NKG2D receptor activation drives primary graft dysfunction severity and poor lung transplantation outcomes.

Clinical outcomes after lung transplantation, a life-saving therapy for patients with end-stage lung diseases, are limited by primary graft dysfunction (PGD). PGD is an early form of acute lung injury with no specific pharmacologic therapies. Here, we present a large multicenter study of plasma and bronchoalveolar lavage (BAL) samples collected on the first posttransplant day, a critical time for investigations of immune pathways related to PGD. We demonstrated that ligands for NKG2D receptors were increased in the BAL from participants who developed severe PGD and were associated with increased time to extubation, prolonged intensive care unit length of stay, and poor peak lung function. Neutrophil extracellular traps (NETs) were increased in PGD and correlated with BAL TNF-α and IFN-γ cytokines. Mechanistically, we found that airway epithelial cell NKG2D ligands were increased following hypoxic challenge. NK cell killing of hypoxic airway epithelial cells was abrogated with NKG2D receptor blockade, and TNF-α and IFN-γ provoked neutrophils to release NETs in culture. These data support an aberrant NK cell/neutrophil axis in human PGD pathogenesis. Early measurement of stress ligands and blockade of the NKG2D receptor hold promise for risk stratification and management of PGD.

Exploiting Isospin Symmetry to Study the Role of Isomers in Stellar Environments.

Proton capture on the excited isomeric state of ^{26}Al strongly influences the abundance of ^{26}Mg ejected in explosive astronomical events and, as such, plays a critical role in determining the initial content of radiogenic ^{26}Al in presolar grains. This reaction also affects the temperature range for thermal equilibrium between the ground and isomeric levels. We present a novel technique, which exploits the isospin symmetry of the nuclear force, to address the long-standing challenge of determining proton-capture rates on excited nuclear levels. Such a technique has in-built tests that strongly support its veracity and, for the first time, we have experimentally constrained the strengths of resonances that dominate the astrophysical ^{26m}Al(p,γ)^{27}Si reaction. These constraints demonstrate that the rate is at least a factor ∼8 lower than previously expected, indicating an increase in the stellar production of ^{26}Mg and a possible need to reinvestigate sensitivity studies involving the thermal equilibration of ^{26}Al.

Shape Changes in the N=28 Island of Inversion: Collective Structures Built on Configuration-Coexisting States in

The neutron-rich nuclei in the N=28 island of inversion have attracted considerable experimental and theoretical attention, providing great insight into the evolution of shell structure and nuclear shape in exotic nuclei. In this work, for the first time, quadrupole collectivity is assessed simultaneously on top of the 3/2^{-} ground state and the 7/2^{-} shape-coexisting isomer of ^{43}S, putting the unique interpretation of shape and configuration coexistence at N=27 and 28 in the sulfur isotopic chain to the test. From an analysis of the electromagnetic transition strengths and quadrupole moments predicted within the shell model, it is shown that the onset of shape coexistence and the emergence of a simple collective structure appear suddenly in ^{43}S with no indication of such patterns in the N=27 isotone ^{45}Ar.

Establishing the Maximum Collectivity in Highly Deformed N=Z Nuclei.

The lifetimes of the first excited 2^{+} states in the N=Z nuclei ^{80}Zr, ^{78}Y, and ^{76}Sr have been measured using the γ-ray line shape method following population via nucleon-knockout reactions from intermediate-energy rare-isotope beams. The extracted reduced electromagnetic transition strengths yield new information on where the collectivity is maximized and provide evidence for a significant, and as yet unexplained, odd-odd vs even-even staggering in the observed values. The experimental results are analyzed in the context of state-of-the-art nuclear density-functional model calculations.

Constraining the Neutron Star Compactness: Extraction of the

The ^{23}Al(p,γ)^{24}Si reaction is among the most important reactions driving the energy generation in type-I x-ray bursts. However, the present reaction-rate uncertainty limits constraints on neutron star properties that can be achieved with burst model-observation comparisons. Here, we present a novel technique for constraining this important reaction by combining the GRETINA array with the neutron detector LENDA coupled to the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The ^{23}Al(d,n) reaction was used to populate the astrophysically important states in ^{24}Si. This enables a measurement in complete kinematics for extracting all relevant inputs necessary to calculate the reaction rate. For the first time, a predicted close-lying doublet of a 2_{2}^{+} and (4_{1}^{+},0_{2}^{+}) state in ^{24}Si was disentangled, finally resolving conflicting results from two previous measurements. Moreover, it was possible to extract spectroscopic factors using GRETINA and LENDA simultaneously. This new technique may be used to constrain other important reaction rates for various astrophysical scenarios.

