be determined to develop new therapeutic strategies. In this review, we highlight the literature related to the role of the cysteine cathepsins in cancer biology, with particular emphasis on their input into tumor biology.

Deep UV narrow-band photodetector based on ion beam synthesized indium oxide quantum dots in Al2O3 matrix.

Semiconductor quantum dots have attracted tremendous attention owing to their novel electrical and optical properties as a result of their size dependent quantum confinement effects. This provides the advantage of tunable wavelength detection, which is essential to realize spectrally selective photodetectors. We report on the fabrication and characterization of a high performance narrow band ultraviolet photodetector (UV-B) based on Indium oxide (In2O3) nanocrystals embedded in aluminium oxide (Al2O3) matrices. The In2O3 nanocrystals are synthesized in an Al2O3 matrix by sequential implantation of In+ and [Formula: see text] ions and post-implantation annealing. The photodetector exhibits excellent optoelectronic performances with high spectral responsivity and external quantum efficiency. The spectral response shows a band-selective nature with a full width half maximum of ∼60 nm, and a responsivity reaching up to 70 A W-1 under 290 nm at 5 V bias. The corresponding rejection ratio to visible region was as high as 8400. The high performance of this photodetector makes it highly suitable for practical applications such as narrow-band spectrum-selective photodetectors. The device design based on ion-synthesized nanocrystals could provide a new approach for realizing a visible-blind photodetector.

Biomarkers of Renal Tumors: the Current State and Clinical Perspectives.

Renal cell carcinoma (RCC) ranks the first death rate among the urogenital tumors, whereas its incidence follows the incidences of prostate and bladder cancer. The diagnosis of RCC at early stages allows immediately undertaking appropriate treatment, which significantly increases patients' survival rate. Early and accurate diagnosis avoids inadequate treatment, provides the disease progression forecast, and permits to apply more efficient therapy. Unfortunately, the small renal tumors are usually asymptomatic resulting in the late diagnosis and, therefore, low efficacy of treatment. Thus, sensible and preventive biomarkers are essential for early RCC detection and monitoring of its progression. So far, many attempts were performed aimed at recognizing novel informative kidney tumor biomarkers applicable for early detection of the disease and possessing prognostic and predictive capabilities. This review summarizes recent advances in renal tumor biomarkers recognition, their diagnostic and prognostic values, and clinical feasibility.

The cancer-retina antigen recoverin as a potential biomarker for renal tumors.

The renal cell carcinoma is the ninth most common cancer with an increasing occurrence and mortality. Recoverin is the first retina-specific photoreceptor protein that was shown to undergo aberrant expression, due to its promoter demethylation, as a cancer-retina antigen in a number of malignant tumors. In this work, we demonstrated that recoverin is indeed expressed in 68.4 % of patients with different subtypes of renal cell carcinoma, and this expression has tendency to correlate with tumor size. Interestingly, 91.7 % of patients with the benign renal tumor, oncocytoma, express recoverin as well in their tumor. Epigenetic analysis of the recoverin gene promoter revealed a stable mosaic methylation pattern with the predominance of the methylated state, with the exception of -80 and 56 CpG dinucleotides (CpGs). While the recoverin expression does not correlate withoverall survival of the tumor patients, the methylation of the recoverin gene promoter at -80 position is associated with better overall survival of the patients. This work is the first report pointing towards the association of overall survival of renal cell carcinoma (RCC) patients with promoter methylation of a cancer-retina antigen. Taken together, these data allow to consider recoverin as a potential therapeutic target and/or marker for renal tumors.

Mast cell accumulation precedes tissue fibrosis induced by intravenously administered amorphous silica nanoparticles.

Despite the increasing use of amorphous silica nanoparticles (SNPs) in biomedical applications, their toxicity after intravenous administration remains a major concern. We investigated the effects of single 7 mg/kg intravenous infusions of 13 nm SNPs on hemodynamic parameters in rats. Hematological and biochemical parameters were assessed at 7, 30, and 60 d post treatment. Silicon content in the liver, lungs, heart, and kidney was analyzed, as well as tissue histology with special emphasis on mast cell (MC) content. SNP infusion had no effect on hemodynamics, nor did it alter hematological or biochemical parameters. SNP retention in the liver was conspicuous for up to 60 d. Among the other organs analyzed, silicon content was significantly increased only in the lung at 1-h post infusion. Despite the relatively low dose, SNP administration caused extensive liver remodeling, including the formation of multiple foreign body-type granulomas starting 7 d post treatment, and subsequent development of fibrosis. Histopathological changes in the liver were not preceded by hepatocyte necrosis. We found increased MC abundance in the liver, lungs, and heart starting on day 30 post treatment. MC recruitment in the liver preceded fibrosis, suggesting that MCs are involved in liver tissue remodeling elicited by intravenously administered SNPs.

Effect of Post-Implantation Heat Treatment Conditions on Photoluminescent Properties of Ion-Synthesized Gallium Oxide Nanocrystals.

