Radiologic Evaluation of Small Renal Masses (II): Posttreatment Management

The increase in the detection of small renal masses (SRMs) and their best knowledge leads to a change in the therapeutic management of these lesions. The use of a less aggressive surgical technique or even an expectant attitude is the current tendency, in order to preserve as much renal function as possible. Imaging techniques are essential in the followup of these lesions. It allows us to know the postsurgical changes and possible complications due to treatment and the presence of local recurrence and metastases. Furthermore, a close radiological followup of SRM related to ablative treatments is mandatory. The purpose of this article is to reveal the imaging features of complications due to surgical or ablative treatments, local recurrence and metastasis, as well as their followup

High-Intensity Focused Ultrasound in Small Renal Masses

High-intensity focused ultrasound (HIFU) competes with radiofrequency and cryotherapy for the treatment of small renal masses as a third option among ablative approaches. As an emerging technique, its possible percutaneous or laparoscopic application, low discomfort to the patient and the absence of complications make this technology attractive for the management of small renal masses. This manuscript will focus on the principles, basic research and clinical applications of HIFU in small renal masses, reviewing the present literature. Therapeutic results are controversial and from an clinical view, HIFU must be considered a technique under investigation at present time. Further research is needed to settle its real indications in the management of small renal masses; maybe technical improvements will certainly facilitate its use in the management of small renal masses in the near future

Stress compensation by gap monolayers for stacked InAs/GaAs quantum dots solar cells

In this work we report the stacking of 10 and 50 InAs quantum dots layers using 2 monolayers of GaP for stress compensation and a stack period of 18 nm on GaAs (001) substrates. Very good structural and optical quality is found in both samples. Vertical alignment of the dots is observed by transmission electron microscopy suggesting the existence of residual stress around them. Photocurrent measurements show light absorption up to 1.2 μm in the nanostructures together with a reduction in the blue response of the device. As a result of the phosphorus incorporation in the barriers, a very high thermal activation energy (431 meV) has also been obtained for the quantum dot emission

InAs/AlGaAs quantum dot intermediate band solar cells with enlarged sub-bandgaps

In the last decade several prototypes of intermediate band solar cells (IBSCs) have been manufactured. So far, most of these prototypes have been based on InAs/GaAs quantum dots (QDs) in order to implement the IB material. The key operation principles of the IB theory are two photon sub-bandgap (SBG) photocurrent, and output voltage preservation, and both have been experimentally demonstrated at low temperature. At room temperature (RT), however, thermal escape/relaxation between the conduction band (CB) and the IB prevents voltage preservation. To improve this situation, we have produced and characterized the first reported InAs/AlGaAs QD-based IBSCs. For an Al content of 25% in the host material, we have measured an activation energy of 361 meV for the thermal carrier escape. This energy is about 250 meV higher than the energies found in the literature for InAs/GaAs QD, and almost 140 meV higher than the activation energy obtained in our previous InAs/GaAs QD-IBSC prototypes including a specifically designed QD capping layer. This high value is responsible for the suppression of the SBG quantum efficiency under monochromatic illumination at around 220 K. We suggest that, if the energy split between the CB and the IB is large enough, activation energies as high as to suppress thermal carrier escape at room temperature (RT) can be achieved. In this respect, the InAs/AlGaAs system offers new possibilities to overcome some of the problems encountered in InAs/GaAs and opens the path for QD-IBSC devices capable of achieving high efficiency at RT

Strain balanced quantum posts for intermediate band solar cells

In this work we present strain balanced InAs quantum post of exceptional length in the context of photovoltaics. We discuss the general properties of these nanostructures and their impact in the practical implementation of an intermediate band solar cell. We have studied the photocurrent generated by strain balanced quantum posts embedded in a GaAs single crystal, and compared our results with quantum dot based devices. The incorporation of phosphorous in the matrix to partially compensate the accumulated stress enables a significant increase of the quantum post maximum length. The relative importance of tunneling and thermal escape processes is found to depend strongly on the geometry of the nanostructures. tunneling and thermal escape processes is found to depend strongly on the geometry of the nanostructures

Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium.

