Search

This paper reviews the low-temperature and low-pressure thermal polymerization of dielectric polyimides that are used for redistribution layers (RDLs). Specifically, this presentation illustrates the significant impact of the low-pressure cure process in reducing cure temperature (by 20° to 50°C) and cure times (by as much as 25%) while providing better imidization ratio, film stress, mechanical (elongation %, tensile strength, Young’s modulus), thermal (Tg, Td5%, CTE), and electrical (Dk, Df) properties for different types of dielectric polyimides. Among the many low-temperature polyimides we have studied, we focus here on the Fujifilm LTC-9300 series (LTC-9310 and LTC-9320) and the Asahi BL-300 series. The excellent post-curing polymerization ratio (as measured by FT-IR) and film stress results are also described. Finally, a proposed mechanism for these dielectric polyimides’ polymerization under reduced pressure is discussed.

The aim of the study was to prospectively evaluate safety and efficacy of bilateral same session ureterorenoscopy (BSS-FURS) for management of bilateral renal calculi.A prospective comparative study was designed to compare the results of BSS-FURS with unilateral flexible ureterorenoscopy (U-FURS) for management of renal calculi between June 2003 and May 2016. A sample size of 55 patients in each arm was calculated considering a 20% increase in the incidence of complications with BSS-FURS over 15% complication rate in U-FURS (alpha = 0.05; Beta = 0.90). Patient demographics, stone burden, total operative time, postoperative creatinine level, duration of hospital stay, perioperative complications and stone free rate (SFR) were compared in both the groups. The literature pertaining to BSS-FURS was reviewed.Although the study group patients had higher overall stone burden (18.60 ± 7.70 mm vs. 13.32 ± 6.43 mm) and significantly longer operative time (48.30 ± 16.71 min vs. 32.95 ± 13.05 min;BSS-FURS is a safe and efficient procedure for the management of bilateral renal calculi in the hands of an experienced endourologist. It has comparable SFR and morbidity compared to U-FURS. Caution should be exercised in patients with struvite stones, as they are more likely to develop postoperative fever.

To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH). A thorough PubMed database search was performed over last 30 years including terms “PSA” and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures. Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters. Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3–6 months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.

Purpose:We sought to determine the optimal cystoscopic interval for intermediate risk, nonmuscle invasive bladder cancer.Materials and Methods:A retrospective analysis of patients with intermediate...

To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi (> 4 cm). All patients with vesical calculi > 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher’s exact test. A p value

The growth of single crystals of Ge-rich SiGe alloys in an extended composition range is demonstrated using the nanomembrane (NM) platform and III-V growth substrates. Thin films of high-Ge-content SiGe films are grown on GaAs(001) to below the kinetic critical thickness and released from the growth substrate by selectively etching a release layer to relax the strain. The resulting crystalline nanomembranes at the natural lattice constant of the alloy are transferred to a new host and epitaxially overgrown at similar compositions to make a thicker single crystal. Straightforward critical-thickness calculations demonstrate that a very wide range of group IV alloys, including those involving Sn, can be fabricated using the NM platform and the proper choice of III-V substrate. Motivations for making new group IV alloys center on band gap engineering for the development of novel group IV optoelectronic structures and devices.

Purpose of review To provide a current comprehensive review of the available urinary biomarkers for the detection and surveillance of bladder cancer. Recent findings The limitations of urine cytology and invasive nature of cystoscopic evaluation have led to a growing search for an ideal, cost-effective biomarker with acceptable sensitivity and specificity. Current FDA approved biomarkers such as UroVysion fluorescent in situ hybridization, Immunocyt, and nuclear matrix protein 22 do not have the specificity, and thus positive predictive value to warrant their cost as a routine adjunct or replacement for cystoscopy. Several promising commercially available assays such as Cxbladder, Assure MDx, and Xpert BC may perform better than cytology in select populations. Novel genomic, epigenetic, inflammatory, and metabolomic-based assays are being analyzed as potential urinary biomarkers. Summary Urinary biomarkers with high sensitivity and specificity are an unmet need in bladder cancer. Several new assays may meet these criteria and future research may justify use in clinical practice.

Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Diagnosis is based on imaging, mainly X-rays and CT along with retrograde pyelography that establishes the fistulous connection. A difficult to diagnose condition, any patient with a supracostal access PCNL who presents with delayed symptoms of breathlessness and has leucocytosis with fluid in the lungs on chest imaging should be suspected to have a nephropleural fistula. The management involves intercostal tube thoracostomy to relieve symptoms and drainage of the operated kidney by double-J stent placement, if not placed already. Prompt recognition and management results in excellent recovery with no sequelae. We present our experience with two such cases and our aim was to familiarise the practising urologist regarding the diagnosis and management of this infrequent condition.

Migration of abdominal wall mesh in an augmented bladder is a rarely encountered complication leading to formation of bladder stones causing recurrent urinary tract symptoms. The usual management of this condition involves either open surgical or a percutaneous approach for removal of the stone and migrated portion of mesh. Diagnosis of a migrated mesh is usually made intraoperatively during cystolitholapaxy. Appropriate management results in symptomatic improvement. Endoscopic management through catheterisable continent appendicovesicostomy has not been described to manage this challenging condition. To the best of our knowledge, we describe herewith the first report of endoscopic management of a large bladder stone formed over migrated mesh which involved removal of migrated mesh with holmium laser via a Mitrafanoff.

To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi ( 4 cm).All patients with vesical calculi 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher's exact test. A p value 0.05 was considered statistically significant.Twenty patients with ten in each cohort were recruited. Preoperative data and mean bladder stone size were comparable in both groups. The duration of surgery was significantly reduced from 70.80 ± 25.28 min in low-power cohort to 40.90 ± 15.01 min in the high-power group (p = 0.005). There were no significant intra-operative complications in either group. All patients were stone-free following the procedure.High-power laser setting of up to 100 W results in a significant reduction in duration of surgery without any increase in the complication rate for treatment of large bladder stones.

INTRODUCTION AND OBJECTIVE:Intermediate risk (IR) NMIBC is a heterogeneous entity with a variable risk of recurrence and progression. The current American Urological Association (AUA)/Society of Ur...

We report short-term outcomes of focal high intensity focused ultrasound use for primary treatment of localized prostate cancer.Single-center prospectively collected data on patients with prostate cancer who underwent primary focal high intensity focused ultrasound from January 2016 to July 2018 were included. All patients underwent a 12-core biopsy with magnetic resonance imaging-ultrasound fusion biopsy depending on the presence of targetable lesions. Any Grade Group was allowed, however only patients with localized disease were included. The primary outcome was oncologic control, defined as negative followup in-field biopsy of treated cancer. Prostate specific antigen, Sexual Health Inventory for Men, International Prostate Symptom Score and Expanded Prostate Cancer Index Composite domain scores were assessed 3-monthly till 12 months. Biopsy was performed at 6 or 12 months for high or low/intermediate risk cancer, respectively.Fifty-two patients with minimum followup of 12 months were included in the study. The majority of patients (67%) had cancer Grade Group 2 or greater. Fifteen patients (28.8%) underwent complete transurethral prostate resection/holmium laser enucleation of prostate procedure for debulking large prostates to avoid postoperative urinary retention. Among 30 (58%) patients who underwent followup biopsies, 25 (83%) had negative in-field biopsy results and 4 (13%) had de-novo positive out-of-field biopsy. Only 5 major complications (all grade III) in 4 patients were noted. Urinary symptoms returned to near baseline questionnaire scores within 3-6 months. Sexual function returned to baseline at 12 months.Focal high intensity focused ultrasound is a safe and effective treatment for patients with localized clinically significant prostate cancer with acceptable short-term oncologic and functional outcomes. The complications are minimal and patient selection is essential. Short-term oncologic outcomes are promising but longer followup is required to establish long-term oncologic outcomes.

