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Background: Enhanced recovery after surgery (ERAS) is a combination of multimodal pathways to improve surgical outcomes. Recommendations for radical cystectomy have been published by the ERAS society for the cystectomy but a lack of evidence is observed for urological procedures such as nephrectomy (Ne) and radical prostatectomy (RP). The aim of our study was to evaluate the impact of enhanced recovery protocol implementation for Ne ad RP at our academic institution., Methods: We performed a retrospective, monocentric, comparative analysis, pre and post implementation of an enhanced recovery protocol for patients undergoing robotic-assisted radical prostatectomy or nephrectomy (partial or total) for cancer. The primary endpoint was the mean length of stay (LOS). Secondary endpoints included 30-days readmission, postoperative complications, 90 days survival, and oncologic outcome at 6 months., Results: We included 264 patients between January, 2019, and December, 2020. Statistical analysis was performed separately by type of surgery. The LOS of patients included in the ERP protocol was decreased on average by 1.3 days IC95% [-2.50; -0.08], P<0.001 for nephrectomies and by 2.2 days IC95% [-3.72; -0.62] P<0.001 for prostatectomies, compared to non-ERP patients. There were no more re-admission, death or oncologic recurrence., Conclusion: In our experience, ERP for oncological nephrectomy and prostatectomy reduced the length of stay, without increasing postoperative complications and readmission., Level of Evidence: IV., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Lipomatoses are benign proliferation of adipose tissue. Lipomas (benign fat tumors) are the most common component of lipomatosis. They may be unique or multiple, encapsulated or not, subcutaneous or sometimes visceral. In some cases, they form large areas of non-encapsulated fat hypertrophy, with a variable degree of fibrosis. They can develop despite the absence of obesity. They may be familial or acquired. At difference with lipodystrophy syndromes, they are not associated with lipoatrophy areas, except in some rare cases such as type 2 familial partial lipodystrophy syndromes (FPLD2). Their metabolic impact is variable in part depending on associated obesity. They may have functional or aesthetic consequences. Lipomatosis may be isolated, be part of a syndrome, or may be visceral. Isolated lipomatoses include multiple symmetrical lipomatosis (Madelung disease or Launois-Bensaude syndrome), familial multiple lipomatosis, the painful Dercum's disease also called Adiposis Dolorosa or Ander syndrome, mesosomatic lipomatosis also called Roch-Leri lipomatosis, familial angiolipomatosis, lipedema and hibernomas. Syndromic lipomatoses include PIK3CA-related disorders, Cowden/PTEN hamartomas-tumor syndrome, some lipodystrophy syndromes, and mitochondrial diseases, especially MERRF, multiple endocrine neoplasia type 1, neurofibromatosis type 1, Wilson disease, Pai or Haberland syndromes. Finally, visceral lipomatoses have been reported in numerous organs and sites: pancreatic, adrenal, abdominal, epidural, mediastinal, epicardial… The aim of this review is to present the main types of lipomatosis and their physiopathological component, when it is known., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort., Methods: We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components., Results: The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039)., Conclusion: In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.

Introduction: Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation., Material and Methods: Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS)., Results: Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively., Conclusion: The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The radiation characteristics of rotor-beam interaction noise are studied experimentally for low Reynolds number small-scale rotors in interaction with beams of different shapes, sizes, and downstream positions. The number of blades ranges from two to four. For the two-bladed rotor, the presence of the beam has no effect on the mean aerodynamic performance. Moreover, the blade passing frequency (BPF) and the high frequency broadband noise (BBN) appear not to be affected by the presence of the beam. On the contrary, the magnitude of the 2×BPF-25×BPF harmonics increases up to 30 dB compared to the case without beam, with an envelope consisting of two humps: one centered around 5×BPF and another around 20×BPF-25×BPF. For the first hump, a dipole-like pattern with minimal amplitude aligned with the beam can be observed, whereas another dipole-like pattern is observed for the higher frequency hump, but with a minimal amplitude over all the rotor disk plane. Compared to the two-bladed rotor, the presence of the beam has an effect on the mean aerodynamic performance of the three- and four-bladed rotors, increasing both the torque and the thrust at iso-rotational speed. This change leads to a change in the directivity of the BPF tone that decreases at a latitude angle of θ=0° and increases at a latitude angle of θ=40°. Moreover, the same two competing humps are observed on the BPF harmonics envelope. Interestingly, the frequency range over which an amplification of the harmonic magnitude is observed seems not to be influenced by the number of blades. Finally, the magnitude of the low frequency hump increases with the beam diameter, the rotational speed, and the number of blades but decreases with the rotor-beam distance. That of the high frequency hump increases also with the rotational speed and the number of blades, but not anymore with the beam diameter, and reaches a maximum value when the rotor-beam distance is at an intermediate distance of L = 25 mm. This hump is also influenced, to a lesser extent, by the shape of the beam. The two different evolutions permit us to conclude that the noise generation mechanisms leading to the two humps must be different. Scaling laws of the acoustical energy are derived for all those parameters. As already done for previous experiments without beam, all of the results are made available as an open database, at https://dataverse.isae-supaero.fr/., (© 2023 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).)