BACKGROUND: The inclusion criterion for active surveillance (AS) is low- or intermediate-risk prostate cancer. The predictive value of the presence of a suspicious lesion at magnetic resonance imaging (MRI) at the time of inclusion is insufficiently known. OBJECTIVE: To evaluate the percentage of patients needing active treatment stratified by the presence or absence of a suspicious lesion at baseline MRI. DESIGN SETTING AND PARTICIPANTS: A retrospective analysis of the data from the multicentric AS GAP3 Consortium database was conducted. The inclusion criteria were men with grade group (GG) 1 or GG 2 prostate cancer combined with prostate-specific antigen <20 ng/ml. We selected a subgroup of patients who had MRI at baseline and for whom MRI results and targeted biopsies were used for AS eligibility. Suspicious MRI was defined as an MRI lesion with Prostate Imaging Reporting and Data System (PI-RADS)/Likert ≥3 and for which targeted biopsies did not exclude the patient for AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was treatment free survival (FS). The secondary outcomes were histological GG progression FS and continuation of AS (discontinuation FS). RESULTS AND LIMITATIONS: The study cohort included 2119 patients (1035 men with nonsuspicious MRI and 1084 with suspicious MRI) with a median follow-up of 23 (12-43) mo. For the whole cohort, 3-yr treatment FS was 71% (95% confidence interval [CI]: 69-74). For nonsuspicious MRI and suspicious MRI groups, 3-yr treatment FS rates were, respectively, 80% (95% CI: 77-83) and 63% (95% CI: 59-66). Active treatment (hazard ratio [HR] = 2.0, p < 0.001), grade progression (HR = 1.9, p < 0.001), and discontinuation of AS (HR = 1.7, p < 0.001) were significantly higher in the suspicious MRI group than in the nonsuspicious MRI group. CONCLUSIONS: The risks of switching to treatment, histological progression, and AS discontinuation are higher in cases of suspicious MRI at inclusion. PATIENT SUMMARY: Among men with low- or intermediate-risk prostate cancer who choose active surveillance, those with suspicious magnetic resonance imaging (MRI) at the time of inclusion in active surveillance are more likely to show switch to treatment than men with nonsuspicious MRI

Reasons for Discontinuing Active Surveillance : Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium

Background: Careful assessment of the reasons for discontinuation of active surveillance (AS) is required for men with prostate cancer (PCa). Objective: Using Movember's Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database, we report on reasons for AS discontinuation. Design, setting, and participants: We compared data from 10 296 men on AS from 21 centres across 12 countries. Outcome measurements and statistical analysis: Cumulative incidence methods were used to estimate the cumulative incidence rates of AS discontinuation. Results and limitations: During 5-yr follow-up, 27.5% (95% confidence interval [CI]: 26.4-28.6%) men showed signs of disease progression, 12.8% (95% CI: 12.0-13.6%) converted to active treatment without evidence of progression, 1.7% (95% CI: 1.5-2.0%) continued to watchful waiting, and 1.7% (95% CI: 1.4-2.1%) died from other causes. Of the 7049 men who remained on AS, 2339 had follow-up for >5 yr, 4561 had follow-up for Conclusions: Our descriptive analyses of current AS practices worldwide showed that 43.6% of men drop out of AS during 5-yr follow-up, mainly due to signs of disease progression. Improvements in selection tools for AS are thus needed to correctly allocate men with PCa to AS, which will also reduce discontinuation due to conversion to active treatment without evidence of disease progression. Patient summary: Our assessment of a worldwide database of men with prostate cancer (PCa) on active surveillance (AS) shows that 43.6% drop out of AS within 5 yr, mainly due to signs of disease progression. Better tools are needed to select and monitor men with PCa as part of AS. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Validation of a 2-gene mRNA urine test for the detection of >= GG2 prostate cancer in an opportunistic screening population

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