Is the Structure of

A more detailed test of the implementation of nuclear forces that drive shell evolution in the pivotal nucleus ^{42}Si-going beyond earlier comparisons of excited-state energies-is important. The two leading shell-model effective interactions, SDPF-MU and SDPF-U-Si, both of which reproduce the low-lying ^{42}Si(2_{1}^{+}) energy, but whose predictions for other observables differ significantly, are interrogated by the population of states in neutron-rich ^{42}Si with a one-proton removal reaction from ^{43}P projectiles at 81 MeV/nucleon. The measured cross sections to the individual ^{42}Si final states are compared to calculations that combine eikonal reaction dynamics with these shell-model nuclear structure overlaps. The differences in the two shell-model descriptions are examined and linked to predicted low-lying excited 0^{+} states and shape coexistence. Based on the present data, which are in better agreement with the SDPF-MU calculations, the state observed at 2150(13) keV in ^{42}Si is proposed to be the (0_{2}^{+}) level.

Localizing the Shape Transition in Neutron-Deficient Selenium.

Neutron-deficient selenium isotopes are thought to undergo a rapid shape change from a prolate deformation near the line of beta stability towards oblate deformation around the line of N=Z. The point at which this shape change occurs is unknown, with inconsistent predictions from available theoretical models. A common feature in the models is the delicate nature of the point of transition, with the introduction of even a modest spin to the system sufficient to change the ordering of the prolate and oblate configurations. We present a measurement of the quadrupole moment of the first-excited state in radioactive ^{72}Se-a potential point of transition-by safe Coulomb excitation. This is the first low-energy Coulomb excitation to be performed with a rare-isotope beam at the reaccelerated beam facility at the National Superconducting Cyclotron Laboratory. By demonstrating a negative spectroscopic quadrupole moment for the first-excited 2^{+} state, it is found that any low-spin shape change in neutron-deficient selenium does not occur until ^{70}Se.

Lifetime Measurements and Triple Coexisting Band Structure in

Lifetime measurements of excited states in the neutron-rich nucleus ^{43}S were performed by applying the recoil-distance method on fast rare-isotope beams in conjunction with the Gamma-Ray Energy Tracking In-beam Nuclear Array. The new data based on γγ coincidences and lifetime measurements resolve a doublet of (3/2^{-}) and (5/2^{-}) states at low excitation energies. Results were compared to the π(sd)-ν(pf) shell model and antisymmetrized molecular dynamics calculations. The consistency with the theoretical calculations identifies a possible appearance of three coexisting bands near the ground state of ^{43}S: the K^{π}=1/2^{-} band built on a prolate-deformed ground state, a band built on an isomer with a 1f_{7/2}^{-1} character, and a suggested excited band built on a newly discovered doublet state. The latter further confirms the collapse of the N=28 shell closure in the neutron-rich region.

Enhanced Electric Dipole Strength for the Weakly Bound States in

An enhanced low-energy electric dipole (E1) strength is identified for the weakly bound excited states of the neutron-rich isotope ^{27}Ne. The Doppler-shift lifetime measurements employing a combination of the γ-ray tracking array GRETINA, the plunger device, and the S800 spectrograph determine the lower limit of 0.030 e^{2} fm^{2} or 0.052 W.u. for the 1/2^{+}→3/2^{-} E1 transition in ^{27}Ne, representing one of the strongest E1 strengths observed among the bound discrete states in this mass region. This value is at least 30 times larger than that measured for the 3/2^{-} decay to the 3/2_{gs}^{+} ground state. A comparison of the present results to large-scale shell-model calculations points to an important role of core excitations and deformation in the observed E1 enhancement, suggesting a novel example of the electric dipole modes manifested in weakly bound deformed systems.

[XPS Greenlight photoselective vaporization for benign prostatic hyperplasia: analysis of the learning curve and contribution of transrectal ultrasound monitoring]. / Traitement de l'hyperplasie bénigne de prostate par photovaporisation au laser Greenlight XPS: analyse de la courbe d'apprentissage et apport de l'échographie endorectale peropératoire.