Introduction: The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021., Materials and Methods: This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation., Results: Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors., Conclusion: The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Context: In patients with neurofibromatosis type 1 (NF1), guidelines suggest screening for pheochromocytoma by metanephrine measurement and abdominal imaging, which may lead to the discovery of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and their differential diagnosis, gastrointestinal stromal tumors (GISTs). Other endocrine manifestations such as follicular thyroid carcinoma and primary hyperparathyroidism have also been reported in a few cases., Objective: This study aimed to describe prevalence and clinical presentation of these manifestations through systematic screening in a large cohort of patients., Methods: In this monocentric retrospective study, 108 patients with NF1 were included and screened for endocrine manifestations and GISTs. Clinical, laboratory, molecular profile, pathology, and morphologic (abdominal computed tomography scan and/or magnetic resonance imaging) and functional imaging were collected., Results: Twenty-four patients (22.2% of the cohort, 16 female, mean age 42.6 years) presented with pheochromocytomas that were unilateral in 65.5%, benign in 89.7%, and with a ganglioneural component in 20.7%. Three female patients (2.8% of the cohort, aged 42-63 years) presented with well-differentiated GEP-NETs, and 4 (3.7%) with GISTs. One patient had primary hyperparathyroidism, 1 patient had medullary microcarcinoma, and 16 patients had goiter, multinodular in 10 cases. There was no correlation between pheochromocytoma and other NF1 tumoral manifestations, nor correlations between pheochromocytoma and NF1 genotype, despite a familial clustering in one-third of patients., Conclusion: The pheochromocytoma prevalence in this NF1 cohort was higher (>20%) than previously described, confirming the interest of systematic screening, especially in young women. The prevalence of GEP-NETs and GISTs was about 3%, respectively. No phenotype-genotype correlation was observed., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: Artificial urinary sphincter (AUS) is a gold standard treatment in male stress urinary incontinence but remains poorly used in elderly patients., Objective: To assess the efficacy, safety, and reoperation-free survival of AUS implantation in male patients over 75 yr of age., Design Setting and Participants: We retrospectively reviewed the charts of all 1233 non-neurological male AUS implantations between 2005 and 2020 at 13 French centers. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75-) at the time of AUS implantation., Outcome Measurements and Statistical Analysis: Our primary endpoint was social continence at 3 mo defined as the use of one or fewer pad daily. We used Kaplan-Meier analyses to assess reoperation-free survival. We sought factors of erosion using logistic regression., Results and Limitations: Early postoperative continence was comparable in both groups (74.4% vs 80.1%, p =  0.114). We observed a higher rate of postoperative complications in GROUP75+ (18.8% vs 12.6%, p =  0.014), but the complications were more frequently of low grade in GROUP75+ ( p =  0.025). The overall reoperation-free survival was similar ( p =  0.076) after a median follow-up of 2 yr. However, patients in GROUP75+ had poorer explantation-free survival ( p  < 0.0001). A history of radiotherapy was a predictive factor of erosion (odds ratio [OR]  =  5.31, p  < 0.01), but age was not (OR  =  1.08, p =  0.87). Unfortunately, our dataset did not include a systematic geriatric evaluation., Conclusions: AUS in elderly patients appears to be an effective option to treat stress urinary incontinence. However, we observed more postoperative complications and explantations, although age was not associated with the onset of erosion. A prospective study is required to determine whether a geriatric evaluation would be an effective strategy to select patients before surgery., Patient Summary: In this study, we looked at outcomes of artificial urinary sphincter in elderly men in a large population. We found satisfying efficacy but slightly more postoperative complications and device infections., (© 2023 The Authors.)