Unilateral acquired diaphragmatic paresis is a known complication of thoracic surgeries. Direct mechanical injury to the phrenic nerve during surgery results in this complication. However its occurrence post-percutaneous nephrolithotomy (PCNL) has not been described. We report a 43-year-old man who underwent prone PCNL for endourological management of left complete staghorn calculus. Access via the 10th left intercostal space, under fluoroscopy, was carried out to remove the calculus. Post-operative, the routine chest radiograph revealed left hemidiaphragmatic blunting. Computerized tomography of the chest confirmed left hemidiaphragmatic elevation, suggesting unilateral diaphragmatic paresis. He did not have any respiratory symptoms, was managed conservatively with chest physiotherapy and incentive spirometry and responded extremely well. The absence of reported cases of diaphragmatic paresis post PCNL lends to a dearth in knowledge regarding recognition and management. This case report aims to acquaint urologists with this rare complication associated with supracostal PCNL and provide a rational management plan.

Series-coupled quadrature LC voltage-controlled oscillators(SQVCOs) perform robustly over a wide tuning range, but have a higher $1/f^{3}$ phase noise than their single-phase counterparts. Switching transistors inject noise into the tank only once per cycle leading to an asymmetric impulse sensitivity function(ISF) and large flicker noise upconversion. Circuit topologies with additional capacitive paths from the drains of the switching transistors are proposed to make the switching transistors inject noise twice in a cycle and reduce the average ISF to nearly zero. The proposed SQVCOs have a phase noise figure of merit(FoM) close to that of a single-phase VCO for a given tank. They also eliminate mode ambiguity usually present in the coupled VCOs. The 2.4 GHz prototypes of two of the proposed SQVCOs in a 0.13 $\mu \text{m}$ CMOS process have $1/f^{3}$ phase noise corners of 400 and 150 kHz compared to 3 MHz in the conventional SQVCO. At 1 MHz/3 MHz offset, the proposed SQVCOs have measured phase noise(FoM) of −133.5/−145.1 dBc/Hz (188.2/190.2 dB) and −130/−140.2 dBc/Hz (192.5/193.2 dB) whereas the conventional SQVCO has −125.5/−137.6 dBc/Hz (180.3/183 dB). The average measured phase error over five chips is 0.9°.

This paper presents the performance assessment of a novel turbofan engine using two energy sources: Liquid Natural Gas (LNG) and kerosene, called Multi-Fuel Hybrid Engine (MFHE). The MFHE is a new engine concept consisting of several novel features, such as a contra-rotating fan to sustain distortion caused by boundary layer ingestion, a sequential dual-combustion system to facilitate “Energy Mix” in aviation and a Cryogenic Bleed Air Cooling System (CBACS) to cool the turbine cooling air. The MFHE has been envisaged as a propulsion system for a long-range Multi-Fuel Blended Wing Body (MFBWB) aircraft. In this research, we study the uninstalled characteristics of the MFHE covering three aspects: 1) the effects of CBACS on the High Pressure Turbine (HPT) cooling air requirement and its consequence on the engine cycle efficiency; 2) the cycle optimization of the MFHE; 3) the performance of the MFHE at a mission level. An integrated model framework consisting of an engine performance model, a sophisticated turbine-cooling model, and a CBACS model is used. The parametric analysis shows that using CBACS can reduce the bleed air temperature significantly (up to 400 K), thereby decreasing the HPT cooling air by more than 40%. Simultaneously, the LNG temperature increases by more than 200 K. The hybrid engine alone reduces the CO2 emission by about 27% and the energy consumption by 12% compared to the current state-of-the-art turbofan engine. Furthermore, the mission analysis indicates a reduction in NOx emission by 80% and CO2 emission by 50% when compared to the baseline aircraft B-777 200ER.

