Satellite Attitude Control with a six-Control Moment Gyro Cluster tested under Microgravity Conditions

International audienceThe attitude control of a satellite equipped with a six-Control Moment Gyro (CMG) cluster is studied, taking into account CMG failure cases and constraints like actuator saturation and real-time aspects. The design of the steering law that allocates the required torques among the actuators is made complex by singularities (gimbal angles of the CMGs where no torque can be created along an axis). This paper describes the problem of a constrained allocation applied to the CMG system, and explains the selected solution. An experimental setup with six CMGs has been designed. It calculates in real-time the attitude guidance laws and control loop. Agile manoeuvres simulating nanosatellite attitude reorientations have been successfully carried out during a European Space Agency (ESA) parabolic flight campaign. The results show that the steering law performs as expected even in case of CMG failures

Satellite Attitude Control with a six-Control Moment Gyro Cluster tested under Microgravity Conditions

The attitude control of a satellite equipped with a six-Control Moment Gyro (CMG) cluster is studied, taking into account CMG failure cases and constraints like actuator saturation and real-time aspects. The design of the steering law that allocates the required torques among the actuators is made complex by singularities (gimbal angles of the CMGs where no torque can be created along an axis). This paper describes the problem of a constrained allocation applied to the CMG system, and explains the selected solution. An experimental setup with six CMGs has been designed. It calculates in real-time the attitude guidance laws and control loop. Agile manoeuvres simulating nanosatellite attitude reorientations have been successfully carried out during a European Space Agency (ESA) parabolic flight campaign. The results show that the steering law performs as expected even in case of CMG failures

Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study

Abstract Background Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evaluated the effect of planned and coordinated patient management within a dedicated renal care network comparatively to standard renal care delivered in nephrology departments of teaching hospitals. Methods This observational matched cohort study included 40 patients with CKD stage 4–5 in the network group as compared with a control group of 120 patients matched for age, sex and diabetic status. Main outcome was a composite endpoint of death from cardiovascular cause and cardiovascular events during the first year after dialysis initiation. Results There was no difference between the two groups neither for the primary outcome (40% vs 41%) nor for the occurrence of death from cardiovascular cause or cardiovascular events. Whereas the proportion of patients requiring at least one hospitalization was identical (83.3% vs 75%), network patients experienced less individual hospitalizations than control patients (2.3±2.0 vs 1.6±1.7) during the year before dialysis start. Patients of the network group had a slower renal function decline (7.7±2.5 vs 4.9±1.1 ml/min/1,73m2 per year; p=0.04). Conclusions In this limited series of patients, we were unable to demonstrate a significant impact of the coordinated renal care provided in the network on early cardiovascular events in incident dialysis patients. However, during the predialysis period, there were less hospitalizations and a slower slope of renal function decrease. </jats:sec

Is There an Interest in Implementing a Multidisciplinary Clinic or Renal Care Network to Improve the Prognosis of Patients with Chronic Kidney Disease?

Chronic kidney disease (CKD) is highly prevalent in several countries and is associated with the incidence of end-stage renal disease (ESRD) and also with premature morbidity and mortality, especially from cardiovascular origin. However, efficient treatments have existed for two decades but have not led to major decrease in either ESRD incidence or premature death of CKD patients. Some authors suggested that the deliverance of suboptimal care can explain, at least partly, these disappointing findings. Several observational studies support this idea by showing that some recommended medications are under-prescribed in CKD patients, and that some patients are sometimes insufficiently monitored for clinical and biological parameters. Therefore, new models of renal care deliverance have been developed, trying to optimise patient treatment with the hope that it could positively impact their outcomes. In this article, we will focus on the multidisciplinary clinic and the renal care network models and we will review the results of the main studies that sought to test the impact of these new structures on patient’s prognosis. Although most of these studies are observational, they predominantly show a positive effect on renal prognosis and also survival. However, the only one randomised clinical trial with long-term follow-up failed to find any positive effect despite increased cost. Therefore, more evidence, based on results of randomised clinical trials, is needed before a wide implementation of this kind of program.</jats:p

Impact of an experimental renal artery stenosis on renal blood flow and oxygen content

La sténose de l’artère rénale (SAR) est à l’origine d’une néphropathie dite « ischémique », dont les mécanismes conduisant au développement d’une insuffisance rénale sont mal connus. Il est utile de savoir à partir de quel degré de SAR surviennent des modifications hémodynamiques significatives dans le rein d’aval, et si une SAR chronique et hémodynamiquement significative peut entraîner une hypoxie rénale. Nous avons donc entrepris 2 études afin de préciser le lien entre degré de SAR et baisse du débit sanguin rénal (DSR), et de rechercher l’apparition d’une hypoxie dans le rein situé en aval d’une SAR chronique. Les résultats de la première étude montrent que la baisse du DSR reste modeste tant que le degré de SAR n’a pas dépassé 70%. Ces résultats nous permettent de conclure qu’une SAR de degré inférieur à 70% n’est probablement associée qu’à des modifications hémodynamiques mineures dans le rein d’aval. Dans la deuxième étude, nous avons décrit l’évolution du contenu rénal en oxygène (CRO) sur une période de 4 semaines après induction d’une SAR chez des rats. La méthode utilisée était l’IRM BOLD, qui permet d’étudier le CRO de manière non-invasive en mesurant le paramètre R2* dont la valeur est inversement proportionnelle au CRO. La mesure hebdomadaire de R2* dans le cortex, la médullaire externe et la partie externe de la médullaire externe des reins sténosés et des reins controlatéraux ne variaient pas au cours de l’étude, malgré l’apparition progressive d’une atrophie des reins en aval de la SAR. Ces données tendent à montrer qu’il n’y a pas d’hypoxie rénale dans notre modèle, et que l’atrophie rénale observée n’est donc pas secondaire à l’hypoxieRenal artery stenosis (RAS) can lead to a so-called “ischemic” nephropathy but the mechanisms responsible for the development of chronic kidney disease in kidney downstream the RAS are largely unknown. There is an interest to know the degree of RAS that involves significant hémodynamic changes in the downstream kidney and if hypoxia occurs in this case. Therefore, we have undertaken two studies in order to describe the link between RAS degree and renal blood flow (RBF) and to search for the development of renal hypoxia in kidney downstream the RAS. Findings of the first study were that only a minor decrease of RBF occurs until the RAS degree reach 70%. We can thus conclude from these results that RAS degree must be at least of 70% to have hemodynamical repercussions in downstream kidney. In the second study, we describe the evolution of renal oxygen content (ROC) before and during 4 weeks after the constitution of RAS. ROC was measured weekly by the MRI BOLD technique, who allows to study ROC non-invasively by measuring the parameter called R2* that is inversely proportional to ROC. The value of R2* in the cortex, the outer medulla and the outer stripe of outer medulla in stenotic kidneys and controlateral kidneys was unchanged instead the development of atrophy of the kidney downstream the RAS. These results suggest that no renal hypoxia occur in this model and that renal atrophy is not caused by hypoxi

To live with normal GFR: when higher is not better

International audienceEriksen et al. unmask an independent link between a high glomerular filtration rate (GFR) and subclinical cardiovascular damage in a large cohort of nondiabetic middle-aged people in Tromso, Norway. Although others have previously reported an association between estimated GFR and cardiovascular risk factors, the present work is remarkable in that it relies on measured GFR, thus overcoming potential bias of the limited accuracy of common GFR estimates in individuals with high GFR values