INTRODUCTION: The aim of this study was to analyze the XPS laser learning curve of one single surgeon with no previous experience of PVP and the impact of the use of reel time transrectal ultrasound (TRUS) monitoring. MATERIALS AND METHODS: Retrospective analysis of the first 100 patients: group 1 (1st-49th patient without TRUS) and group 2 (50th-100th with TRUS). The learning curve was analyzed through technical variables: vaporization time/intervention time (VT/IT) (%), energy delivered (J)/prostate volume (J/mL) and delivered energy (J/s or Watt), peroperative conversion into monopolar transurethral resection, postoperative complication, duration of catheterization and hospitalization and evolution of International Prostate Symptom Score (IPSS), PSA level, prostate residual volume and Qmax. Relationships between variables were evaluated by analysing the covariance (R 2 software. 14.2). RESULTS: A significant increase in VT/IT (P=0.0001) and the energy delivered per mL prostate (P=0.043) was reported in group 1. The average energy delivered per second was significantly higher in group 2 (P=0.0016). No difference was observed in terms of intra- or postoperative complication and catheterization time. The duration of hospitalization was significantly shorter in group 2 (P=0.03). The use of TRUS was associated with a gain of energy delivered by prostate volume at the end of learning curve (P=0.018). Prostate residual volume was significantly lower in the group 2 (P=0.0004). CONCLUSION: In our experience, 50 procedures are required to achieve the learning curve of PVP. The use of reel time TRUS would increase the energy delivered by prostate volume.

[Is statin use associated with D'Amico risk groups and biochemical recurrence after radical prostatectomy?]. / Impact de la prise de statines sur les groupes à risques de progression de D'Amico et la survie sans récidive biologique après prostatectomie totale.

OBJECTIVE: To examine the association between statin use and prostate cancer (PC) stratified with D'Amico risk groups and biochemical recurrence (BR) in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS: All medical charts of patients managed from 2004 to 2008 for PC with RP were reviewed retrospectively. The use and the type of statin were identified. Patients were split according to the use (S+) or not (S-) of statin. The two groups were compared using the Chi(2) test. A logistic regression was performed for multivariate analysis. RESULTS: Overall, 377 patients were included. Mean age was 64 (48-76) (median, range). Ninety-seven patients (27.5%) used statin for at least a year. Groups S- and S+ were comparable in terms of age, obesity, diabetes, preoperative PSA, biopsy Gleason score or clinical stage. The use of statin was statistically associated with D'Amico risk groups (P=0.003). The number of high-risk PC was higher in Group S+ (23.7% vs. 10.7%) with an odds ratio of 2.4 (P=0.009). With a mean follow up of 33±10 months, the overall 2-years-BR was 89%. The 2-years-BR was higher in the S+ (93% vs. 88%, P=0.16). After adjustment, this difference was statistically significant with a hazard ratio of 0.46 (P=0.036). CONCLUSION: The use of statin was associated with high risk PC in this study. Surprisingly, the statin use seem also to be associated with better disease-free survival, independently of other risk factors.

[Predicting prostate cancer with dynamic endorectal coil MR and proton spectroscopic MR imaging]. / Détection du cancer de la prostate par IRM endorectale dynamique et spectroscopique-proton.

PURPOSE: Determine the feasibility of dynamic gadolinium enhanced MRI and spectroscopic imaging in routine clinical practice using standard equipment and its usefulness for patients with negative biopsies and high degree of suspicion of prostate cancer. PATIENTS AND METHODS: Fifty five patients underwent endorectal MRI using T2W spin echo (SE) imaging, dynamic gadolinium enhanced imaging and proton spectroscopic imaging before repeat US-guided transrectal biopsies. The statistical analysis consisted in the correlation of the results obtained with each of the two MRI techniques and the results of the biopsies in the corresponding prostate lobe. RESULTS: 32 patients were included in the analysis. Biopsies revealed cancer for 15 patients. The statistical analysis showed a lack of significant correlation between T2W-SE imaging and biopsy results. A correlation with statistical significance was found between dynamic gadolinium enhanced imaging and biopsies (p=0,0018) and between spectroscopic imaging results and biopsies in the corresponding lobe (p=0,0001). CONCLUSION: Endorectal MRI with a standard clinical equipment using dynamic gadolinium enhanced imaging and spectroscopic imaging may be used in clinical routine to improve detection and localization in prostate cancer compared to T2 weighted spin echo imaging.

