Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database.

Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods: For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results: In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions: This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

Corrigendum to "RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned" [Eur. Urol. Open Sci. 54 (2023) 33-42].

[This corrects the article DOI: 10.1016/j.euros.2023.05.007.].

Cyanoacrylate Glue Masquerading as an Obstructive Calculus: Rare Sequelae of Angioembolization for Renal Pseudoaneurysm.

Renal pseudoaneurysm is a well-known albeit rare vascular complication following renal trauma, percutaneous interventions, renal biopsy, and partial nephrectomy. Angioembolization has become an effective treatment option for pseudoaneurysm using Cyanoacrylate glue, Gel-foams, Micro-coils, polyvinyl alcohol, etc. We herein present a 20-year-old gentleman with infected left hydroureteronephrosis secondary to an impacted foreign body in a ureter, specifically, down-migrated cyanoacrylate glue. This is two weeks following glue angioembolization for a left upper polar segmental renal artery pseudoaneurysm secondary to stab injury. He underwent a successful left-side ureteroscopic extraction of this polymerized glue, following which his symptoms subsided. These complications of glue migration following angioembolization are infrequent, and reports of it are scarce in the literature. Stringent follow-up and timely intervention are essential to mitigate disastrous outcomes.

High-Throughput Virtual Screening of Host Materials and Rational Device Engineering for Highly Efficient Solution-Processed Organic Light-Emitting Diodes.

The appropriate choice of host and electron-transporting material (ETM) plays a very crucial role in the generation and collection of radiative excitons in the desired recombination zone of organic light-emitting diodes (OLEDs). Due to the sustainable development of material organic chemistry, there is a big library of functional materials that leads to uncountable combinations of device structures, which might achieve a desirable high device performance. However, there is no appropriate methodology available for the fast virtual screening of organic materials and designing a suitable device structure. Here, we have used the electrical software package SETFOS 4.5 for high-throughput virtual screening of host materials and developed a highly efficient multistack OLED device structure. To further enhance the device performance, a co-host approach has been used, and the final device structure has also been optimized with two different ETMs. The best-optimized Ir(ppy)3-based solution-processed green OLED device exhibited a maximum power efficiency (PE) of 83.20 lm/W and brightness of 61,362 cd/m2 with a driving voltage of 2.1 V without using any light extraction outcoupling techniques, which is the best among the OLEDs in its own category. The developed device structure has also been utilized to fabricate highly efficient blue hazard-free low-color temperature OLEDs for a physiologically friendly light at night. The resultant 2083 K OLED device displayed a maximum PE of 51.4 lm/W and luminance of 44,548 cd/m2 with a turn-on voltage of 2.1 V that is also 42 and 104 times safer in terms of retinal protection and ∼4 and ∼11 times safer in terms of melatonin generation when compared with those of a real candle and incandescent bulb, respectively. The observed excellent device performance may be attributed to the balanced charge carrier in the recombination zone, broader emissive layer due to a mixed-host system, less accumulation of charges at the injecting surfaces, well-aligned triplet energy and molecular orbital energy level of the host and guest, and high electron mobility and enhanced hole blocking ability of the employed ETM in the designed OLED device structure.

Role of Molecular Orbital Energy Levels in OLED Performance.

Abundant molecules enable countless combinations of device architecture that might achieve the desirable high efficiency from organic light-emitting diodes (OLEDs). Due to the relatively high cost of OLED materials and facilities, simulation approaches have become a must in further advancing the field faster and saver. We have demonstrated here the use of state-of-art simulation approaches to investigate the effect of molecular orbital energy levels on the recombination of excitons in OLED devices. The devices studied are composed of 1,1-bis[(di-4-tolylamino)phenyl]cyclohexane (TAPC) as hole transporting material (HTM), 4,4'-Bis(9-carbazolyl)-1,1'-biphenyl (CBP) as host, 2,2',2"-(1,3,5-benzinetriyl)-tris(1-phenyl-1-H-benzimidazole) (TPBi) or bathophenanthroline (Bphen) as electron transporting materials. The outcomes reveal that exciton recombination highly sensitive to the energy-level alignment, injection barriers, and charge mobilities. A low energy-barrier (<0.4 eV) between the layers is the key to yield high recombination. The lowest unoccupied molecular orbital (LUMO) levels of the organic layers have played a more pivotal role in governing the recombination dynamics than the highest occupied molecular orbital (HOMO) level do. Furthermore, the Bphen based device shows high exciton recombination across the emissive layer, which is >106 times greater than that in the TPBi based device. The high carrier mobility of Bphen whose electron mobility is 5.2 × 10-4 cm2 V-1 s-1 may lead to low charge accumulation and hence high exciton dynamics. The current study has successfully projected an in-depth analysis on the suitable energy-level alignments, which would further help to streamline future endeavours in developing efficient organic compounds and designing devices with superior performance.

