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International audience; PURPOSE: We conceived and proposed a unique and optimized nomogram to predict cancer specific survival after radical nephroureterectomy in patients with upper tract urothelial carcinoma by merging the 2 largest multicenter data sets reported in this population. MATERIALS AND METHODS: The international and the French national collaborative groups on upper tract urothelial carcinoma pooled data on 3,387 patients treated with radical nephroureterectomy for whom full data for nomogram development were available. The merged study population was randomly split into the development cohort (2,371) and the external validation cohort (1,016). Cox regressions were used for univariable and multivariable analyses, and to build different models. The ultimate reduced nomogram was assessed using Harrell's concordance index (c-index) and decision curve analysis. RESULTS: Of the 2,371 patients in the nomogram development cohort 510 (21.5%) died of upper tract urothelial carcinoma during followup. The actuarial cancer specific survival probability at 5 years was 73.7% (95% CI 71.9-75.6). Decision curve analysis revealed that the use of the best model was associated with benefit gains relative to the prediction of cancer specific survival. The optimized nomogram included only 5 variables associated with cancer specific survival on multivariable analysis, those of age (p = 0.001), T stage (p

Multiparametric MRI has gained tremendous importance in the daily practice for patients at risk or diagnosed with prostate cancer. Interpretation of multiparametric-MRI is a complex task, supposedly restricted to experienced radiologists. The purpose of this review is to analyze fundamentals of multiparametric-MRI interpretation and to describe how multiparametric-MRI training could be organized.Recently, professional guidelines have been published to provide technical and interpretation frameworks and harmonize multiparametric-MRI practice, but the question of physicians training in prostate multiparametric-MRI reading is still pending. What kind of education, practice, and training makes a radiologist able to reliably interpret a prostate multiparametric-MRI? How can findings be reported to be easily understood? How much experience is needed? How can we train urologists and other physicians to review the examinations they request? Is double-reading necessary?An institutional-based competency certification process for prostate multiparametric-MRI interpretation may encourage nonspecialized radiologists to qualify for prostate imaging in a standardized and reproducible way, exactly as urologists need it.

Using a limited temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) dataset to assess the impact of the arterial input function (AIF) choice on the transfer constant (K(trans) ) to distinguish prostate carcinoma (PCa) from benign tissue.Thirty-eight patients with clinically important peripheral PCa (≥0.5 cc) were retrospectively studied. These patients underwent 1.5T multiparametric prostate MR with PCa and benign regions of interest (ROIs) selected using a visual registration with morphometric reconstruction obtained from radical prostatectomy. Using three pharmacokinetic (PK) analysis software programs, the mean K(trans) of ROIs was computed using three AIFs: an individual AIF (Ind-AIF) and two literature population average AIFs of Weinmann (W-AIF) and of Fritz-Hansen (FH-AIF). A pairwise comparison of the area under the receiver operating characteristic curves (AUROCC) obtained with different AIFs was performed.AUROCCs obtained with W-AIF (ranging from 0.801 to 0.843) were significantly higher than FH-AIF (ranging from 0.698 to 0.780, 0.002 ≤ P ≤ 0.045) and similar to or higher than Ind-AIF (ranging from 0.591 to 0.839, 0.014 ≤ P ≤ 0.9). Ind-AIF and FH-AIF provided similar AUROCC (0.34 ≤ P ≤ 0.81). The pairwise correlation of K(trans) values was moderate to very strong when comparing W-AIF with FH-AIF (the Spearman's correlation coefficients [SCCs] ranged from 0.55 to 0.93) and very weak to moderate when comparing W-AIF with Ind-AIF (the SCCs ranged from 0.018 to 0.59) or FH-AIF with Ind-AIF (the SCCs ranged from 0.30 to 0.51).W-AIF yielded a higher performance than FH-AIF and a similar or higher performance than Ind-AIF in distinguishing PCa from benign tissue.

