[Advocating a new health order].

Le système de santé français reste à ce jour encore trop médico-centré Une véritable révolution doit s'opérer afin de le faire évoluer, nécessitant de revoir nos schémas de pensée habituels et d'intégrer les évolutions technologiques telles que l'intelligence artificielle D'autres acteurs peuvent y contribuer, comme les infirmiers en pratique avancée, grâce à une formation solide et une volonté politique forte.

The Effect of Upper Body Mass and Initial Knee Flexion on the Injury Outcome of Post Mortem Human Subject Pedestrian Isolated Legs.

In the ECE 127 Regulation on pedestrian leg protection, as well as in the Euro NCAP test protocol, a legform impactor hits the vehicle at the speed of 40 kph. In these tests, the knee is fully extended and the leg is not coupled to the upper body. However, the typical configuration of a pedestrian impact differs since the knee is flexed during most of the gait cycle and the hip joint applies an unknown force to the femur.

Focal cryoablation: a treatment option for unilateral low-risk prostate cancer.

Objectives: To assess oncological (biochemical and histological recurrence) and functional (urinary and potency) outcomes in patients with unilateral low-risk organ-confined prostate cancer (PCa) treated with focal cryoablation (FC).

Patients And Methods: From January 2009 to March 2012, patients with localized PCa who refused active surveillance were assigned to a FC protocol. This was a prospective, single-arm cohort study.

Kinematics and dynamics of the pelvis in the process of submarining using PMHS sled tests.

This study focused on a better understanding and characterization of the submarining phenomenon that occurs in frontal crashes when the lap belt slides over the anterior superi or iliac spine. Submarining is the consequence of the pelvis kinematics relative to the lap belt, driven by the equilibrium of forces and moments applied to the pelvis. The study had two primary purposes; the first was to provide new PMHS data in submarining test configurations, the second was to investigate the Hybrid II and Hybrid III dummies biofidelity regarding submarining.

Focal brachytherapy for selected low-risk prostate cancers: a pilot study.

Purpose: To evaluate the feasibility and the early toxicity of focal brachytherapy in highly selected localized prostate cancer patients.

Methods And Materials: Twenty-one patients underwent a focal brachytherapy between February 2010 and March 2012, representing 3.7% of the cases treated by our group during this period.

Evaluation of erectile function after laparoscopic radical prostatectomy in a single center.

Introduction: To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and received postoperative medical therapy for erectile dysfunction.

Materials And Methods: We performed a prospective study in men who underwent laparoscopic radical prostatectomy between September 2003 and November 2005 at our center and who received penile rehabilitation after surgery. All patients had antegrade interfascial dissection.

Study of rib fracture mechanisms based on the rib strain profiles in side and forward oblique impact.

Rib fractures constitute a good indication of severity as there are the most frequent type of AIS3+ chest injuries. In 2008, Trosseille et al. showed a promising methodology to exhibit the rib fracture mechanisms, using strain gauges glued on the ribs of Post-Mortem Human Subjects (PMHS) and developing a specific signal analysis.

Investigation on occupant ejection in high severity rear impact based on post mortem human subject sled tests.

Occupant protection in rear impact involves two competing challenges. On one hand, allowing a deformation of the seat would act as an energy absorber in low severity impacts and would consequently decrease the risk of neck injuries. However, on the other hand, large deformations of the seat may increase the likelihood of occupant ejection in high severity cases.

Pathologic findings in radical prostatectomy specimens from patients eligible for active surveillance with highly selective criteria: a multicenter study.

Objective: To evaluate the pathologic features of surgical specimens after radical prostatectomy in patients with low-risk prostate cancer fulfilling the strictest pathologic selection criteria for active surveillance.

Methods: Retrospective analysis of 10 785 consecutive radical prostatectomy performed in 10 university hospitals (January 2003 through December 2008). A total of 919 patients fulfilled the following unique and very stringent criteria: T1c, prostate-specific antigen (PSA) <10 ng/mL, a single positive biopsy, tumor length <3 mm, and Gleason score <7.

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up.

Purpose: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU).

Materials And Methods: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan.

Comparison of the rate, location and size of positive surgical margins after laparoscopic and robot-assisted laparoscopic radical prostatectomy.