Surface plasmon-enhanced solution-processed phosphorescent organic light-emitting diodes by incorporating gold nanoparticles.

Organic light-emitting diodes (OLEDs) have attracted increasing attention due to their superiority as high quality displays and energy-saving lighting. However, improving the efficiency of solution-processed devices especially based on blue emitter remains a challenge. Excitation of surface plasmons on metallic nanoparticles has potential for increasing the absorption and emission from optoelectronic devices. We demonstrate here that the incorporation of gold nano particles (GNPs) in the hole injection layer of poly(3,4-ethylene dioxythiophene):polystyrene sulfonic acid with an appropriate size and doping concentration can greatly enhance the efficiency OLED device especially at higher voltage. Apparently, the spectral of the multiple plasmon resonances of the GNPs and the luminescence of the emitting materials significantly overlap with each other. At 1000 cd m-2 for example, the power efficiency of a studied green device is increased from 29.0 to 36.2 lm W-1, an increment of 24.8%, and the maximum brightness improved from 21 550 to 27 810  cd m-2, an increment of 29.1%, as 2 wt% of a 12 nm GNP is incorporated. Remarkably, designed blue OLED also exhibited an increment of 50% and 35% in power efficacy at 100 and 1000 cd m-2, respectively, for same device structure. The reason why the enhancement is marked may be attributed to a strong absorption of the short-wavelength emission from the device by the gold nano particles, which in turn initiates a strong surface plasmon resonance effect, leading to a high device efficiency.

Approaches for Long Lifetime Organic Light Emitting Diodes.

Organic light emitting diodes (OLEDs) have been well known for their potential usage in the lighting and display industry. The device efficiency and lifetime have improved considerably in the last three decades. However, for commercial applications, operational lifetime still lies as one of the looming challenges. In this review paper, an in-depth description of the various factors which affect OLED lifetime, and the related solutions is attempted to be consolidated. Notably, all the known intrinsic and extrinsic degradation phenomena and failure mechanisms, which include the presence of dark spot, high heat during device operation, substrate fracture, downgrading luminance, moisture attack, oxidation, corrosion, electron induced migrations, photochemical degradation, electrochemical degradation, electric breakdown, thermomechanical failures, thermal breakdown/degradation, and presence of impurities within the materials and evaporator chamber are reviewed. Light is also shed on the materials and device structures which are developed in order to obtain along with developed materials and device structures to obtain stable devices. It is believed that the theme of this report, summarizing the knowledge of mechanisms allied with OLED degradation, would be contributory in developing better-quality OLED materials and, accordingly, longer lifespan devices.

Synthesis of Solution-Processable Donor-Acceptor Pyranone Dyads for White Organic Light-Emitting Devices.

A series of donor-acceptor pyranones (3a-m, 4a-h) were synthesized using α-oxo-ketene- S, S-acetal as the synthon for their application as emissive materials for energy-saving organic light-emitting devices (OLEDs). Among them, five pyranones 3f, 3g, 3h, 3m, and 4e exhibited highly bright fluorescence in the solid state and weak or no emission in the solution state. Photophysical analysis of these dyes revealed that only 3f and 3m showed aggregation-induced emission behavior in a THF/water mixture (0-99%) with varying water fractions ( fw) leading to bright fluorescence covering the entire visible region, while other derivatives 3g, 3h, and 4e did not show any fluorescence signal. The computational studies of the compounds revealed that the longer wavelength absorption originates from HOMO to LUMO electronic excitation. These dyes exhibited good thermal stability with 5% weight loss temperature in the range of 218-347 °C. The potential application of the donor-acceptor pyranone dyads was demonstrated by fabrication of solution-processed OLEDs. Remarkably, OLED devices prepared using highly emissive compounds 6-(anthracen-9-yl)-4-(methylthio)-2-oxo-2 H-pyran-3-carbonitrile (3m) and 6-(4-methoxyphenyl)-4-(methylthio)-2-oxo-2 H-pyran-3-carbonitrile (3f) displayed pure white emission with CIE coordinates of (0.29, 0.31) and (0.32, 0.32), respectively. Additionally, the resultant devices exhibited external quantum efficiencies of 1.9 and 1.2% at 100 cd m-2, respectively.

Room-Temperature Columnar Liquid Crystals as Efficient Pure Deep-Blue Emitters in Organic Light-Emitting Diodes with an External Quantum Efficiency of 4.0.