Background: With an increasing prevalence in industrialized countries, lithiasis represents a public health problem with significant economic cost. Ureteroscopy is nowadays the main treatment for kidney and ureteral stones with increasingly broad indications. While this treatment is relatively safe and effective, the complications can be severe., Aim: The aim of this study was to investigate the preoperative risk factors of complication in the 30 days following a rigid or flexible ureteroscopy in a large cohort of patients., Methods: A retrospective multicenter study was conducted in 5 French centers between January 1st 2017 and 31st December 2018. All flexible and rigid ureteroscopies performed were included. All preoperative and per operative data were collected in an electronic database. Outcomes and complications within 30 days of the procedure were also collected. Univariate and multivariable analyses evaluated for potential predictors of postoperative complications., Results: 1124 procedures were included. According to the occurrence of a postoperative complication, patients were divided into two groups, 109 in the group with complications. The majority of complications were minor, with only 13.7% classified as Clavien 3-4. In univariate analysis, ASA score>2 (odd ratio, OR=1.68, P=0.04), WHO performance status≥1 (OR=1.50, P=0.04) and neurologic disease (OR=2.78, P=0.005) were predictors of postoperative complications. In multivariable analysis, Charlson's score (OR=0.79, P=0.01) and ASA score>2 (OR=1.48, P=0.03) were independents risk factors of postoperative complication. Concerning major complications, in univariate analysis, cardiovascular disease (OR=3.71, P=0.032) and BMI (OR=0.87, P=0.02) were the only predictors of major complications after ureteroscopy. Only BMI was found In multivariable analysis (OR=0.86, P=0.01) CONCLUSION: Baseline characteristics and comorbidities of the patients, especially neurological diseases, were the main risk factors for short-term complications after ureteroscopy. Ureteroscopy remains a relatively safe and effective procedure. However, we advise surgeons to take precautions with fragile patients with multiple comorbidities or neurological disease., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The past decade has seen the emergence of numerous alternatives to traditional surgery for benign prostatic obstruction. Further trials are ongoing and will probably change our views on management of male lower urinary tract symptoms., (Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence., Methods: The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day., Results: Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group., Conclusion: AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings., Level of Evidence: 4., (Copyright © 2021. Published by Elsevier Masson SAS.)

Aims: To evaluate the impact of an history of radiation therapy on the outcomes of artificial urinary sphincter (AUS) implantation in male patients., Methods: The charts of all patients who underwent AUS implantation for stress urinary incontinence (SUI) after prostate surgery in thirteen centers between 2004 and 2020 were retrospectively reviewed. We excluded patients with neurogenic SUI. Continence rates and incidence of complications, revision and cuff erosion were evaluated. The outcomes in irradiated men were compared to those of non irradiated men., Results: A total of 1277 patients who had an AUS met the inclusion criteria with a median age of 70 years, of which 437 had an history of prior radiotherapy. There was no difference in comorbidities. In irradiated patients, postoperative social continence, urethral atrophy and infection rates were respectively 75.6%, 2.4% and 9.5% and 76.8%, 5.4%, and 5.8% in nonirradiated men (respectively, p = 0.799, p = 0.128, p = 0.148). There were more urethral erosion in irradiated male patients. After a mean follow up of 36.8 months, the explantation free survival was poorer in irradiated patients (p = 0.001)., Conclusion: These data suggest that pelvic radiotherapy before AUS adversely affect device survival with and increased greater occurrence of infection-erosion and therefore of explantation., (© 2021 Wiley Periodicals LLC.)

Introduction: Evaluation of fetal well-being during labor is based on fetal heart rate (FHR) analysis, which requires physiology expertise. The aim of the present study was to assess medical residents' fetal physiology training in terms of theoretical knowledge, FHR interpretation, and use of second-line examinations., Methods: This single-center, prospective study of obstetrics and gynecology residents (N = 34) at CHU de Lille Hospital (Lille, France) was conducted from November 2017 to November 2018. Evaluation and training were conducted in three stages. First, residents' pre-training knowledge of FHR interpretation and use of fetal scalp blood sampling (FBS) was assessed using clinical cases. Second, a didactic training session on fetal physiology was delivered. Finally, post-training knowledge was evaluated using the same cases presented during pre-training. I: Pre-training, 3%, 11.8%, and 14.7% of residents considered their training on fetal physiology, FHR analysis, and second-line examinations, respectively, to be sufficient. Training significantly improved their theoretical knowledge, which was assessed using multiple-choice questions (median [interquartile range]: 1.5 [1.0-2.0] vs. 4.0 [3.0-4.5], p<0.001), and reduced the number of FBS requested (36.3% vs. 29.5%, p = 0.002). Krippendorff's alpha coefficient for the reproducibility of residents' responses improved significantly, reflecting greater homogenization of clinical practice decisions (alpha [95% confidence interval]: 0.60 [0.55-0.65] vs. 0.72 [0.67-0.76])., Conclusion: Improved fetal physiology knowledge promotes more accurate FHR interpretation, better indications for second-line examinations, and greater homogenization of clinical practice decisions. Future studies should evaluate the impact of fetal physiology training on clinical practice., Competing Interests: Declaration of Competing Interests The authors report no conflict of interest., (Copyright © 2021. Published by Elsevier Masson SAS.)

