Assessment of oncological and functional outcomes of retropubic radical prostatectomy: An academic center experience.

PURPOSE: To report perioperative, pathological, oncological and functional outcomes of a contemporary series of retropubic radical prostatectomy (RRP), performed by one experienced surgeon. METHODS: We analyzed data from a prospectively gathered database of consecutive patients who were treated by an RRP as first-line treatment for localized prostate cancer, from January 2014 to December 2019, in a single French academic center. RESULTS: Overall, 364 patients were included. Median age and PSA were 65.7 years and 8.0ng/mL. According to D'Amico risk classification, 13.7% patients had a low-risk prostate cancer, 41.5% a favorable intermediate-risk, 23.4% an unfavorable intermediate-risk and 21.4% a high-risk prostate cancer. The rates of pT2 and pT3 were 48.6% (n=177) and 51.4% (n=187), respectively. The rates of non-nerve sparing surgery (NSS), unilateral NSS and bilateral NSS were 19.5% (n=71), 32.7% (n=119) and 47.8% (n=174). Total positive surgical margin (PSM) rate was 12.6% (n=46). Total pT2 PSM and pT3 PSM rates were 0.6% (n=1) and 24.1% (n=45) and achieved a statistical difference (P<0.001). At a median follow-up of 1.9-year, biochemical recurrence (BCR) occurred in 47 (12,9%) patients. Extracapsular extension was associated with a poor BCR-free survival as compared to organ confined disease (P<0.0001). At 2.7 years of follow-up, urinary continence rate was 88% (322/364). After exclusion of non-NSS RRP and non-interpretable questionnaires (score 1-4), median IIEF-5 score was 16 (8-20). CONCLUSION: Retropubic radical prostatectomy ensures optimal pathological and functional results, in a current predominantly population of intermediate-risk prostate cancer and high-risk prostate cancer. LEVEL OF EVIDENCE: 3.

[Living-donor robotic-assisted kidney transplantation: French academic center experience]. / Transplantation rénale robot-assistée avec donneur vivant : expérience d'un centre universitaire français.

INTRODUCTION: The main objective was to report the intra-, post-operative and functional outcomes of living-donor robotic-assisted kidney transplantation (RAKT), performed by a surgeon skilled in robotic surgery. The secondary objective was to compare the results of RAKT, based on the surgeon's experience. METHODS: For this retrospective cohort study, we analyzed data from consecutive patients who underwent living-donor RAKT from July 2015 to March 2020 and compared the results of RAKT according to the surgeon's experience (group 1: 1-14th RAKT versus group 2: 15-29th RAKT). RESULTS: Twenty-nine living-donor RAKT were performed. The median age and BMI of the recipients were: 57.0 (44.0-66.0) years and 32.7 (23.5-39.6)kg/m2. The median overall operative time and median console time were: 140.0 (122.5-165.0) and 120.0 (107.5-137.5) minutes. The median rewarming time, arterial, venous and urinary anastomoses durations were: 35.0 (27.5-45.0), 15.0 (11.0-20.0), 12.0 (10.0-16.0), 20.0 (16.0-23.0) minutes. Two (6.9%) minor and 5 (17.2%) major (Clavien-Dindo≥III) postoperative complications occurred. At 2 years of follow-up, patient and transplant survival was 100% (n=29) and 93.1% (n=27). After the 14th RAKT, the rewarming time (P=0.01) and venous anastomosis duration (P=0.004) were statistically shorter. CONCLUSION: Living-donor robotic-assisted kidney transplantation, performed by a surgeon skilled robotic surgery, ensures good functional results in the medium term. LEVEL OF EVIDENCE: 3.

[Type I collagen in xenogenic bone material regulates attachment and spreading of osteoblasts over the beta1 integrin subunit]. / Typ-I-Kollagen im xenogenen Knochenmaterial reguliert Anbindung und Verbreitung von Osteoblasten über die beta 1-Integrin-Untereinheit.