Resume Introduction L’incidence des nodules testiculaires decouverts lors du bilan d’infertilite est en augmentation. Ces nodules sont suspects de malignite. Aucun examen paraclinique ne permet une orientation histologique face a ces nodules. Les recommandations proposent en priorite un traitement par orchidectomie totale. Patients et methode Au travers d’une etude de cohorte retrospective de patients infertiles, notre objectif est d’etudier le rehaussement de nodules testiculaires apres injection de produit de contraste ultrasonore. L’objectif secondaire est de definir si l’echographie de contraste peut argumenter en faveur d’une prise en charge d’epargne testiculaire. De juin 2010 a mars 2013, 24 patients ont eu une echographie de contraste pour etude d’une anomalie du parenchyme testiculaire detectee sur une echographie prealable realisee pour bilan d’infertilite. Les caracteristiques du rehaussement echographique ont ete correlees avec les resultats anatomopathologiques des patients operes et les traitements proposes (chirurgie ou surveillance). Resultats Quinze patients ont ete surveilles, 9 ont ete operes (7 orchidectomies partielles, 2 orchidectomies totales). L’analyse anatomopathologique a retrouve 4 tumeurs a cellules de Leydig, 2 tumeurs a cellules de Sertoli et 3 seminomes. Aucune evolution defavorable n’a ete notee lors de la surveillance. Cette etude a montre une semeiologie typique de rehaussement intense precoce et homogene avec phenomene de wash in pour 100 % des tumeurs a cellules de Leydig operees. Toutes les tumeurs a cellules de Leydig ont ete traitees par orchidectomie partielle. Les seminomes ont un rehaussement intense dans 100 % des cas avec phenomene de wash in dans 2 cas sur 3. Quand ce wash in etait decrit, il etait toujours qualifie d’heterogene. Tous les seminomes ont finalement ete traites par orchidectomie totale. La sensibilite et la valeur predictive positive du rehaussement echographique intense pour le diagnostic de cancer du testicule etait de 89 % (Se) et 80 % (VPP). Conclusion Il existe une semeiologie de rehaussement echographique des nodules testiculaires avec des caracteristiques pouvant orienter en faveur d’une tumeur maligne, d’un seminome ou d’une tumeur a cellules de Leydig. Si une etude prospective le confirmait, ces modalites pourraient orienter vers une prise en charge favorisant une preservation du parenchyme testiculaire. Niveau de preuve 5.

The current challenge in prostate cancer (PCa) focal therapy indication and planning is how to accurately estimate tumor parameters such as volume, extent and grade. In addition to biopsy results, MRI provides an estimation of PCa contour, volume and histopathological characteristics such as presence of high Gleason grade. Among MRI sequences, diffusion-weighted imaging with apparent diffusion coefficient map is the sequence that showed the best results for cancer aggressiveness characterization.It was shown that the higher the Gleason score, the lower the apparent diffusion coefficient value. However, accuracy is not sufficient for peripheral zone cancers to be validated for clinical decision and it was not enough investigated for transition zone cancers. Analysis of tumor extent showed a significant underestimation of tumor volume by imaging and this finding should be taken into consideration when planning focal therapy procedures.Pathological implications of MRI for focal therapy planning are significant but not mature enough to be validated. Future research should aim to quantify cellularity and architectural patterns of PCa Gleason system in correlation with signal abnormalities for better assessment of tumor aggressiveness and extent, and to compare the boundaries of tumors between MRI and histopathological evaluation in order to define an optimal treatment margin.

International audience; PURPOSE:To evaluate the influence of preoperative factors on the survival of patients diagnosed with upper tract urothelial carcinoma (UTUC) who underwent a radical nephroureterectomy (RNU).METHODS:A multicentre retrospective study was performed on all patients with UTUC who underwent a RNU. Multiple preoperative criteria were tested as prognostic factors for cancer-specific survival (CSS) using univariate and multivariable Cox regression analyses.RESULTS:Overall, 476 patients with a median age of 69.2 (IQR 60.8-76.5) years were included. The median follow-up was 27.8 months (IQR 10.5-49.3). At the time of diagnosis, 400 (84.1 %) patients presented with symptoms and 76 patients (15.9 %) were asymptomatic. Renal failure, altered general health, a preoperative locally advanced tumour and multifocal disease appeared to be preoperative prognostic factors for CSS (p = 0.01, 0.03, 0.001 and 0.03, respectively) in the univariate analysis. Only renal failure (p = 0.03), a preoperative locally advanced tumour (0.004), and multifocal locations (p = 0.01) were confirmed as independent factors of CSS in the multivariate analysis. The independent prognosticators of definitive muscle-invasive stage and non-organ-confined disease were preoperative renal failure (p = 0.02, 0.027, respectively), locally advanced stage (p < 0.001

This article presents numerical predictions of velocity, temperature, and absolute humidity distributions in an indoor ice rink with ventilation and heating. The computational fluid dynamics (CFD) simulation includes the effects of radiation between all inside surfaces of the building envelope, turbulent mixed convection, and vapor diffusion, as well as conduction through the walls and condensation on the ice. The net radiative fluxes for each element of the envelope's inside surfaces are calculated with a modified version of Gebhart's method. This modification reduces the calculation time and the memory required to store the radiation view factors for the discretized elements of the inside surfaces of the envelope. The predicted temperatures show very good agreement with measured data. The CFD code also calculates the heat fluxes toward the ice due to convection from the air, to condensation of vapor, and to radiation from the walls and ceiling. It is shown that a low emissivity ceiling reduces ...