Purpose: To compare transcorporal vs bulbar artificial urinary sphincter (AUS) implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this population., Methods: The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. The primary endpoint was device explantation-free survival. Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal., Results: 464 patients were included for analysis. 88 patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. Explantation-free survival was similar in both groups (estimated 5-year explantation free survival rates 55.3% vs. 58.4%; p=0.98). In the subgroup of patients with a history of previous AUS explantation, transcorporal approach tended to bring longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate analysis, the only risk factor of shorter explantation-free survival was the history of previous AUS explantation (HR=2.65; p=0.01)., Conclusions: Transcorporal AUS implantation was not associated with longer explantation-free survival. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival and this subgroup of patients may be the only one to draw benefits of transcorporal AUS implantation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The main objective of this study was to assess the prevalence and risk factors of male artificial urinary sphincter (AUS) mechanical failures and nonmechanical failures., Materials and Methods: The charts of all male patients who underwent AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations due to infections and/or erosions. The causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), nonmechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and nonmechanical failures were determined by Cox proportional hazards model., Results: A total of 1,020 patients met the inclusion criteria. After a median followup of 20 months, the estimated 5-year and 10-year overall revision-free survival was 60% and 40%, respectively. There were 214 AUS revisions: 59 (27.6%) for mechanical failures, 121 (56.5%) for nonmechanical failures and 34 (15.9%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01-1.07]; p=0.01) and revision for nonmechanical failure (HR=1.05 [1.02-1.09]; p=0.004)., Conclusions: Half of the male AUS patients underwent device revision within the first 10 years after implantation. Nonmechanical failures are the primary cause of AUS revision in nonneurological men. Larger cuff size appears to be the main determinant of AUS revision risk.

Purpose of Review: Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation., Recent Findings: Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience., Summary: The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

In this paper, an experimental characterisation of low Reynolds number rotors is performed in an anechoic room. Two commercially available two-bladed rotors as well as four three-dimensional (3D)-printed rotors with different numbers of blades (from two to five) are tested. The latter have canonical geometry, with an NACA0012 blade section profile, extruded in the radial direction with constant chord and constant 10° pitch. The experimental setup and the 3D printing strategy are first validated using results from the literature for the commercially available rotors. For all the tested rotors, four noise characteristics are analysed: the overall sound pressure level (OASPL), the amplitude of the blade passing frequency (BPF), and the amplitude of its first harmonic and the high-frequency broadband noise. For all the rotors, an increase in all noise characteristics is observed with the rotational speed (rpm) for all directivity angles. Moreover, an interesting change of pattern is observed for the amplitudes of the BPF and of its first harmonic, with, in the vicinity of the rotor plane, a minimum value for low rpm and/or high number of blades, and a maximum value for high rpm and/or low number of blades. This change in directivity leads to a similar change of directivity of the OASPL. For the broadband noise, a dipole-like pattern is obtained with a minimum value at θ=-10°, i.e., aligned with the trailing edge and thus indicating the generation of trailing edge noise. Finally, scaling laws that characterise the amplitude of the different noise components with respect to the rpm are proposed.

Phakomatoses encompass a group of rare genetic diseases, such as von Hippel-Lindau syndrome (VHL), neurofibromatosis type 1 (NF1), tuberous sclerosis complex (TSC) and Cowden syndrome (CS). These disorders are due to molecular abnormalities on the RAS-PI3K-Akt-mTOR pathway for NF1, TSC and CS, and to hypoxia sensing for VHL. Phakomatoses share some phenotypic traits such as neurological, ophthalmological and cutaneous features. Patients with these diseases are also predisposed to developing multiple endocrine tissue tumors, e.g., pheochromocytomas/paragangliomas are frequent in VHL and NF1. All forms of phakomatoses except CS may be associated with digestive neuroendocrine tumors. More rarely, thyroid cancer and pituitary or parathyroid adenomas have been reported. These susceptibilities are noteworthy, because their occurrence rate, prognosis and management differ slightly from the sporadic forms. The aim of this review is to summarize current knowledge on endocrine glands tumors associated with VHL, NF1, TSC, and CS, especially neuroendocrine tumors and pheochromocytomas/paragangliomas. We particularly detail recent advances concerning prognosis and management, especially parenchyma-sparing surgery and medical targeted therapies such as mTOR, MEK and HIF-2 α inhibitors, which have shown truly encouraging results., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chevalier, Dupuis, Jannin, Lemaitre, Do Cao, Cardot-Bauters, Espiard and Vantyghem.)