Objective: • To review and compare the rate, location and size of positive surgical margins (PSMs) after pure laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP).

Patients And Methods: • The study comprised 200 patients who underwent RALP and 200 patients who underwent LRP up to January 2008. • We compared patient age, body mass index, preoperative prostate-specific antigen (PSA), preoperative stage and grade, prostate size, pathological stage and grade and neurovascular bundle preservation, as well as PSM rate, size and location.

One-step customized transurethral resection of the prostate and permanent implant brachytherapy for selected prostate cancer patients: technically feasible but too toxic.

Introduction: Patients with prominent median lobe hyperplasia and/or high International Prostate Symptom Score (IPSS) are often contraindicated for prostate brachytherapy, mainly because of the risk of post-implant urinary retention. We evaluated an approach combining in the same operative step a limited transurethral resection (TURP) of the median lobe, immediately followed by permanent implant-free seed brachytherapy.

Methods And Materials: From January 2007 to November 2008, 22 patients underwent a customized limited TURP of their median lobe immediately before brachytherapy.

Pathologic reassessment of prostate cancer surgical specimens before molecular retrospective studies.

Purpose: The retrospective use of prostate cancer tissue is crucial to design tumor marker prognostic studies. We hypothesize that comparison between recent and more historical cases could introduce biases due to stage and grade migration upon time.

Design: We reviewed 544 margin-free specimens from patients treated for clinically localized prostate cancer by radical prostatectomy between 2000 and 2005.

Duloxetine for mild to moderate postprostatectomy incontinence: preliminary results of a randomised, placebo-controlled trial.

Background: Duloxetine is effective in the management of stress urinary incontinence (SUI) in women but has been poorly evaluated in the treatment of SUI following radical prostatectomy (RP).

Objective: To establish the superiority of duloxetine over placebo in SUI after RP.

Design, Setting, And Participants: We conducted a prospective, randomised, placebo-controlled, double-blind, monocentric superiority trial.

Current status of natural orifice trans-endoscopic surgery (NOTES) and laparoendoscopic single site surgery (LESS) in urologic surgery.

Laparoendoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09.

Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view.

Purpose: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view.

Materials And Methods: We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP) and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy.

Laparoscopic radical prostatectomy is feasible and effective in 'fit' senior men with localized prostate cancer.

OBJECTIVE To assess the effect of age and comorbidity on short-term complications, long-term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer. PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index.

Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris experience.

Background And Purpose: Radical cystectomy is the gold standard for management of invasive and recurrent high-grade superficial bladder cancer. We present our initial experience with robot-assisted laparoscopic cystoprostatectomy (RALCP) with extended pelvic lymphadenectomy (epLAD) and intracorporeal enterourethral anastomosis (IEUA). A video demonstrating our technique is available online at www.

Comprehensive surgical and chemotherapy treatment for invasive bladder cancer.

Introduction: The treatment of transitional cell bladder cancer with muscular invasion remains difficult, due to the numerous patterns of biological behaviour of the disease. There is controversy regarding the application of systemic therapy in invasive bladder carcinoma and the ideal time for the indication of perioperative chemotherapy. This is an overview of systemic therapy in invasive bladder cancer.

The effect of angle on the chest injury outcome in side loading.

Thoracic injury criteria and injury risk curves in side impact are based on impactor or sled tests, with rigid or padded surfaces while airbags are very common on current cars. Besides, the loading is generally pure lateral while real crashes or regulations can generate oblique loadings. Oblique tests were found in the literature, but no conclusion was drawn with regard to the effect of the direction on the injury outcome.

[Intermittent androgen deprivation (IAD) for advanced prostate cancer. Why not the standard of therapy?].

Summary Objectives: To review the literature and present a contemporary image of androgen deprivation for prostate cancer.

Methods: We conducted a PubMed search on intermittent androgen deprivation. Articles obtained on intermittent androgen deprivation (IAD) and the experiences at Institut Montsouris were used for the review.

Health and quality of life in urology: issues in general urology and urological oncology.

Objectives: Frequently, the term "quality of life" has been used to justify personal and professional decisions in all fields of medicine. Nowadays, quality of life studies are based on development and validation of sensitive measures of patient outcomes, incorporating functional status and perceived health status. Thus, quality of life has become an outcome as important as survival and effectiveness.