Trans-rectal ultrasonography (TRUS) with lipiodol injection for localization of the prostatic apex before radiotherapy planning.

PURPOSE: To evaluate reliability of Trans-rectal ultra-sonography (TRUS) guidance with lipiodol injection for prostate localization before radiotherapy planning. MATERIAL AND METHODS: From October 1997 to March 2000, 31 patients with prostatic adenocarcinoma and six patients with anastomotic recurrence after radical prostatectomy had TRUS-guided injection of lipiodol. Two milliliters of lipiodol were injected into each side of the prostate and 1 ml into both seminal vesicles with a 22 Gauge CHIBA needle and US probe guide before radiotherapy planning. We had established a contrast quality index (0 for no prostate enhancement to 5 for efficient pacification without any diffusion). On simulation films, we had performed anatomic measurements for comparison with other anatomic studies. RESULTS: For all 37 patients, TRUS-guided injection was well tolerated. Among 31 patients with the prostate in situ, three had no apex opacification and 15 had no vesicle enhancement or peri-vesicle space diffusion. However, in 19 patients there was good contrast quality with an index score of > or =3. The majority of patients had prostatic apex between 1.5 and 3.5 cm from ischial tuberosities ligne (27 from 28 evaluable for apex). Among 19 evaluable patients, 15 had seminal vesicles 2-4 cm above the top of pubis. For six patients with anastomotic recurrence after radical prostatectomy, lipiodol was precious aid to locate it. We had only one failure because of a precocious bladder absorption relating to a delay which is too long between rectal probe locating and portal films. CONCLUSION: TRUS injection of lipiodol is a simple, inexpensive, relatively safe technique for localization of prostatic apex, but not appropriate for seminal vesicles enhancement. This is also an interesting method to locate anastomotic recurrence.

Kock pouch procedures: continuing experience and evolution in 135 cases.

Between April 1985 and January 1989, 135 consecutive patients underwent construction of a Kock pouch (to the skin in 72 patients, a urethral pouch in 45, an ileorectal pouch in 10 and a hemi-Kock pouch augmentation cystoplasty in 8). The operative mortality (30 days) rate was 4.4%. There were 16 early complications (12.4%) leading to 14 reoperations (11%), with a followup of 6 to 60 months. After Kock pouch to the skin, the late complication rate was 26.1% in the Kock-Skinner technique group and 7.4% in the simplified technique group, and 94.2% of the patients were continent. After a urethral Kock pouch daytime continence was achieved in 93% of the patients within 2 months and nighttime dryness was noted in 65% within 3 months. After an ileorectal Kock pouch all patients were continent day and night, as were those after hemi-Kock pouch augmentation, although 5 of the latter patients required intermittent catheterization.

[Impotence in a urologic service]. / L'impuissance en service d'urologie.

In a recent experience we have studied 297 patients for impotence. 102 were considered psychogenic and 195 organic; 105 of the latter had isolated or associated arterial or venous lesions. The remaining 81 patients had preponderant organic pathology: Peyronie's disease, neurological disease, diabetes and pelvic trauma. All patients were explored by NPT (nocturnal penile tumescence), Doppler examination, intra-cavernous papaverine test, angiography and erectile flow associated with cavernography. We report our microvascular surgery results from the last seven years. 80 reconstructive vascular procedures were performed on a population of patients who averaged 50 years of age. 50 epigastric-cavernous by-passes were performed. Complete recovery has been observed in 14% with an average of 42 months follow-up. Erection improvement with possibility of vaginal intromission in 58%. Immediate or secondary thrombosis and priapism in 28%. 21 arterial epigastric-dorsal unilateral by-passes were performed with an average follow-up of 20 months. In 11 cases the arterial micro-revascularization was associated with deep dorsal vein ligature. Results are as follows: 10 excellent, 4 significant improvement, 3 failures and too short follow-up in three. 9 isolated venous ligature with a mean follow-up of 15 months. Complete recovery was observed in 3 patients, improvement in 3 and failure in 2. The author emphasizes the interest of a better selection of surgical indications, improvement of microsurgical techniques with epigastric-dorsal anastomosis associated with postoperative anticoagulant therapy whenever possible.