Introduction: BCG instillations are the gold-standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC) with a decreased risk of tumor recurrence and muscle infiltration. From 2012 to 2014, a stock shortage of the Connaught strain has led to the cessation of supply for immucyst in France. The objective of this study was to evaluate the potential impact of BCG shortage on the management of patients with NMIBC., Patients and Methods: We conducted a retrospective single-center study including patients followed from May 2005 to May 2015 with a high-risk NMIBC (primo-diagnosis). Patients were separated into two groups: not impacted by the shortage (NISG: 56 patients) and impacted by the shortage (ISG: 53 patients). Data on tumour recurrence (RFS), muscle progression (PFS) and overall and specific survival (OS and SS) were also analysed., Results: The BCG induction schedule could not be carried out in 20.8% of cases in the ISG compared to only 5.3% of cases in NISG (P=0.02). Similarly, the maintenance treatment was incomplete for 56.6% of cases versus 37.5% in NISG (P=0.047). Nevertheless, it should be underlined that very high-risk NMIBC received a complete induction BCG schedule. The ISG seems to have benefited with the evolution of the guidelines with the use of diagnosis bladder fluorescence but without significant difference on the rate of second look bladder trans-uretral resection. The cystectomy rate was higher in ISG. No significant difference in RFS, PFS, OS, and SS between the two groups., Conclusion: In our experience, RFS, PFS, OS or SS were not impacted by the BCG shortage. These data may be explained by a better selection of very high-risk patients including the recommended BCG schedule and more frequently the use of diagnosis bladder fluorescence., Level of Evidence: 3., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: Fertility preservation is essential before cancer treatment. When ejaculated sperm preservation is not possible, testicular tissue can be surgically collected by Onco-TESE technic (Oncological Testicular Sperm Extraction) to isolate sperm. We report on our experience with Onco-TESE in testicular cancer patients at the Rouen University Hospital., Material and Method: Retrospective study including all pubescent men, treated for testicular cancer, uni- or bilateral, before any carcinological therapy, who have undergone Onco-TESE at the Rouen University Hospital. Fragment weight, detection of sperm or its precursors were analysed. A histological interpretation of the testicular tumor was carried out. For each positive sample, straws were kept at the French Sperm Bank., Results: Twenty-four patients had an Onco-TESE: 58.34% severe sperm alteration (SSA) and 41.36% sperm collection failure (SCF), between 1996 and 2019. The mean age was 26.6 (±5.29) years. The mean procedure and length of stay were 71minutes (±30.7) and 3.75 days (±2.83), respectively. The rate of positive testicular biopsies (TB) was 58.33% overall and 66,67% in the case of TB on tumour testis. One patient had a Clavian-Dindo III complication. The mean number of straws preserved per patient was 14.28 (±15.34) for 7.14% use., Conclusion: Our results seem to confirm that Onco-TESE is an effective solution for preserving fertility in men with testicular cancer in cases of SSA or SCF., Level of Evidence: III., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Longitudinal bone growth occurs through endochondral ossification (EO), controlled by various signaling molecules. Retinoid X Receptor (RXR) is a nuclear receptor with important roles in cell death, development, and metabolism. However, little is known about its role in EO. In this study, the agonist SR11237 was used to evaluate RXR activation in EO. Rats given SR11237 from post-natal day 5 to post-natal day 15 were harvested for micro-computed tomography (microCT) scanning and histology. In parallel, newborn CD1 mouse tibiae were cultured with increasing concentrations of SR11237 for histological and whole-mount evaluation. RXR agonist-treated rats had shorter long bones than the controls and developed dysmorphia of the growth plate. Cells invading the calcified and dysmorphic growth plate appeared pre-hypertrophic in size and shape, in correspondence with p57 immunostaining. Additionally, SOX9-positive cells were found surrounding the calcified tissue. The epiphysis of SR11237-treated bones showed increased TRAP staining and additional TUNEL staining at the osteo-chondral junction. MicroCT revealed morphological disorganization in the long bones of the treated animals. This study suggests that stimulation of RXR causes irregular ossification, premature closure of the growth plate, and disrupted long bone growth in rodent models.

Purpose: The objective of this study was to investigate the prognostic role of three inflammatory markers: the neutrophil to lymphocyte ratio (NLR), the lymphocyte to monocyte ratio (LMR), and the platelet to lymphocyte ratio (PLR) as prognostic indicators in squamous cell carcinoma of the head and neck (HNSCC)., Methods: Patients with HNSCC treated with primary surgery, with or without adjuvant radiochemotherapy were enrolled. The preoperative NLR, LMR, and PLR were recorded. Confounding variables were also recorded: age, sex, BMI, comorbidities, performance status, AJCC T and N stage and HPV status. Endpoints were overall survival (OS) and event-free survival (EFS). Survival analysis was performed using Kaplan-Meier analysis, and multivariable analysis was performed using Cox proportional hazards regression. Survival models were evaluated using Harrell's concordance index (c-index)., Results: NLR (p = 0.2413), PLR (p = 0.1593), and LMR (p = 0.0552) were not significantly associated with OS in the multivariable analysis. With regard to EFS, low LMR (HR = 2.95, 95% CI 1.54-5.65, p = 0.001), high PLR (HR = 2.68, 95% CI 1.42-5.09, p = 0.003), and high NLR (HR = 3.37, 95% CI 1.7-6.69, p < 0.001) were associated with EFS. The multivariable c-index was highest for LMR (0.762), followed by NLR (0.761) and PLR (0.739)., Conclusion: The LMR, PLR, and NLR were not associated with OS, but were associated with EFS in HNSCC. These markers are easily obtainable, and in the age of individualized patient care and precision medicine, they might represent further risk stratification tools for HNSCC patients.