A novel design of aggregation-induced emission (AIE) active columnar (Col) luminomesogens is reported, and they are demonstrated to act as highly efficient deep-blue emitters in organic light-emitting diodes (OLEDs). All derivatives exhibit Col liquid crystalline (LC) behavior at room temperature over a wide temperature range and desirable alignment properties, which is very important in using them as materials for organic electronic devices. These new AIE active luminomesogens were found to act as highly efficient emitters in OLEDs and unveiled a maximum external quantum efficiency of 4.0% for the first time in Col LCs with Commission International de l'E'clairage coordinates of (0.17, 0.07), which closely matches the National Television System Committee (NTSC) standard, corresponding to pure deep blue color. The detailed supramolecular assembly of the compounds has been characterized by modeling in the mesophase derived from small- and wide-angle X-ray scattering results.

Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis.

PURPOSE: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300-500-µ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. RESULTS: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3-28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. CONCLUSIONS: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.

Tuning the Photophysical and Electroluminescence Properties in Asymmetrically Tetrasubstituted Bipolar Carbazoles by Functional Group Disposition.

Carbazoles decorated with both donor and acceptor fragments offer a classical way to optimize bipolar functional properties. In this work, a series of carbazoles featuring triphenylamine donors and cyano acceptors are synthesized and their structure-property relationship is studied. The effects of connectivity and the chromophore number density on photophysical and electroluminescence properties are investigated. The position of the triphenylamine donor on the 3,6-dicyanocarbazole nucleus significantly affected the photophysical and electroluminescence properties. The dye possessing triphenylamine on C2 and C7 displayed a red shift in absorption when compared with the structural analogue with triphenylamine tethered to C1 and C8. The emission wavelength of the dyes are tunable from blue to green, by altering the position of triphenylamine and cyano substituents. All of the dyes exhibited positive solvatochromism in emission, attributable to the photoinduced intramolecular charge transfer from the triphenylamine donor to the cyano acceptor. However, the extent of charge transfer and hybridization of local and charge-transfer-excited states is highly dependent on the position of triphenylamine and cyano groups on the carbazole nucleus. Dyes containing cyano substituents at C2 and C7 showed a prolonged excited state lifetime, broad emission, and large Stokes shifts, indicating the presence of a higher charge transfer component in the excited state. The dyes displayed exceptional thermal stability with the onset decomposition temperature (10% weight loss) > 350 °C. Electrochemical measurements revealed low oxidation potential for dyes containing triphenylamine at C3 and/or C6. Addition of a cyano acceptor on carbazole led to the stabilization of lowest unoccupied molecular orbital. Furthermore, the materials were tested as emitting dopants in solution-processable multilayer organic light emitting diodes and found to display deep-blue/sky-blue electroluminescence with external quantum efficiency as high as 6.5% for a deep-blue emitter (CIE y ∼ 0.06).

An Approach for Measuring the Dielectric Strength of OLED Materials.

Surface roughness of electrodes plays a key role in the dielectric breakdown of thin-film organic devices. The rate of breakdown will increase when there are stochastic sharp spikes on the surface of electrodes. Additionally, surface having spiking morphology makes the determination of dielectric strength very challenging, specifically when the layer is relatively thin. We demonstrate here a new approach to investigate the dielectric strength of organic thin films for organic light-emitting diodes (OLEDs). The thin films were deposited on a substrate using physical vapor deposition (PVD) under high vacuum. The device architectures used were glass substrate/indium tin oxide (ITO)/organic material/aluminum (Al) and glass substrate/Al/organic material/Al. The dielectric strength of the OLED materials was evaluated from the measured breakdown voltage and layer thickness.

Impact of learning curve on the perioperative outcomes following robot-assisted partial nephrectomy for renal tumors.

INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving "trifecta" outcomes following RAPN. METHODS: We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience. We used warm ischemia time (WIT) <20 min, operative time <120 min, and blood loss <100 ml as endpoints for plotting the LCs. Trifecta was analyzed in relation to our LC. RESULTS: Surgeon experience was found to correlate with WIT, operative time, and blood loss. Overall 18.5% of patients developed complications. Complication rate reduced with increasing surgeon experience. LC was 44 cases for WIT ≤20 min, 44 cases for operative time <120 min, and 54 cases for blood loss <100 ml. Trifecta outcome was achieved in 67.6% patients overall and was found to correlate with increasing surgeon experience. Improvement in trifecta outcomes continued to occur beyond the LC. CONCLUSIONS: RAPN is a viable option for nephron-sparing surgery in patients with renal carcinoma. For a surgeon trained in laparoscopy, acceptable perioperative outcomes following RAPN can be achieved after an LC of about 44 cases. Increasing surgeon experience was associated with improved "trifecta" achievement following RAPN.