Xenogenic bone biomaterials have been proposed as an alternative to autografts or allografts in human bone restoring or in complement of prosthetic surgery. When appropriate treatments were applied, immunological, inflammatory, bacteriological or virological adverse responses can be prevented. However, these treatments may interact with type I collagen, the major component of the organic bone matrix. Type I collagen can bind osteoblasts via specific cell surface receptors, the integrins. In this work, two different xenogenic biomaterials were studied. Both biomaterials have a bovine bone origin. They displayed similar architectural organization with connected plates and rods and similar surface topography and roughness. They differed by the presence or not of collagen type I. The first one was characterized by preservation of the type I collagen matrix associated with spindle-shaped hydroxypatite crystals and the second was solely composed by heat-modified apatite crystals. Osteoblast-like cells (Saos-2) were cultured on both biomaterials and examined in scanning and transmission electron microscopy after 7 and 14 days. Both biomaterials were cytocompatible as demonstrated by good ultrastructural cell preservation. (1) At the surface of the collagen containing biomaterial, cells were elongated in shape and oriented according to the trabecular architecture and to the superficial collagen network. After 14 days of culture, cells were confluent and the biomaterial surface was hidden by the cell sheet. The beta 1 integrin subunit was detected by immunogold in transmission electron microscopy in close relationship with the superficial collagen fibres of the biomaterial and with the outer cell surface. When cultures were carried out in presence of anti beta 1 integrin subunit, cells were packed and piled up with lack of specific orientation. (2) At the surface of the deproteinized biomaterial, cells were globular without specific disposition and often partially attached to the surface. After 14 days of culture, large areas of the biomaterial surface remained uncovered. Anti beta 1 subunits conjugated with gold particles were detected around the cells but with no specific association with the deproteinized biomaterial. These results strongly suggest that presence of type I collagen fibres in the matrix of a bone biomaterial is of major interest to determine cell attachment, spreading and orientation via interaction between type I collagen and beta 1 integrin subunit of osteoblasts.

Migration of metal and polyethylene particles from articular prostheses may generate lymphadenopathy with histiocytosis.

Wear particles released from hip or knee prostheses are known to be involved in the fibrohistiocytic membrane interposed between bone and implant. During surgical treatment for pelvic carcinoma (5 cases) and for isolated pseudomalignant lymphadenopathy (4 cases) lymph nodes in 9 patients who had had lower limb articular replacement were harvested. Light microscopy and image analysis of the nodes showed florid endosinusal histiocytosis, predominant in the cortical area. Using Oil Red O staining and polarized light, metal particles and polyethylene particles were detected in the large histiocytes. Scanning electron microscopy with electron backscattering allowed us to localize metal particles and perform elemental microanalysis. Iron, cobalt, chromium, nickel, zirconium, and barium, known to be used in prosthetic and cementing materials, were identified as component of these particles. Large amounts of polyethylene particles appeared in all cases while metal particles were found to be abundant in only 2 cases. Thus, migration of polyethylene debris from the prosthetic site seems to be the major factor in development of the histiocytes induced in satellite lymph nodes.

Activity of cilofungin (LY 121019), a new lipopeptide antibiotic, on the cell wall and cytoplasmic membrane of Candida albicans. Structural modifications in scanning and transmission electron microscopy.

Cilofungin, a new biosemisynthetic analog of echinocandin B, inhibits the synthesis of beta-(1,3)-glucan resulting in severe modifications of the cell wall and cytoplasmic membrane of sensitive organisms. The morphological modifications to budding yeast cells, pseudomycelium, mycelium and germ tubes of Candida albicans were studied by scanning and transmission electron microscopy after 3 and 16 h exposure to cilofungin. Changes in yeast cell morphology were apparent after 3 h in 0.1 microgram ml-1 cilofungin but were more marked in 1 and 10 micrograms ml-1 cilofungin. Most of the yeasts failed to separate and formed aggregates. Cracks and discontinuities were present in the cell wall and the cell membrane became undulated and fractured. Inclusions into the periplasmalemma space were observed, along with a release of cellular components. An important inhibition of germ tube formation was noted and the structure of true mycelium and pseudomycelium was severely modified. The budding area of yeast cells was particularly susceptible to damage by cilofungin.

Complement activation and cyto-immunological alterations of the respiratory mucosa.

The action of activated complement on the upper respiratory tract was studied using the registration of ciliary beating and the transmission and scanning electron microscopy of ciliated cell lesions. The alternative pathway of activation was done using (1) non-specific activators, i. e. zymosan, dextran sulfate and polymerised sIgA, and (2) specific activators, i. e. "Ag-sIgA" immune complexes on normal mucosa and contact between an antigen and the tracheal mucosa of an immunized animal. In all cases, a quick alteration of the ciliary beating rythm was registered as well as more or less extensive cytological destruction. Such results were obtained with or without adjunction of complement; this suggested the existence of complement locally. A new method to demonstrate the occurrence of complement was developed, and the results showed that complement was present in the trachea. The above results were corroborated (1) by EDTA inhibition of the two complement pathways which prevented stopping of the ciliary beating and eliminated most of the cytological lesions, whilst EGTA left the alternative pathway operative with consequent alterations, and (2) by using C6-deficient rabbits in which no alterations were found. This study demonstrated that under certain conditions, local sIgA may activate the complement, and this fact explains many aspects of these immunological reactions of the respiratory epithelium.