A novel and promising way for creating nanomaterials based on gallium oxide is the ion synthesis of Ga2O3 nanocrystals in a SiO2/Si dielectric matrix. The properties of nanocrystals are determined by the conditions of ion synthesis-the parameters of ion irradiation and post-implantation heat treatment. In this work, the light-emitting properties of Ga2O3 nanocrystals were studied depending on the temperature and annealing atmosphere. It was found that annealing at a temperature of 900 °C leads to the appearance of intense luminescence with a maximum at ~480 nm caused by the recombination of donor-acceptor pairs. An increase in luminescence intensity upon annealing in an oxidizing atmosphere is shown. Based on data from photoluminescence excitation spectroscopy and high-resolution transmission electron microscopy, a hypothesis about the possibility of the participation of a quantum-size effect during radiative recombination is proposed. A mechanism for the formation of Ga2O3 nanocrystals during ion synthesis is suggested, which makes it possible to describe the change in the luminescent properties of the synthesized samples with varying conditions of post-implantation heat treatment.

Markers of local kidney cancer recurrence: A surgeon's mistake or a pattern? Review.

The influence of various morphological, anatomical, genetic and other factors on the local recurrence-free survival of patients who have undergone different renal cell cancer (RCC) treatment is still a rather complex, ambiguous and controversial issue for practicing oncourologists. This review evaluates the effect of several factors on both recurrence-free survival and local recurrence-free survival. The review includes articles, clinical cases, literature reviews, and meta-analyses highlighting the analysis of independent and interrelated predisposing factors for developing local recurrence of RCC from 1984 to 2020. The PubMed, Web of Science, and Scopus databases were searched in English, Spanish, and German. A review of the literature showed the role of the following indices in the local recurrence RCC: microvascular invasion (p = 0.001), tumor necrosis (p = 0.0001), high malignancy (Fuhrman III or IV) (HR = 38.3, 95% CI 3.1-467, p = 0.004) as histological factors, tumor size as an anatomical factor. Thus, the authors state that every centimeter of the tumor increases the risk of local recurrence (p < 0.05). A group from the Mayo Clinic showed the equivalence of different treatment methods in local RCC recurrence. Thus, in the group of patients with cT1a stage kidney cancer, the 5-year local recurrence-free survival rates were 97.7% (96.7-98.6), 95.9% (92.3-99.6), and 95.9% (92.3-99.6) for renal resection, RFA, and cryoablation, respectively. Surgical margin status is the most studied and controversial marker of local renal cell carcinoma recurrence. Researchers found a direct effect of PSM on the risk of local RCC recurrence (p < 0.01). The personalized approach with the search and evaluation of predisposing factors for the local recurrence, as well as further selection of the most optimal treatment, will allow oncourologists to improve both the effectiveness of primary treatment and the recurrence-free survival of patients.

Surgical treatment of renal cell carcinoma with tumor thrombosis of the inferior vena cava and the right heart: How we do it.

OBJECTIVE: Renal cell carcinoma with inferior vena cava thrombosis is a rare disease with a poor prognosis without surgical treatment. We report our 11-year experience in the surgical treatment of renal cell carcinoma with extension of the inferior vena cava. METHODS: We conducted a retrospective analysis of patients undergoing surgical treatment for renal cell carcinoma with invasion of the inferior vena cava in two hospitals from May 2010 to March 2021. To assess the spread of the tumor process invasion, we used the Neves and Zincke classification. RESULTS: A total of 25 people underwent surgical treatment. Sixteen patients were men, nine were women. Thirteen patients underwent cardiopulmonary bypass (CBP) surgery. The following postoperative complications were recorded: two cases of disseminate intravascular coagulation (DIC), two cases of acute myocardial infarction (MI) and one case of coma of unknown reason, Takotsubo syndrome and postoperative wound dehiscence. Three patients deceased (16.7%) of DIC syndrome and AMI. After discharge, one of the patients had a recurrence of tumor thrombosis 9 months after surgery, and another patient had the same 16 months later, presumably due to the neoplastic tissue in the adrenal gland on the contralateral side. CONCLUSION: We believe that this problem should be dealt with by an experienced surgeon with a multidisciplinary team in the clinic. The use of CPB provides benefits and reduces blood loss.

Structure and Chemical Composition of Ion-Synthesized Gallium Oxide Nanocrystals in Dielectric Matrices.

The ion-beam synthesis of Ga2O3 nanocrystals in dielectric matrices on silicon is a novel and promising way for creating nanomaterials based on gallium oxide. This research studies the regularities of changes, depending on the synthesis regimes used, in the chemical composition of ion-implanted SiO2/Si and Al2O3/Si samples. It has been shown that the formation of Ga-O chemical bonds occurs even in the absence of thermal annealing. We also found the conditions of ion irradiation and annealing at which the content of oxidized gallium in the stochiometric state of Ga2O3 exceeds 90%. For this structure, the formation of Ga2O3 nanocrystalline inclusions was confirmed by transmission electron microscopy.