A numerical simulation of the heat and mass transfer phenomena in a ventilated ice rink has been carried out using the standard κ – ɛ turbulence model. The complexity of the geometry has been taken into account by considering elements such as the plastic protection panels which have a significant effect on the flow field. The results calculated for four different configurations show the flow pattern, the isotherms and the lines of constant absolute and relative humidity. Values of the effective draft temperature are presented for several positions in the zone occupied by the spectators. The heat losses through the walls and ceiling as well as the latent, convective and radiative heat flux into the ice are presented and analyzed.

Objectifs L’objectif de cette etude etait d’evaluer l’apport de l’IRM multiparametrique comme parametre a part entiere pour predire la presence de cancer significatif sur piece de prostatectomie, et donc pour influencer la decision de traitement chez les patients presentant un cancer de prostate potentiellement eligible a une surveillance active (SA) apres realisation de biopsies systematisees + -ciblees. Methodes Etude retrospective de 77 patients potentiellement eligibles a une SA pour un cancer de prostate localise (PSA ≤15 ng/mL, stade ≤ T2a, score de Gleason = 6, 1 a 3 biopsies positives et une longueur tumorale maximale ≤ 5 mm) et traites par prostatectomie totale (PT) entre 01/2008 et 08/2015. Tous les patients ont eu une IRM et des biopsies systematisees ± ciblees. Pour chaque patient, un score de suspicion IRM etait attribue selon une echelle 1 a 5. Les facteurs predictifs de la presence de cancer significatif sur les pieces de PT (score de Gleason ≥ 7 et/ou diametre tumoral maximal >10 mm) etaient evalues par une regression logistique. Resultats L’âge median etait de 61 ans et le PSA median de 6,7 ng/mL. Au total, 49 (64 %) patients presentaient une IRM positive (score ≥ 3). Un cancer significatif etait retrouve dans 45 (58 %) cas. Le taux de cancer significatif etait plus eleve chez les patients presentant une IRM positive (76 % vs 46 % ; p = 0,009). En analyse multivariee, une IRM positive etait un facteur predictif de la presence d’un cancer significatif sur la piece operatoire (OR = 3,0 ; p = 0,04), tout comme l’âge (OR = 1,17 ; p = 0,004) et la densite du PSA (OR = 1,10 ; p = 0,02).( Fig. 1 ) Conclusion Notre etude a montre que l’IRM est un examen fiable pour selectionner les patients eligibles a une SA meme en cas de doute apres realisation de biopsies prostatiques comprenant des biopsies ciblees. Cet examen pourrait constituer un critere a part entiere en vue d’une inclusion en SA.