Objective: The aim of fetal heart rate monitoring during labour is to identify and prevent foetal distress, but its evaluation is not perfect. Fetal scalp blood sampling for pH measurement is one of the second-line methods of monitoring when fetal heart rate is classified as suspicious. This study aims to determine when pH testing should be performed after a prolonged deceleration., Study Design: This was an experimental study in a fetal sheep model. A partial umbilical cord occlusion was performed for seven minutes followed by a recuperation period of 30 min. Hemodynamic parameters (heart rate, mean blood pressure and intra-amniotic pressure) and blood gases were recorded before occlusion (T0), during occlusion (T4), just after the end of occlusion (T7), and then 10, 20 and 30 min after occlusion (T17, T27 and T37 respectively)., Results: Ten experiments were carried out. During partial cord occlusion, the fetal pH decreased significantly to acidosis. After a prolonged deceleration with fetal acidosis, the pH recovered to a normal value, defined by a pH greater than or equal to 7.25, after 20 min of recuperation., Conclusion: After a prolonged deceleration, fetal pH normalizes between 20 and 30 min thereafter. Thus, if a foetal blood sample is indicated, this delay must be respected in order to avoid inducing an unnecessary intervention decision., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Joint homeostasis failure can result in osteoarthritis (OA). Currently, there are no treatments to alter disease progression in OA, but targeting early changes in cellular behavior has great potential. Recent data show that nuclear receptors contribute to the pathogenesis of OA and could be viable therapeutic targets, but their molecular mechanisms in cartilage are incompletely understood. This study examines global changes in gene expression after treatment with agonists for four nuclear receptor implicated in OA (LXR, PPARδ, PPARγ, and RXR). Murine articular chondrocytes were treated with agonists for LXR, PPARδ, PPARγ, or RXR and underwent microarray, qPCR, and cellular lipid analyses to evaluate changes in gene expression and lipid profile. Immunohistochemistry was conducted to compare two differentially expressed targets (Txnip, Gsta4) in control and cartilage-specific PPARδ knockout mice subjected to surgical destabilization of the medial meniscus (DMM). Nuclear receptor agonists induced different gene expression profiles with many responses affecting lipid metabolism. LXR activation downregulated gene expression of proteases involved in OA, whereas RXR agonism decreased expression of ECM components and increased expression of Mmp13. Functional assays indicate increases in cell triglyceride accumulation after PPARγ, LXR, and RXR agonism but a decrease after PPARδ agonism. PPARδ and RXR downregulate the antioxidant Gsta4, and PPARδ upregulates Txnip. Wild-type, but not PPARδ-deficient mice, display increased staining for Txnip after DMM. Collectively, these data demonstrate that nuclear receptor activation in chondrocytes primarily affects lipid metabolism. In the case of PPARδ, this change might lead to increased oxidative stress, possibly contributing to OA-associated changes., Key Message: Nuclear receptors regulate metabolic genes in chondrocytes. Nuclear receptors affect triglyceride levels. PPARδ mediates regulation of oxidative stress markers. Nuclear receptors are promising therapeutic targets for osteoarthritis.

Nearfield Acoustic Holography (NAH) is a powerful acoustic imaging method, but its application in aeronautics can be limited by intrusive measurements of acoustic field. In this paper, a moving fluid medium NAH procedure using non-intrusive velocity measurements is proposed. This method is based on convective Kirchhoff-Helmholtz integral formula. Convective equations and convective Green's function are used to derive convective real-space propagators including airflow effects. Discrete Fourier transforms of these propagators allow the assessment of acoustic fields from acoustic pressure or normal acoustic velocity measurements. As the aim is to derive an in-flow velocity-based NAH method, this study is especially focused on real convective velocity-to-pressure propagator. In order to validate this procedure, simulations in the case of monopole sources radiating in various uniform subsonic flows have been performed. NAH provides very favorable results when compared to the simulated fields. A comparison of results obtained by the real propagator and those obtained by the wave number-frequency-domain one developed by Kwon et al. [J. Acoust. Soc. Am. 128(4), 1823-1832 (2010)] shows the interest of using the real-form in the case of pressure backward propagation from velocity measurements. The efficiency of the developed procedure is confirmed by a wind tunnel campaign with a flush-mounted loudspeaker and non-intrusive Laser Doppler Velocimetry velocity measurements.