In Silico, In Vitro, and Clinical Investigations of Cathepsin B and Stefin A mRNA Expression and a Correlation Analysis in Kidney Cancer.

The cysteine protease Cathepsin B (CtsB) plays a critical role in multiple signaling pathways, intracellular protein degradation, and processing. Endogenous inhibitors regulate its enzymatic activity, including stefins and other cystatins. Recent data proved that CtsB is implicated in tumor extracellular matrix remodeling, cell invasion, and metastasis: a misbalance between cathepsins and their natural inhibitors is often considered a sign of disease progression. In the present study, we investigated CtsB and stefin A (StfA) expression in renal cell carcinoma (RCC). mRNA analysis unveiled a significant CTSB and STFA increase in RCC tissues compared to adjacent non-cancerogenic tissues and a higher CtsB expression in malignant tumors than in benign renal neoplasms. Further analysis highlighted a positive correlation between CtsB and StfA expression as a function of patient sex, age, tumor size, grade, lymph node invasion, metastasis occurrence, and survival. Alternative overexpression and silencing of CtsB and StfA confirmed the correlation expression between these proteins in human RCC-derived cells through protein analysis and fluorescent microscopy. Finally, the ectopic expression of CtsB and StfA increased RCC cell proliferation. Our data strongly indicated that CtsB and StfA expression play an important role in RCC development by mutually stimulating their expression in RCC progression.

Fluorescently Labeled Gadolinium Ferrate/Trigadolinium Pentairon(III) Oxide Nanoparticles: Synthesis, Characterization, In Vivo Biodistribution, and Application for Visualization of Myocardial Ischemia-Reperfusion Injury.

Various gadolinium compounds have been proposed as contrasting agents for magnetic resonance imaging (MRI). In this study, we suggested a new synthesis method of gadolinium ferrate/trigadolinium pentairon(III) oxide nanoparticles (GF/TPO NPs). The specific surface area of gadolinium ferrate (GdFeO3) and trigadolinium pentairon(III) oxide (Gd3Fe5O12) nanoparticles was equal to 42 and 66 m2/g, respectively. The X-ray diffraction analysis confirmed that the synthesized substances were GdFeO3 and Gd3Fe5O12. The gadolinium content in the samples was close to the theoretically calculated value. The free gadolinium content was negligible. Biodistribution of the GF/TPO NPs was studied in rats by fluorescent imaging and Fe2+/Fe3+ quantification demonstrating predominant accumulation in such organs as lung, kidney, and liver. We showed in the in vivo rat model of myocardial ischemia-reperfusion injury that GF/TPO NPs are able to target the area of myocardial infarction as evidenced by the significantly greater level of fluorescence. In perspective, the use of fluorescently labeled GF/TPO NPs in multimodal imaging may provide basis for high-resolution 3D reconstruction of the infarcted heart, thereby serving as unique theranostic platform.

Emergency versus elective ureteroscopy for the management of ureteral stones.

OBJECTIVE: To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. METHODS: We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction. RESULTS: A total of 2957 patients' medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes (p < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B (p = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively, p = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%, p < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%, p < 0.001), possibly as a result of the number of pre-stented patients (73%). CONCLUSIONS: Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.

The study of the relevance of macro- and microelements in the hair of young wrestlers depending on the style of wrestling.

While participating in an intensive training process, the athlete's body requires not only energy, but also specific macro- and microelements. The purpose of this study was to show the meaning of monitoring the level of mineral trace elements in athletes-wrestlers during physical activity. As an experimental group, 66 male wrestlers aged 18-20 years with at least 3 years of intensive wrestling experience were examined. The control group consisted of 92 young cadets of military school aged 18-20 years, who had previous sports training, but were not engaged in wrestling. To determine the quantitative content of trace elements, the hair was cut from the back of the head for the entire length in an amount of at least 0.1 g. an examined using the mass spectrometer ICP-MS Agilent 7900. Strong positive correlations were found for sodium with potassium and rubidium, magnesium with calcium, potassium with rubidium, and rubidium with caesium among wrestlers. Wrestlers were found to have higher levels of a number of macro- and microelements, including toxic ones.

Ion-Beam Synthesis of Gallium Oxide Nanocrystals in a SiO2/Si Dielectric Matrix.

A new method for creating nanomaterials based on gallium oxide by ion-beam synthesis of nanocrystals of this compound in a SiO2/Si dielectric matrix has been proposed. The influence of the order of irradiation with ions of phase-forming elements (gallium and oxygen) on the chemical composition of implanted layers is reported. The separation of gallium profiles in the elemental and oxidized states is shown, even in the absence of post-implantation annealing. As a result of annealing, blue photoluminescence, associated with the recombination of donor-acceptor pairs (DAP) in Ga2O3 nanocrystals, appears in the spectrum. The structural characterization by transmission electron microscopy confirms the formation of ß-Ga2O3 nanocrystals. The obtained results open up the possibility of using nanocrystalline gallium oxide inclusions in traditional CMOS technology.