Objectifs L’adenocarcinome ductal (ACD) est une entite rare de cancer de prostate de haut grade dont les caracteristiques cliniques et biologiques sont mal connues. A partir d’une serie retrospective multicentrique des cas regroupes sous l’egide du CCAFU, nous avons evalue les donnees cliniques des ACD et determine leurs caracteristiques moleculaires sur la base de marqueurs de classification deja identifies pour les carcinomes acinaires. Methodes Les donnees anatomo-cliniques initiales et evolutives ont ete collectees, ainsi qu’un echantillon de tumeur inclus en paraffine. L’etude en immunohistochimie sur tissue micro-array a analyse l’expression du RA, PSA, ERG, PTEN, Ki67, EGFR et SPINK1. L’expression de ces marqueurs a ete comparee a celle de cancers prostatiques acinaires de haut grade traites par prostatectomie radicale apparies sur le stade. La survie sans recidive biologique a ete analysee par le test du log rank et le modele de Cox. Sept centres ont adresse un total de 84 cas, dont 65 cas ont ete retenus apres relecture. Resultats L’âge median etait de 67 ans [53–92] avec un suivi median de 27 mois [1–177]. Sept patients etaient metastatiques d’emblee. Le PSA median etait de 8,79 ng/mL [0–2400]. Quarante-cinq patients ont eu une prostatectomie avec 34,8 % de pT2, 65,2 % de pT3, et 42,8 % de R1. ERG et SPINK1 etaient exprimes dans 41,8 % et 10,6 % des cas. Une perte complete de l’expression de PTEN est observee dans 36,2 % des tumeurs. En analyse multivariee chez les patients prostatectomises, l’expression de SPINK1 est un facteur predictif independant de survie sans recidive biologique (p = 0,018) comme le PSA (p = 0,017) le stade T (p = 0,016) le Gleason (p = 0,023) et l’expression du PSA (p = 0,004) Comparativement aux acinaires de haut grade, la proliferation tumorale est significativement plus elevee (p = 0,048), avec une perte d’expression de PTEN plus frequente (p = 0,02). Conclusion Les marqueurs ERG et SPINK, utilises pour la classification des adenocarcinomes acinaires, sont retrouves avec une frequence identique et de facon egalement exclusive dans les ACD, avec une valeur pronostique de l’expression de SPINK. Ces resultats demontrent neanmoins des differences de caracteristiques cliniques et biologiques des ACD prostatiques par rapport aux cancers acinaires standards.

The main purpose of this work was to develop a mathematical model and computer programs for ejector studies in refrigeration cycles. Version A of the program was written for optimal ejector design while Version B, with more built-in flexibility, was intended for simulation. The study is a one-dimensional analysis of compressible refrigerant flow, based on a forward marching technique of solution for the conservation equations. Refrigerant properties were evaluated using NIST [NIST Standard Reference Database 23, NIST Thermodynamics and Transport Properties of Refrigerants and Refrigerant Mixtures, 1998, REFPROP, Version 6.01] subroutines for equations of state solutions. The approach assesses the flow locally and provides the flexibility of returning upstream for correcting adjustments. Model validation against the R141b data of Huang et al. [Int. J. Refrig. 22 (1999) 354] has shown very good agreement under all conditions. Analysis with refrigerant R142b was performed for typical refrigeration conditions. The entrainment ratio ω, the compression ratio P6/P2 and geometric parameters such as diameters and axial dimensions were used to assess performance. Local distributions of pressure, temperature and Mach number were obtained for typical conditions and the mixing chamber was found to greatly impact operation and performance, by controlling the shock wave occurrence and intensity.

Les territoires steppiques ont connu une forte croissance démographique, une augmentation des surfaces cultivées et une urbanisation élevée. Ces dynamiques ont entraîné une évolution et restructuration importante de l'occupation de l'espace. Ces processus ont contribué à une dégradation préoccupante des ressources pastorales naturelles. Notre questionnement porte sur les conséquences de l'évolution des régies sociales du régime juridique concernant le foncier, pour l'utilisation des terres de parcours et les modalités adaptatives de gestion des activités d'élevages ovins. Cette étude a été conduite selon une approche pluridisciplinaire et participative. Elle s'est réalisée dans le cadre de trois projets de coopération (Mashrek/Maghreb Ill, SOC Maghreb et SAGA). Notre contribution a permis d'obtenir des résultats et des exemples concrets montrant comment le changement de statut foncier des terres de parcours a impacté les systèmes de production pastoraux et les ressources naturelles. Nos travaux ont été conduits dans deux régions steppiques qui présentent une valeur de pertinence vis-à-vis des questions soumises à la recherche notamment dans le domaine de la dynamique foncière : Djelfa et Tébessa. Les résultats ont montré que le paysage steppique a subi des évolutions fortes en matière de régulations foncières. En dépit de nouvelles formes d'accès à l'appropriation des terres de parcours, les règles sociales foncières (héritage socioculturel et familial) ou système dit trivialement "traditionnel" continuent à peser considérablement dans les questions liées à la gestion des terres de parcours. Les territoires steppiques ont connu une forte croissance démographique, une augmentation des surfaces cultivées et une urbanisation élevée. Ces dynamiques ont entraîné une évolution et restructuration importante de l'occupation de l'espace. Ces processus ont contribué à une dégradation préoccupante des ressources pastorales naturelles. Notre questionnement porte sur les conséquences de l'évolution des régies sociales du régime juridique concernant le foncier, pour l'utilisation des terres de parcours et les modalités adaptatives de gestion des activités d'élevages ovins. Cette étude a été conduite selon une approche pluridisciplinaire et participative. Elle s'est réalisée dans le cadre de trois projets de coopération (Mashrek/Maghreb Ill, SOC Maghreb et SAGA). Notre contribution a permis d'obtenir des résultats et des exemples concrets montrant comment le changement de statut foncier des terres de parcours a impacté les systèmes de production pastoraux et les ressources naturelles. Nos travaux ont été conduits dans deux régions steppiques qui présentent une valeur de pertinence vis-à-vis des questions soumises à la recherche notamment dans le domaine de la dynamique foncière : Djelfa et Tébessa. Les résultats ont montré que le paysage steppique a subi des évolutions fortes en matière de régulations foncières. En dépit de nouvelles formes d'accès à l'appropriation des terres de parcours, les règles sociales foncières (héritage socioculturel et familial) ou système dit trivialement "traditionnel" continuent à peser considérablement dans les questions liées à la gestion des terres de parcours.

