Updated National Study of Functional Graft Renal Cell Carcinomas: Are They a Different Entity?

OBJECTIVE: To analyze de novo graft carcinoma characteristics from our updated national multicentric retrospective cohort. METHODS: Thirty-two transplant centers have retrospectively completed the database. This database concerns all kidney graft tumors including urothelial, and others type but excludes renal lymphomas over 31 years. RESULTS: One hundred and fifty twokidney graft carcinomas were diagnosed in functional grafts. Among them 130 tumors were Renal Cell Carcinomas. The calculated incidence was 0.18%. Median age of the allograft at diagnosis was 45.4 years old. The median time between transplantation and diagnosis was 147.1 months. 60 tumors were papillary carcinomas and 64 were clear cell carcinomas. Median tumor size was 25 mm. 18, 64, 21 and 1 tumors were respectively Fuhrman grade 1, 2, 3 and 4. Nephron sparing surgery (NSS) was performed on 68 (52.3%) recipients. Ablative therapy was performed in 23 cases (17.7%). Specific survival rate was 96.8%. CONCLUSION: This study confirmed that renal graft carcinomas are a different entity: with a younger age of diagnosis; a lower stage at diagnosis; a higher incidence of papillary subtypes.

Assessment of quality of glycemic control in intensive care patients treated with an insulin infusion at a teaching hospital.

OBJECTIVE: To describe the quality of glycemic control in patients in intensive care units (ICUs) treated with an intravenous (IV) insulin infusion at a teaching hospital. METHOD: This retrospective study included patients admitted to the ICU and treated with an IV insulin infusion for at least 12 h between August 1 and November 30, 2011. Medical charts were reviewed. The primary quality indicator for glycemic control was the mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L target range. RESULTS: A total of 351 patients were included; 61.5% of subjects had no known diabetes. Admissions were mainly for surgery (61.3%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.8±7.3. The mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L range was 35% for all subjects and 26.2% for patients with diabetes. If a target of 6.1 to 10 mmol/L was considered, those values became 63% and 54.6%. At least 1 episode of hyperglycemia (>10 mmol/L), hypoglycemia (<4 mmol/L) or severe hypoglycemia (<2.2 mmol/L) was documented in 68%, 9% and 1% of subjects, respectively. Glycemic variability (SD) was 1.9 mmol/L, and the median hyperglycemic index was 0.77 (interquartile [IQ]: 0.24 to 1.63). CONCLUSION: The quality of glycemic control in patients in the ICU at our hospital needs to be improved. A new computerized IV insulin protocol is currently being tested.

Insulin infusion therapy in critically ill patients.

While dysglycemia (hyperglycemia, hypoglycemia and glucose variability) is clearly associated with increased mortality in critically ill patients, target range of blood glucose control remains controversial. Standardized insulin infusion protocols constitute the basis of treatment of these patients. The choice of protocol and its implementation is a great challenge. In this article, we review the published data to help define the essential elements that compose a good protocol and apply the right conditions to make it safe and effective.

Migration routes and staging areas of trans-Saharan Turtle Doves appraised from light-level geolocators.

The identification of migration routes, wintering grounds and stopover sites are crucial issues for the understanding of the Palearctic-African bird migration system as well as for the development of relevant conservation strategies for trans-Saharan migrants. Using miniaturized light-level geolocators we report a comprehensive and detailed year round track of a granivorous trans-Saharan migrant, the European Turtle Dove (Streptopelia turtur). From five recovered loggers, our data provide new insights on migratory journeys and winter destinations of Turtle Doves originating from a breeding population in Western France. Data confirm that Turtle Doves wintered in West Africa. The main wintering area encompassed Western Mali, the Inner Delta Niger and the Malian/Mauritanian border. Some individuals also extended their wintering ranges over North Guinea, North-West of Burkina Faso and the Ivory-Coast. Our results reveal that all individuals did not spend the winter period at a single location; some of them experienced a clear eastward shift of several hundred kilometres. We also found evidence for a loop migration pattern, with a post-breeding migration flyway lying west of the spring route. Finally, we found that on their way back to breeding grounds Turtle Doves needed to refuel after crossing the Sahara desert. Contrary to previous suggestions, our data reveal that birds used stopover sites for several weeks, presumably in Morocco and North Algeria. This later finding is a crucial issue for future conservation strategies because environmental conditions on these staging areas might play a pivotal role in population dynamics of this declining species.

Cloning, expression and regulation of chicken ovalbumin upstream promoter transcription factors (COUP-TFII and EAR-2) in the rat anterior pituitary gland.

Chicken ovalbumin upstream promoter transcription factors (COUP-TF)-II (NR2F2) and EAR-2 (NR2F6) are structurally related orphan members of the nuclear receptors superfamily. There are growing evidences that these factors play important roles during processes of differentiation and proliferation of several tissues. To better understand their role in the differentiated adult rat pituitary gland, we cloned COUP-TFII and EAR-2 cDNAs from an anterior pituitary cDNA library. Subsequently, we raised and characterized specific antibodies to the N-terminal domain of both nuclear receptors. We next examined their cellular and subcellular distribution in the pituitary gland and determined their regulation during pregnancy. COUP-TFII and EAR-2 pituitary genes display, respectively, 90 and 100% homologies with their human and mouse homologues. Cellular expression of both nuclear receptors was mainly detected in the lactotropes of male and female rats, with a prominent distribution in the nuclear compartment for EAR-2, and interestingly both proteins were significantly upregulated in pituitaries of pregnant vs. cycling female rats. Thus, our results have characterized cloning of rat pituitary COUP-TFII and EAR-2 genes, demonstrated that they are both specifically expressed in lactotropes, and strongly suggested that they may play an important role in modulating prolactin (PRL) gene expression during pregnancy.

Early survival in roe deer: causes and consequences of cohort variation in two contrasted populations.

Time- and sex-specific summer survival of roe deer fawns was estimated using capture-mark-recapture methods in two enclosed populations living in contrasting conditions. The population of Trois Fontaines (eastern France) was roughly constant in size throughout the study period, while in Chizé (western France), the population experienced frequent summer droughts and numbers decreased continuously during the study. Early survival of fawns was low and highly variable over the years at both Chizé and Trois Fontaines, and demonstrated marked variations between cohorts that need to be taken into account when modelling roe deer population dynamics. In Trois Fontaines, fawn survival was positively correlated with early body growth and total rainfall in May and June. In Chizé, fawn survival decreased with increasing density and tended to increase with increasing rainfall in May and June and adult female body mass. These factors explained more than 75% of the variability in early survival observed in both populations. Variation between cohorts had different consequences for the two populations. At Trois Fontaines, cohort variation was limited to a numerical effect on early survival. However at Chizé, cohort variation was long-lasting and affected the phenotypic quality of survivors at later ages, and thereby future survival and breeding abilities (both numerical and quality effects). Male and female fawns had similar survival over their first summer in both populations. This result contrasts with the lower survival of young males often observed in ungulates. Two ultimate causes can be proposed to account for the low and variable survival of roe deer fawns over the first summer: the high energy expenditures incurred by does during each breeding attempt and/or the low absolute body size of newborn roe deer fawns.