The rarity of primary seminal vesical adenocarcinoma (PSVA) coupled with mostly late and advanced presentation with high mortality makes it an unanticipated malignancy with poor prognosis. Although there has been sporadic reporting of cases, the dearth of literature makes standardised care a challenge. The detection has incorporated immunohistochemistry for establishing the site of origin as well as the differentiation of primary from metastatic cancer. Surgical management with seminal vesiculectomy continues to be the mainstay of treatment, but difficult anatomy and delayed intervention do lead to an increased chance of residual disease that may warrant further adjuvant chemoradiation. We present a case report where PSVA developed in a patient with Zinner syndrome—an observation that is extremely rare with a literature review of PSVA including the various aspects of management including contemporary diagnosis techniques.

Purpose of review To provide a comprehensive review of the available biomarkers for the detection and active surveillance of prostate cancer and simplify decision-making while choosing between them. Recent findings The limitations of PSA and mpMRI and the invasive nature of prostate biopsy has led to a constant search for serum and urinary biomarkers for both the detection and monitoring during active surveillance of prostate cancer. 4K, PHI and PCA3 have been validated in prospective clinical trials for initial detection of prostate cancer and recent evidence points to potential differentiation between indolent and aggressive cancer. However, the usage in monitoring tumor dynamics is debatable because of lack of conclusive evidence. The answer to the existing problems lies in high-quality studies to establish definitive evidence and also to help choose between the plethora of biomarkers available today. Summary Despite the advancements in innovation and usage of biomarkers in prostate cancer, there exists tremendous potential in improving them to fulfil the unmet need that exists today. Studies to establish conclusive evidence and integration with imaging can tremendously aid diagnosis and monitoring.

Because of their promise of wide bandwidths and high data-rates, fifth-generation (5G) wireless systems are expected to be deployed worldwide over the next decade. Several bands in the 25-to-40GHz range are allocated for 5G radios. A single widely tunable LC VCO covering the required bands is difficult to design, but is more compact than a set of multiple narrowly tuned VCOs, and is, therefore, preferred. In practice, it is difficult to simultaneously achieve low phase noise and wide tuning range by varying only the capacitor in an LC VCO because (a) switchable capacitor banks have a poor quality factor, Q, at millimeter-wave frequencies and degrade the phase noise, and (b) using wide switches to increase Q increases parasitics and reduces the tuning range.

Our understanding of the potential impact of ischemia time on renal function during nephron-sparing surgery (NSS) is based on decades of low-quality evidence. Recent studies have shown that the baseline quality of the renal parenchyma and the quantity of parenchyma remaining, rather than duration of ischemia, are more important in predicting renal functional recovery. A prospective clinical trial evaluating actual renal parenchyma under clamp conditions during NSS showed minimal structural and functional changes that were reversible and were not associated with duration of ischemia. Patients with known preoperative kidney disease should be optimized before surgery and care should be taken intraoperatively to preserve the maximum amount of healthy parenchyma. A thorough evaluation of evidence is warranted before setting or changing surgical practice and approach. Patient summary: This mini-review reveals that a limited duration of ischemia during nephron-sparing surgery for kidney cancer does not have a significant impact on renal function. Baseline renal function and the amount of parenchyma preserved appear to play a more important role in predicting postoperative renal function.

Osteitis pubis is a rare but known complication of multiple urological procedures including transurethral resection of the prostate, prostate cryotherapy, photovaporisation of the prostate, high-intensity focused ultrasound treatment of the prostate, prostatectomy and cystectomy, especially in the context of salvage therapy for prostate cancer. Patients can present with significant often intractable pain secondary to this condition. We report a case of a patient with a history of radiation therapy and salvage cryoablation who presented with osteitis pubis, calcification of the prostatic tissue bed which was inseparable from the pubic symphysis. Treatment with salvage holmium laser enucleation of the prostate and holmium lithotripsy was demonstrated to be effective for palliative management of osteitis pubis from prostatic calcification ossifying into the pubic symphysis.