BACKGROUND Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. METHOD Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. RESULTS Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). CONCLUSION The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. LEVEL OF EVIDENCE 5.

Current selection criteria for active surveillance based on systematic biopsy underestimate prostate cancer volume and grade. We investigated the role of additional magnetic resonance imaging targeted biopsy in reclassifying patients eligible for active surveillance based on systematic biopsy.We performed a study at 2 institutions in a total of 281 men with increased prostate specific antigen. All men met certain criteria, including 1) prebiopsy magnetic resonance imaging, 12-core transrectal systematic biopsy and 2 additional magnetic resonance imaging targeted biopsies of lesions suspicious for cancer during the same sequence as systematic biopsy, and 2) eligibility for active surveillance based on systematic biopsy results. Criteria for active surveillance were prostate specific antigen less than 10 ng/ml, no Gleason grade 4/5, 5 mm or less involvement of any biopsy core and 2 or fewer positive systematic biopsy cores. Patient characteristics were compared between reclassified and nonreclassified groups based on magnetic resonance imaging targeted biopsy results.On magnetic resonance imaging 58% of the 281 patients had suspicious lesions. Magnetic resonance imaging targeted biopsy was positive for cancer in 81 of 163 patients (50%). Of 281 patients 28 (10%) were reclassified by magnetic resonance imaging targeted biopsy as ineligible for active surveillance based on Gleason score in 8, cancer length in 20 and Gleason score plus cancer length in 9. Suspicious areas on magnetic resonance imaging were in the anterior part of the prostate in 15 of the 28 men (54%). Reclassified patients had a smaller prostate volume (37 vs 52 cc) and were older (66.5 vs 63 years) than those who were not reclassified (p0.05).Magnetic resonance imaging targeted biopsy reclassified 10% of patients who were eligible for active surveillance based on systematic biopsy. Its incorporation into the active surveillance eligibility criteria may decrease the risk of reclassification to higher stages during followup.

MRI is an increasingly important imaging modality for prostate cancer diagnosis. Further indications are being validated in prostate cancer to establish the prognostic, to guide treatment and to follow up patients especially after partial treatment. The first part of this work has focused on clinical studies of MRI in patient selection for active surveillance. The performance of MRI particularly in the detection of anterior cancers would reduce the risk of initial underestimation of tumor burden and therefore reduce the risk of reclassification during active surveillance protocols. The second part of this work has focused on the correlation between the signal abnormalities on MRI and intra-prostatic areas. We used a simple and reproducible technique for MRI and histopathology registration and we correlated signal abnormalities recorded on MRI with quantitative histopathological parameters at prostatectomy surgical specimens., L’IRM représente une modalité d’imagerie du cancer de la prostate qui occupe une place de plus en plus importante pour le diagnostic positif. D’autres indications sont en cours de validation pour établir le pronostique, pour guider le traitement et pour assurer le suivi après traitement notamment partiel. La première partie de ce travail a porté sur les études cliniques de l’IRM dans la sélection des candidats à une surveillance active. Les performances de l’IRM particulièrement dans la détection des cancers antérieurs permettront de réduire le risque de sous-estimation initiale des tumeurs et par conséquent le risque de la reclassification au cours des protocoles de surveillance active. La seconde partie de ce travail a porté sur la corrélation entre les anomalies de signal à l’IRM et les zones tumorales et non tumorales intra-prostatiques. La validation d’une technique simple et reproductible de recalage a permis ensuite une corrélation des anomalies de signal enregistrées sur l’IRM et des paramètres histo-pathologiques quantitatifs des pièces opératoires de prostatectomie.