Elucidating the signalling pathways that regulate chondrocyte differentiation, such as the actin cytoskeleton and Rho GTPases, during development is essential for understanding of pathological conditions of cartilage, such as chondrodysplasias and osteoarthritis. Manipulation of actin dynamics in tibia organ cultures isolated from E15.5 mice results in pronounced enhancement of endochondral bone growth and specific changes in growth plate architecture. Global changes in gene expression were examined of primary chondrocytes isolated from embryonic tibia, treated with the compounds cytochalasin D, jasplakinolide (actin modifiers) and the ROCK inhibitor Y27632. Cytochalasin D elicited the most pronounced response and induced many features of hypertrophic chondrocyte differentiation. Bioinformatics analyses of microarray data and expression validation by real-time PCR and immunohistochemistry resulted in the identification of the nuclear receptor retinoid related orphan receptor-alpha (Ror-alpha) as a novel putative regulator of chondrocyte hypertrophy. Expression of Ror-alpha target genes, (Lpl, fatty acid binding protein 4 [Fabp4], Cd36 and kruppel-like factor 5 [Klf15]) were induced during chondrocyte hypertrophy and by cytochalasin D and are cholesterol dependent. Stimulation of Ror-alpha by cholesterol results in increased bone growth and enlarged, rounded cells, a phenotype similar to chondrocyte hypertrophy and to the changes induced by cytochalasin D, while inhibition of cholesterol synthesis by lovastatin inhibits cytochalasin D induced bone growth. Additionally, we show that in a mouse model of cartilage specific (Col2-Cre) Rac1, inactivation results in increased Hif-1alpha (a regulator of Rora gene expression) and Ror-alpha(+) cells within hypertrophic growth plates. We provide evidence that cholesterol signalling through increased Ror-alpha expression stimulates chondrocyte hypertrophy and partially mediates responses of cartilage to actin dynamics.

Integrin-linked kinase (ILK) is key for cell survival, migration, and adhesion, but little is known about its role in epidermal development and homeostasis in vivo. We generated mice with conditional inactivation of the Ilk gene in squamous epithelia. These mice die perinatally and exhibit skin blistering and severe defects in hair follicle morphogenesis, including greatly reduced follicle numbers, failure to progress beyond very early developmental stages, and pronounced defects in follicular keratinocyte proliferation. ILK-deficient epidermis shows abnormalities in adhesion to the basement membrane and in differentiation. ILK-deficient cultured keratinocytes fail to attach and spread efficiently and exhibit multiple abnormalities in actin cytoskeletal organization. Ilk gene inactivation in cultured keratinocytes causes impaired ability to form stable lamellipodia, to directionally migrate, and to polarize. These defects are accompanied by abnormal distribution of active Cdc42 to cell protrusions, as well as reduced activation of Rac1 upon induction of cell migration in scraped keratinocyte monolayers. Significantly, alterations in cell spreading and forward movement in single cells can be rescued by expression of constitutively active Rac1 or RhoG. Our studies underscore a central and distinct role for ILK in hair follicle development and in polarized cell movements, two key aspects of epithelial morphogenesis and function.

The molecular mechanisms controlling differentiation of mesenchymal precursor cells into chondrocytes (chondrogenesis) are not completely understood. We have recently shown that the small GTPase RhoA inhibits this process. Here we demonstrate that a different Rho GTPase family member, Rac1, promotes chondrogenesis. Pharmacological inhibition of Rac1 expression in micromass culture resulted in reduced mRNA levels of the chondrogenic markers collagen II and aggrecan, and decreased accumulation of glycosaminoglycans. Expression of the essential chondrogenic transcription factors Sox9, Sox5, and Sox6 was also reduced upon inhibition of Rac1 signaling. In contrast, overexpression of Rac1 in the chondrogenic ATDC5 cell line increased mRNA transcripts of Sox9, 5, and 6, collagen II, and aggrecan. Inhibition of Rac1 resulted in a reduction in the number, size, and organization of cellular condensations and decreased expression of N-cadherin. Overexpression of Rac1 resulted in an increase in N-cadherin expression levels. Furthermore, genetic ablation of Rac1 in primary micromass cultures resulted in reduced expression of chondrogenic markers. Additionally, we provide evidence that Cdc42 also promotes chondrogenesis. Overexpression of Cdc42 in ATDC5 cells resulted in increased expression of Sox5, Sox9, and collagen II but not Sox6, aggrecan, or N-cadherin. Therefore, we demonstrate that Rac1 and Cdc42 are positive regulators of chondrogenesis, but act at least in part through different cellular and molecular mechanisms.

