Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis.

The primary objective of the current study is to undertake a comparative analysis of the effectiveness and safety of minimally-invasive partial nephrectomy (MIPN; including laparoscopic and robotic approaches) and open partial nephrectomy (OPN) for the treatment of highly complex renal tumors (defined as PADUA or RENAL score ≥ 10). A comprehensive search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) to identify relevant studies published in the English language up to April 2023. The current study employed Review Manager 5.4 and encompassed controlled trials of both MIPN and OPN for the treatment of highly complex renal tumors. This study comprised a total of eight comparative trials involving 1161 patients. MIPN demonstrated a significant reduction in length of hospital stay (weighted mean difference [WMD] - 2.08 days, 95% confidence interval [CI] - 2.48, - 1.68; p < 0.00001), blood loss (WMD - 39.86 mL, 95% CI - 75.32, - 4.39; p = 0.03), transfusion rates (odds ratio [OR] 0.30, 95% CI 0.13, 0.71; p = 0.006), and overall complications (OR 0.46, 95% CI 0.31, 0.70; p = 0.0003). However, there were no significant differences between MIPN and OPN in terms of operative time, warm ischemia time, conversion to radical nephrectomy rates, renal functional and oncologic outcomes. This study reveals that MIPN presents several benefits in comparison to OPN, including decreased length of hospital stay, blood loss, transfusion rates, and complications, while still offering renal functional and oncological outcomes that are comparable to those of OPN in patients with highly complex renal tumors.

Current Progress in Natural Deep Eutectic Solvents for the Extraction of Active Components from Plants.

In the last decade, natural deep eutectic solvents (NADESs) have gained more and more attention due to their green, convenient preparation, low toxicity and biodegradability. It is widely used in various fields, especially in the extraction of active components from plants, formed by the combination of hydrogen bond donors (HBDs) and hydrogen bond acceptors (HBAs) at a certain condition. In this article, six preparation methods of NADESs were summarized and the interactions that occur in the eutectic behavior of NADES including hydrogen bonding, electrostatic interaction and van der Waals force were also reviewed. What is more, its significant extraction capacity on flavonoids, phenols, alkaloids and plant pigments endows its extensive applications in the extraction of active components from medicinal plants. Extraction factors including solvents properties (viscosity, carbon chain length, number of hydroxyl groups), extraction condition (water content, extraction temperature, extraction time, solid-liquid ratio), extraction method and recycling method were discussed. In addition, NADESs can also be combined with other technologies, like molecular imprinting, monolithic column, to achieve efficient and specific extraction of active ingredients. Further systematic studies on the biodegradability and biotoxicity are put forward to be urgent.

Optimization of the extraction process of flavonoids from Trollius ledebouri with natural deep eutectic solvents.

In recent years, natural deep eutectic solvents have been favored greatly due to their environment friendly, mild biological toxicity and simple biodegradability. Natural deep eutectic solvents gradually applied for the extracting bioactive compounds from natural products efficiently. In this study, 20 natural deep eutectic solvents were prepared and their physical and chemical properties were tested. The ultrasonic-assisted extraction method was used to extract flavonoids from Trollius ledebouri and high-performance liquid chromatography-ultraviolet was applied to examine two main bioactive flavonoids (orientin and vitexin). Compared with traditional solvents (water and 60% ethanol solution), natural deep eutectic solvents composed of L(-)-proline and levulinic acid (molar ratio 1:2) show a super extraction efficiency. On this basis, the response surface method was used to optimize the extraction temperature, extraction time, water contents, and solid-liquid ratio. As a consequence, the extraction temperature 60℃, extraction time 18 min, water content 14% (v/v), and the solid-liquid ratio 48 mL·g-1 were chosen as the best extraction process. This study shows that natural deep eutectic solvents can effectively extract flavonoids from T. ledebouri, laying a foundation for the further application of natural deep eutectic solvents to extract bioactive compounds from natural products.