Prebiopsy multiparametric prostate MRI (mp-MRI), followed by transrectal ultrasound-guided (TRUS-G) target biopsies (TB) of the prostate is a key combination for the diagnosis of clinically significant prostate cancers (CSPCa), to avoid prostate cancer (PCa) overtreatment. Several techniques are available for guiding TB to the suspicious mp-MRI targets, but the simplest, cheapest, and easiest to learn is “cognitive,” with visual registration of MRI and TRUS data. This review details the successive steps of the method (target detection, mp-MRI reporting, intermodality fusion, TRUS guidance to target, sampling simulation, sampling, TRUS session reporting, and quality insurance), how to optimize each, and the global indications of mp-MRI-targeted biopsies. We discuss the diagnostic yield of visually-registered TB in comparison with conventional biopsy, and TB performed using other registration methods.

Generally the hydrocarbon recovery factor and the complexity of the recovery mechanism are directly related. With the maturation of a producing field, enhanced monitoring plans and the implementation of fit-for-purpose data analyses workflows become necessary to understand well and reservoir dynamics for adequate reservoir management decisions. However, in reality, shifting the paradigm to adopt appropriate work strategies can, in certain circumstances, be restrained by several factors, including organizational issues. In this paper, the risk of implementing simplified reservoir management practices in a complex carbonate field is evaluated. An extensive study carried out in a thin oil-rim carbonate reservoir which undergoes substantial gas and water injection in its huge gas cap and aquifer respectively. The objective of the study is to review the use of conventional lift curves i.e., oil rate – well head pressure cross plot, to: Predict well performance changes under varying production conditions. Accurately allocate daily well production. It is found that the use of a simplified approach for well performance analyses and production allocation may not be representative in this particular case. The potential risks of using simplified approach are identified and the need of adopting sophisticated processes, to carry out appropriate modelling for representative results, are also discussed in this work. This study conceptually demonstrates that a fully integrated reservoir/well/network coupled model is required to accurately address such cases. An integrated approach would not only benefit better understanding of well and reservoir behavior, but it would also aid meaningful decisions for establishing reservoir management best practices and strategies.

The association between Lynch syndrome and prostate cancer has been studied. Recent studies report an association between these two diseases.Literature review based on PubMed search was performed using the following keywords: Lynch syndrome and prostate cancer.Eight articles analyzing cohorts of subjects carrying Lynch syndrome were analysed including 6786 patients with 175 cancers. Prostate cancers were more frequent with a standardized incidence ratio (SIR) from 0.93 (95% CI: 0.19-2.7) and 5.9 (95% CI 4.1-17.1) and occurs at a younger age than in the general population mainly for mutations in the MSH2 gene.Prostate cancer seem more frequent and occur earlier in individuals harboring a mutation in the MSH2 gene while it does not appear to be any difference compared to the general population for other mutations in Lynch syndrome.

To assess long term biochemical recurrence free survival after radical prostatectomy according to open, laparoscopic and robot-assisted surgical approach and clinicopathological stage.A cohort study of 1313 consecutive patients treated by radical prostatectomy for localized or locally advanced prostate cancer between 2000 and 2013. Open surgery (63.7%), laparoscopy (10%) and robot-assisted laparoscopy (26.4%) were performed. Biochemical recurrence was defined by PSA0,1ng/mL. The biochemical recurrence free survival was described by Kaplan Meier method and prognostic factors were analysed by multivariable Cox regression.Median follow-up was 57 months (IQR: 31-90). Ten years biochemical recurrence free survival was 88.5%, 71.6% and 53.5% respectively for low, intermediate and high-risk D'Amico groups. On multivariable analysis, the worse prognostic factor was Gleason score (P0.001). Positive surgical margins rate was 53% in pT3 tumours and 24% in pT2 tumours (P0.001). Biochemical recurrence free survival (P=0.06) and positive surgical margins rate (P=0.87) were not statistically different between the three surgical approaches.Biochemical recurrence free survival in our study does not differ according to surgical approach and is similar to published series. Ten years biochemical recurrence free survival for high-risk tumours without hormone therapy is 54% justifying the role of surgery in the therapeutic conversations in this group of tumours.3.