In Germany, vibration-induced white finger (VWF) disease is accepted as an occupational disease (BK No. 2104 BKV), for which compensation may be paid provided that the sociolegal requirements are met in accordance with the list of occupational diseases that is valid at the time. A cold provocation test (thermometry, infrared thermography) is helpful in the diagnosis of VWF and we believe that it could contribute to the standardization of vascular assessment methods. In Germany, the approved degree of the decrease in earning power is downgraded as disease symptoms improve with time; therefore, insured individuals suffering from VWF are regularly reassessed every 1-3 years. In the context of such follow-up examinations and the assessment of reversibility of this disease, a standardized cold provocation test is of central importance. Currently, there is a lack of data that confirm the diagnostic value of this test. Further investigations on VWF patients to validate the use of the cold provocation test in obtaining sufficient data for determining the satisfactory diagnostic value of this test are required.

Chondrosarcomas of the temporo-mandibular joint are exceptional and have been previously reported in the literature in only seven cases. A case located in the temporal bone with extension in the infratemporal fossa and the cranial base is presented. Treatment consisted in a wide surgical resection combined with postoperative radiotherapy. The patient is alive with a follow-up of more than two years.

The underlying causes in series of benign tumours and pseudo-tumours and cysts of the maxillary bone observed in children over a ten-year period in the Saint-Vincent-de-Paul Hospital in Paris are reported. Besides the frequently encountered odontogenic cysts, most cases involved aneurysmal cysts and benign odontogenic tumours, as well as rare tumours including a hydatic cyst. Several lesions were discovered on a panoramic X ray performed for orthodontal survey.

In connection with medical appraisements of the occupational disease No. 2104 "Vibration-induced vasospastic disease" 240 patients could be examined a first time, 94 of them a second time, 42 patients a third time and 11 patients a forth time. The interval between examinations was 2, 4 or 6 years respectively. The standard procedure besides clinical whole body examination included anamnestic questionnaire, cold-provocation test with infrared thermography and vibrotactile perception test. The evaluation of the diagnoses in principle followed the Stockholm vascular V and sensorineural SN stages and was used to establish the grade of disability for compensation. The re-examinations after 2-6 years gave information on the development of the health status after cessation of vibration exposure. In only about 54% of all cases there was any improvement, in 39% the health status was unchanged, in 7% aggravated. It is obvious that the reversibility of the VWF if any needs many years abstaining from vibration exposure.

The vibration sensitivity of the skin at the ten fingertips was tested with 72 chain saw operators examined due to VWF-disease and compared with controls. The vibrotactile perception threshold (frequency f = 125 Hz, load p = 1.3 N) proved to be 3 to 5 times as high for the exposed group compared to controls. There was no correlation between vibration sensitivity and peripheral circulation found in cold provocation test. Two different testing instruments (pallaesthesiometer = vibrotactometer) showed significant differences in results probably due to different technical details of the methods. It may be concluded that a standardization of the instrumentation and method is necessary for testing the vibrotactile perception threshold as a part of the nervous function in a comparable manner.

The current state of scientific knowledge of the biodynamic behaviour of the vertebral column under the influence of whole-body vibration whilst sitting and results from epidemiological studies caused the medical board of experts on occupational health of the Federal Ministry of Labour in Germany to add a new occupational disease to the official list of occupational diseases. The occupational disease "diseases of the lumber spine from disc degeneration caused by long-term (mainly vertical) whole-body vibration exposure" has been introduced. The medical preconditions with the symptoms and the diagnostic methods are presented. With regard to the occupational preconditions for the acknowledgement of this occupational disease, a procedure is suggested which leads to the determination of the total occupational vibration exposure dose. Another requirement for recognition is that the chronic recurrent complaints have caused the patient to avoid any form of vibration exposure.

Some facts about euthanasia practices in The Netherlands are given. It is shown that there are several possible courses of action at the end of life, of which active euthanasia is the most problematic. Euthanasia is related to respect for the patient and the patient's right to refuse medical treatment. Some moral arguments against and in favour of euthanasia are discussed.

The purpose of the occupational medicine component of a joint research project was to study the effects of grip and push forces on the acute reaction of the hand-arm system under vibrating conditions. Several series of experiments were carried out by means of a vibration simulator in a laboratory environment in order to study biodynamic vibration behaviour, muscle response, skin temperature, shifts of the vibration perception threshold and the intensity of subjective vibration perception; in addition, field tests with hammer drills were conducted. On the whole, the findings obtained suggest that the coupling of the hand with the handle involved in using vibrating tools has a considerable impact on the stresses to which the hand-arm system is exposed. For this reason, future national and international rules and regulations on vibration assessment should take into consideration the effects of variations in coupling intensity.