Vinyl-Linked Cyanocarbazole-Based Emitters: Effect of Conjugation and Terminal Chromophores on the Photophysical and Electroluminescent Properties.

A series of carbazole-based dyes functionalized with different auxochromes via vinyl linker have been synthesized and characterized. A progressive shift in the absorption maximum is observed as the conjugation and electron-donating nature of chromophore increases. Dyes containing electron-releasing terminal groups such as triphenylamine and carbazole exhibited positive emission solvatochromism attributable to an induced intramolecular charge transfer from triphenylamine/carbazole donor to cyano acceptor. The superior electroluminescence performance of disubstituted dyes demonstrates the role of an additional cyanocarbazole in achieving balanced charge transport compared to monosubstituted analogues. In addition, the electroluminescence performance of the dyes exhibited trends attributable to the electron richness of the linker/terminal chromophore. Thus, the carbazole-based derivatives displayed better electroluminescence efficiency than the analogous fluorene derivatives. Similarly, 2,7-substituted carbazole derivative exhibited better performance than the 3,6-substituted carbazole derivative. A doped electroluminescent device containing 3 wt % tricarbazole derivative showed blue emission with a high external quantum efficiency of 5.3% at a practical brightness of 1000 cd/m2.

A new molecular design based on hybridized local and charge transfer fluorescence for highly efficient (>6%) deep-blue organic light emitting diodes.

A deep-blue emitter was developed by modifying carbazole nuclear positions C2 & C7 with a triphenylamine donor and C3 & C6 with a cyano acceptor. The molecular design features cross-conjugated localized and charge transfer chromophores which results in a hybridized local charge transfer (HLCT) excited state. An organic light emitting diode (OLED) using this material exhibited high external quantum efficiency (6.5%) with excellent color saturation (CIEy ∼ 0.06) and small full-width at half maximum (48 nm).

Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes.

INTRODUCTION: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. MATERIALS AND METHODS: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN)  and delayed graft function were also recorded. RESULTS: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. CONCLUSIONS: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity.

SIU/ICUD Consultation on Urethral Strictures: Evaluation and follow-up.

For the 2010 International Consultation on Urethral Strictures, all available published data relating to the evaluation and follow-up of patients with anterior urethral stricture or posterior urethral stenosis were reviewed and evaluated. Selected manuscripts were classified by Level of Evidence using previously established criteria. Consensus was achieved through group discussion, and formal recommendations were established and graded on the basis of levels of evidence and expert opinion. Retrograde urethrography remains the de facto standard for the evaluation of patients with urethral stricture. It can readily be combined with voiding cystourethrography to achieve a synergistic evaluation of the entire urethra, and this approach is currently recommended as the optimal method for pretreatment staging. Cystoscopy is recommended as the most specific procedure for the diagnosis of urethral stricture and is a useful adjunct in the staging of anterior urethral stricture, particularly to confirm abnormal or equivocal findings on imaging studies. Cystoscopy is also an important modality for assessing the bladder neck and posterior urethra in the setting of a pelvic fracture-related urethral injury. Although urethrography and cystoscopy remain the principle forms of assessment of the patient with urethral stricture, additional adjuncts include uroflowmetry, symptom scores, quality of life assessments, ultrasonography, computed tomography, and magnetic resonance imaging. These modalities might be helpful to further evaluate patients in select circumstances or provide a less invasive approach to monitoring outcomes after surgical treatment. Further research is needed to establish consensus opinion as to the definition of success after urethroplasty and to develop standardized patient outcome measures.

SIU/ICUD Consultation on Urethral Strictures: Pelvic fracture urethral injuries.

The posterior urethra pierces the perineal diaphragm in close relationship to the pubic arc elements of the bony pelvis to which it is tethered by attachments to the puboprostatic ligaments and the perineal membrane. Because of these relationships, it is not surprising that fracture disruptions of the pelvic ring can be associated with injuries to the urethra at this level. Although the relationship between pelvic fracture and posterior urethral injury has been recognized for >1 century, considerable controversy exists on almost any aspect of these injuries, from the anatomy and classification of the injuries to the strategies for acute management, reconstruction, and treatment of complications, to mention just a few. What it is not controversial and well known is that these injuries can result in significant morbidity in the long run--mainly strictures, erectile dysfunction, and urinary incontinence--which can cause lifelong disability. It also well known that, just as in many other areas of trauma, the severity and duration of the complications can be reduced considerably if the injury is diagnosed and treated promptly and efficiently. This chapter summarizes the most relevant published evidence about the management of pelvic fracture urethral injuries. This comprehensive review, performed by an international panel of experts, will provide valuable information and recommendations to help urologists worldwide improve the treatment and outcomes of their injured patients.