Development of innovative materials and thermal treatments for DEMO water cooled blanket

One of the options currently taken into account for the realization of the first DEMO reactor is the "water-cooled lanket". This option implies an irradiation temperature for the blanket material in the range of 280–350 °C. Therefore, in light of the under irradiation behaviour of EUROFER, namely of the DBTT shift toward high temperature due to the low irradiation temperature embrittlement, the target of the hereby reported activities is the development of much tougher alloys, to try to tolerate the embrittlement due to the low irradiation temperature. We report in this paper the work done to optimize the toughness of Eurofer 97, increasing the normalizing temperature and maintaining a small grain size using multiple normalizing treatments. We report also the mechanical behaviour of two 9Cr1WTa type alloys, produced and tested with the same aim to find alloys more resistant to embrittlement at low irradiation temperature. Keywords: EUROFER 97, RAFM steels, Microstructure, Heat treatment, Tensile, Charpy, KLS

A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques

Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence "without pads" or "social continence" based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery

Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis

Background: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan-Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24-77) months of follow-up were reviewed. After PSM, no differences at 5-years RFS, PFS, and CSS at both Kaplan-Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25-0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively

Clinical approach for the classification of congenital uterine malformations

A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field

The role of contact hysteroscopy

Contact hysteroscopy has been replaced by a new technique based on the use of a special hysteroscope. The instrument was designed to study the squamocolumnar junction and the lesions of the portion. A new technique, endometrial dating, uses the Hamou hysteroscope to study endometrial physiology. We improved endometrial dating and discovered a new pattern, the pseudofunctional dysvascular endometrium (PFDE), that seemed to pertain to uterine bleeding. We also studied the PFDE syndrome in the presence of dysfunctional uterine bleeding. In this study we reviewed the three procedures and assessed their results. We conclude that contact microhysteroscopy is a reliable diagnostic procedure, and should be considered part of diagnostic hysteroscopy, not an independent technique

Plexiform neurofibroma of the penis associated with erectile dysfunction due to arterial steeling

Introduction: Solitary involvement of the genitourinary tract by Von Recklinghousen disease (VRD) is extremely rare. Aims: This report documents the management of a case of a plexiform neurofibroma on the penile shaft associated with erectile dysfunction. The literature surrounding VRD and its effects on the genital area was also investigated. Methods. After a complete preoperative investigation of the nature of the mass and of the erectile dysfunction, the neurofibroma was completely excised with preservation of the neurovascular bundle. Results: At 6-months postoperative follow-up, there was no sign of tumor recurrence and the glans sensation was maintained. The erectile dysfunction persisted postoperatively and failed to respond to medical treatment. Conclusions: A complete excision of penile neurofibromas is mandatory to prevent recurrence or malignant degeneration and can be safely performed preserving the neurovascular bundle

Plexiform neurofibroma of the penis associated with erectile dysfunction due to arterial steeling

Introduction: Solitary involvement of the genitourinary tract by Von Recklinghousen disease (VRD) is extremely rare. Aims: This report documents the management of a case of a plexiform neurofibroma on the penile shaft associated with erectile dysfunction. The literature surrounding VRD and its effects on the genital area was also investigated. Methods. After a complete preoperative investigation of the nature of the mass and of the erectile dysfunction, the neurofibroma was completely excised with preservation of the neurovascular bundle. Results: At 6-months postoperative follow-up, there was no sign of tumor recurrence and the glans sensation was maintained. The erectile dysfunction persisted postoperatively and failed to respond to medical treatment. Conclusions: A complete excision of penile neurofibromas is mandatory to prevent recurrence or malignant degeneration and can be safely performed preserving the neurovascular bundle