To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs.A systematic review of the scientific literature was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM using the following keywords: epidemiology; risk factor; tobacco; aristolochic acid; urothelial carcinoma; ureter; renal pelvis. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned.The estimated UTUC incidence is 1.2 cases/100,000 inhabitant per year in Europe. The incidence of renal pelvis tumor has been stable for 30years, while the frequency of ureteric locations has increased over time. Locally advanced stage and high grade are more frequent at the time of diagnosis. The median age for diagnosis is 70-years-old. Male-to-female ratio is nearly 2. Main carcinogenic factors are tobacco consumption and occupational exposure. There are specific risk factors for UTUC such acid aristolochic (balkan's nephropathy and Chinese herbs nephropathy). Familial cases are distinct from sporadic cases. UTUCs belong to the HNPCC syndrome and they rank third in its tumor spectrum.UTUCs are scarce tumors with specific epidemiologic characteristics. UTUCs share common risk factors with other urothelial carcinomas such as bladder tumors but have also specific risk factors that clinicians should know.

The incidence of testicular nodules discovered during infertility evaluation is increasing. These nodules are suspicious of malignancy. There is no paraclinical examination which allows histological orientation to these nodules. The recommendations propose priority treatment by total orchidectomy.Through a retrospective cohort study of infertile patients, our goal is to study the enhancement of testicular nodules after injection of ultrasound contrast. The secondary objective is to determine whether CEUS may argue in favor of conservative treatment. From june 2010 to march 2013, 24 patients had underwent ultrasound contrast study of abnormal testicular parenchyma detected prior to infertility evaluation carried ultrasound. The characteristics of ultrasound enhancement were correlated with the pathological findings of surgical patients and proposed treatments (surgery or surveillance).Fifteen patients were followed up, 9 were operated (7 partial orchidectomies, 2 total orchidectomies). Histological analysis found four Leydig cell tumors, 2 Sertoli cell tumors and 3 seminomas. No adverse changes were noted during the follow-up. This study showed a typical semiology of early, intense and homogeneous enhancement with a phenomenon of wash in 100% of Leydig cell tumors. All Leydig cell tumors have been treated by partial orchidectomy. Seminomas have intense enhancement in 100% of cases. There was a phenomenon of wash in 2 out of 3 cases. When a wash in was described, it was always described as heterogeneous. All seminomas were finally treated by total orchidectomy. The sensitivity and positive predictive value of ultrasound intense enhancement for the diagnosis of testicular cancer was 89% (Se) and 80% (PPV).There is a semiology of ultrasound enhancement of testicular nodules with features that can guide in favor of a malignant tumor, seminoma or Leydig cell tumor. If a prospective study was undertaken, these arrangements could guide us to treatments promoting preservation of the testicular parenchyma.

This article is devoted to prove a stability result for an absorption coefficient for a transport equation in a smooth domain $\Omega$ with $\partial \Omega=\Gamma^+ \cup \Gamma^-$. We consider the transport equation $ \partial_t u +\nabla a \cdot \nabla u + V(x)u=0,\ \ \mbox{ in } \ \Omega \times (0,T)$ with boundary condition $u(x,t)=h(x,t),\ \ \mbox{ on } \ \Gamma^- \times (0,T)$ and initial condition $u(x,t)=u_0(x),\ \ x \in \Omega$, where $a$ is such that $\nabla a \cdot \nu >0$ on $\Gamma^+$ and $\nabla a \cdot \nu

To evaluate the impact of radical prostatectomy on lower urinary tract symptoms by using the International Prostate Symptom Score and International Prostate Symptom Score quality of life.The present prospective study comprised 804 patients having localized prostate cancer who underwent radical prostatectomy. International Prostate Symptom Score and International Prostate Symptom Score quality of life were recorded preoperatively, and at 1, 3, 6, 12 and 24 months. Two study groups were considered: group 1 included patients with International Prostate Symptom Score ≤7 (mild) and group 2 included patients with International Prostate Symptom Score ≥8 (moderate to severe). Student's t-test and logistic regression were carried out to detect a predictive factor of International Prostate Symptom Score ≤7 at 24 months.The mean International Prostate Symptom Score was 5.58 ± 6.6, 11.12 ± 7.1 and 7.62 ± 6 at baseline, 1 month and 3 months, respectively (P0.0001). The mean quality of life score showed the same evolution with a significant difference at 1 and 3 months. The mean International Prostate Symptom Score was initially 1.57 ± 1.9 in group 1 and 13.51 ± 5.5 in group 2 (P0.0001), evolving to 3.41 ± 3.1 and 7.69 ± 5.8 at 24 months (P0.0001), respectively. The mean quality of life score was significantly different between the groups initially, and at 6 and 12 months with P0.0001, P = 0.005 and P = 0.02, respectively. The multivariate logistic regression showed that age, prostate volume and preoperative International Prostate Symptom Score were independent predictive factors of International Prostate Symptom Score ≤7 at 24 months (P0.0001). In group 2, 47 patients (17%) had an International Prostate Symptom Score ≥8 at 24 months, 15 of them (32%) having a QoL score ≥3.The present study shows the beneficial impact of radical prostatectomy on lower urinary tract symptoms. However, a proportion of patients with a baseline International Prostate Symptom Score ≥8 maintain the same score at 24 months, with worsening in quality of life score in one-third of them.

