Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study)

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35–0.66]; severe: 0.29 [0.16–0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours

Jules Horowitz reactor.development of an experimental loop integrating an optimized irradiation process.

International audienceExperimental reactors enable researchers to address industry and scientific organiza-tion's needs, by providing support to the existing nuclear reactors (Gen.2), by prepar-ing the future generations of reactors (Gen.3, Gen.4) or by supporting fusion related issues and medical applications. It is for this specific purpose that the Jules Horowitz Polyvalent Irradiation Reactor (JHR) is under construction at the CEA Cadarache Research Center (located South of France). This Material Testing Reactor (MTR type) is designed to irradiate materials or fuel samples to conduct various types of experimental tests. The reactor will also produce Mo99 radioelements that will supply 25% to 50% of current European needs.The purpose of this paper is to describe a new fuel irradiation loop, called ADELINE, specifically dedicated to study fuel rod behavior under power ramp transients. The de-sign of the instrumented loop is still ongoing but the test device will be fully operational when JHR will start. ADELINE loop is planned to perform various types of power ramps, from slow to high ramp rates, from low to very high power changes, on different types of fuel concepts such as regular fuel, PCI resistant fuel, Enhanced Accident Tolerant fuel concepts, etc). The main feature of the test device is to provide the industry with well characterized ramps tests allowing defining reliable SCC-PCI (Stress Corrosion Cracking-Pellet Cladding Interaction) failure thresholds. In order to increase its irradiation capacity (2 to 3 power ramps per JHR cycle), each phase of the experimental procedure has been carefully optimized for instance, non-destructive examinations are performed before and after the test in JHR hot cells, specific loading tools have been designed to facilitate the handling phases or reliable test protocols have been qualified on a similar test device (like the one used in OSIRIS). The objective is to fulfill all the customers' needs, in a high quality experimental environment

Vascular dysfunctions in the isolated aorta of double-transgenic hypertensive mice developing aortic aneurysm

Angiotensin-II and oxidative stress are involved in the genesis of aortic aneurysms, a phenomenon exacerbated by endothelial nitric oxide synthase (eNOS) deletion or uncoupling. The purpose of this work was to study the endothelial function in wild-type C57BL/6 (BL) and transgenic mice expressing the h-angiotensinogen and h-renin genes (AR) subjected to either a control, or a high-salt diet plus a treatment with a NO-synthase inhibitor, N-ω-nitro-L-arginine-methyl-ester (L-NAME; BLSL and ARSL). BLSL showed a moderate increase in blood pressure, while ARSL became severely hypertensive. Seventy-five percent of ARSL developed aortic aneurysms, characterized by major histo-morphological changes and associated with an increase in NADP(H) oxidase-2 (NOX2) expression. Contractile responses (KCl, norepinephrine, U-46619) were similar in the four groups of mice, and relaxations were not affected in BLSL and AR. However, in ARSL, endothelium-dependent relaxations (acetylcholine, UK-14304) were significantly reduced, and this dysfunction was similar in aortae without or with aneurysms. The endothelial impairment was unaffected by catalase, superoxide-dismutase mimetic, radical scavengers, cyclooxygenase inhibition, or TP-receptor blockade and could not be attributed to sGC oxidation. Thus, ARSL is a severe hypertension model developing aortic aneurysm. A vascular dysfunction, involving both endothelial (reduced role of NO) and smooth muscle cells, precedes aneurysms formation and, paradoxically, does not appear to involve oxidative stress

Contribution of K+ channels to endothelium-derived hypolarization-induced renal vasodilation in rats in vivo and in vitro

We investigated the mechanisms behind the endothelial-derived hyperpolarization (EDH)-induced renal vasodilation in vivo and in vitro in rats. We assessed the role of Ca2+-activated K+ channels and whether K+ released from the endothelial cells activates inward rectifier K+ (Kir) channels and/or the Na+/K+-ATPase. Also, involvement of renal myoendothelial gap junctions was evaluated in vitro. Isometric tension in rat renal interlobar arteries was measured using a wire myograph. Renal blood flow was measured in isoflurane anesthetized rats. The EDH response was defined as the ACh-induced vasodilation assessed after inhibition of nitric oxide synthase and cyclooxygenase using L-NAME and indomethacin, respectively. After inhibition of small conductance Ca2+-activated K+ channels (SKCa) and intermediate conductance Ca2+-activated K+ channels (IKCa) (by apamin and TRAM-34, respectively), the EDH response in vitro was strongly attenuated whereas the EDH response in vivo was not significantly reduced. Inhibition of Kir channels and Na+/K+-ATPases (by ouabain and Ba2+, respectively) significantly attenuated renal vasorelaxation in vitro but did not affect the response in vivo. Inhibition of gap junctions in vitro using carbenoxolone or 18α-glycyrrhetinic acid significantly reduced the endothelial-derived hyperpolarization-induced vasorelaxation. We conclude that SKCa and IKCa channels are important for EDH-induced renal vasorelaxation in vitro. Activation of Kir channels and Na+/K+-ATPases plays a significant role in the renal vascular EDH response in vitro but not in vivo. The renal EDH response in vivo is complex and may consist of several overlapping mechanisms some of which remain obscure