PURPOSE OF REVIEW The current challenge in prostate cancer diagnosis is how to accurately measure the risk of disease progression and guide the treatment decision process between effective intervention for potentially harmful tumors and active surveillance for indolent disease. The issue is how to better identify patients harboring insignificant disease using the current diagnosis pathway based on 12-core systematic biopsy, which misclassifies tumor volume and/or grade in up to 30% of cases. Integrating MRI into the diagnosis process may help to better determine if the cancer is at very low risk of disease progression, i.e. clinically indolent or insignificant. RECENT FINDINGS Recent advances in prostate imaging techniques suggest that multiparametric MRI has a high negative predictive value (up to 95%) in ruling out clinically significant prostate cancer and may potentially have clinical use in diagnostic pathways in men at risk for prostate cancer. Prospective studies should be performed to examine the rate of reclassification using MRI-targeted biopsy in patients potentially eligible for active surveillance based on current tests (12-cores systematics biopsies). SUMMARY Patients with nonsuspicious multiparametric MRI represent a special very low-risk group of men with either no disease or clinically insignificant disease, allowing them to be managed conservatively.

Laminar mixed convection in the entrance region of an inclined tube with longitudinal external fins (corresponding to the basic element of a flat plate solar collector) has been studied numerically. The system is subjected to a uniform solar flux and convective losses on its top surface; it is insulated on its bottom surface. The results show that the secondary flow induced by buoyancy has a very significant effect on the axial flow and on the isotherms in both the fluid and the solid. Furthermore, due to circumferential conduction in the tube wall, more heat reaches the fluid from the bottom half of the fluid–solid interface than from its top half. The circumferentially average Nusselt number shows the usual decrease with axial distance from the tube inlet towards a constant value in the fully developed region. This constant value is considerably higher for the finned tube than the corresponding value for a bare tube. Both these values are significantly higher than one for fully developed forced convection. A parametric study shows the effects of the fin and tube materials, of the solar flux and the fin’s width on the thermal performance of the collector.

The developing flow with mixed laminar convection in an inclined tube has been studied numerically for four different thermal boundary conditions: a uniform heat flux is applied over the entire circumference or its top half at either the outer tube surface or the fluid-solid interface. The calculated results for local parameters (circumferential distribution of the interfacial temperature, axial velocity profile, etc.) and for average variables (circumferentially average values of the Nusselt number and of the interfacial shear stress) are quite different, especially for high values of Grashof number. Thus, for Gr = 10 6 , Re = 500 and Pr = 7, the asymptotic average Nusselt number for a uniform heat flux applied over the entire outer tube surface is 16.47; the corresponding values for a heat flux applied on the fluid-solid interface is 26.14 for uniform flux over the entire circumference and 29.71 for a heat flux applied only on the top half of the interface.

Conjugate heat transfer in an inclined tube combining developing mixed convection of a Boussinesq fluid with nonuniform heating of the outer tube surface has been studied numerically. Viscous dissipation and axial diffusion are neglected. Thus the governing equations are parabolic in the axial direction and elliptic in the other two directions. Although the bottom half of the outer tube surface is assumed adiabatic, circumferential conduction through the wall results in a significantly different heat flux distribution at the solid-fluid interface. Thus, far from the entrance, the fraction of the externally supplied heat reaching the fluid from the bottom half of the interface is 72% for copper, 60% for steel, and 30% for glass tubes. This significant redistribution of the heat flux influences the thermal and hydrodynamic fields and has important effects on the Nusselt number, which cannot be predicted if the thermal boundary condition is applied at the solid-fluid interface.