Le canal lombaire étroit chez la personne âgée de plus de 75 ans. Facteurs déterminants du résultat fonctionnel

Introduction: lumbar spinal stenosis is a common pathology. When symptomatic, an intermittent radicular claudication appears. The stenosis seen most commonly develops focally, at the intervertebral junction, as a result of a complex process of ligamentum flavum hypertrophy, facet arthropathy, disc herniation, and sometimes spondylolisthesis. Degenerative lumbar spinal stenosis is the most frequent indication for functional spine neurosurgery in the elderly. Aging population in developed countries lives with significant comorbidities wich complicates patient management. The screening of patient's eligibility for surgery implies the knowledge of all issues including the prognosis factors related to functional improvement. Objectives: This retrospective study aims to discuss the effectiveness of surgery, in terms of pain/satisfaction, for 73 patients aged 75 years and above suffering from a lumbar canal stenosis, treated between 2006 and 2014. Patients and methods: We reviewed all files information: demographic, pre- and postoperative clinical, non-clinical therapeutic and surgical data. Results: seventy-three patients met the study criteria. The median level of satisfaction was 85%. No deterioration after surgery or deaths occured. Statistical analysis using multiple linear regression indicates that analgesic intake before (pConclusion: functional outcome of surgery for lumbar spinal stenosis is very good, despite advanced age. Elderly should not be a contraindication for decompressive lumbar spine surgery, however, since this high-risk population is more likely to suffer operative complications, special precautions are required. Factors associated with post-operative satisfaction are painkilling medication use and persistence of the radicular pain. A prospective study using patient-satisfaction standardised questionnaire would allow us to consolidate and potentially complete our results.Introduction : le canal lombaire étroit est une pathologie fréquente. Lorsqu'il est symptomatique, il se manifeste par une claudication radiculaire intermittente. La sténose acquise se développe préférentiellement au niveau de la jonction entre deux vertèbres par des phénomènes dégénératifs complexes associant une hypertrophie du ligament jaune, une altération des facettes articulaires, des protrusions discales et parfois un spondylolisthésis. C'est la première indication en neurochirurgie fonctionnelle rachidienne chez les personnes âgées. La population vieillissante des pays industrialisés, est accablée par de nombreuses comorbidités qui compliquent sa prise en charge. La sélection des patients éligibles à une chirurgie nécessite de connaître les enjeux d'un tel traitement et notamment les facteurs pronostiques liés à l'amélioration fonctionnelle. Objectifs: cette étude rétrospective a pour but de rechercher des déterminants du résultat fonctionnel dans la chirurgie du canal lombaire étroit chez des patients âgés de plus de 75 ans, en terme de satisfaction postopératoire. Patients et méthodes: il s'agit d'une étude rétrospective, monocentrique sur dossiers médicaux. Les patients inclus ont été opérés entre octobre 2006 et décembre 2014 d'une laminectomie lombaire et avaient au moins 75 ans lors de l'intervention. Des données démographiques, cliniques, para-cliniques, thérapeutiques, chirurgicales et de suivi ont été recueillies. Résultats : soixante-treize patients ont pu être sélectionnés avec une médiane de satisfaction de 85%. Aucun patient de notre étude n'a présenté d'aggravation secondaire à la chirurgie et aucun n’est décédé. L'analyse par modèle de régression linéaire montre que la prise d'antalgiques en pré- (pConclusion : les résultats fonctionnels de la chirurgie du canal lombaire étroit restent très bons malgré un âge avancé. L'âge ne doit pas être un frein à la chirurgie, mais des précautions particulières à la population vieillissante s'imposent. Les facteurs liés à la satisfaction postopératoire sont la consommation d'antalgiques et la persistance d'une radiculalgie. Une étude prospective utilisant des questionnaires de satisfaction standardisés nous permettrait de conforter et éventuellement de compléter nos résultats

Towards the understanding of the cocoa transcriptome: Production and analysis of an exhaustive dataset of ESTs of Theobroma cacao L. generated from various tissues and under various conditions

Theobroma cacao L., is a tree originated from the tropical rainforest of South America. It is one of the major cash crops for many tropical countries. T. cacao is mainly produced on smallholdings, providing resources for 14 million farmers. Disease resistance and T. cacao quality improvement are two important challenges for all actors of cocoa and chocolate production. T. cacao is seriously affected by pests and fungal diseases, responsible for more than 40% yield losses and quality improvement, nutritional and organoleptic, is also important for consumers. An international collaboration was formed to develop an EST genomic resource database for cacao. Fifty-six cDNA libraries were constructed from different organs, different genotypes and different environmental conditions. A total of 149,650 valid EST sequences were generated corresponding to 48,594 unigenes, 12,692 contigs and 35,902 singletons. A total of 29,849 unigenes shared significant homology with public sequences from other species. Gene Ontology (GO) annotation was applied to distribute the ESTs among the main GO categories. A specific information system (ESTtik) was constructed to process, store and manage this EST collection allowing the user to query a database. To check the representativeness of our EST collection, we looked for the genes known to be involved in two different metabolic pathways extensively studied in other plant species and important for T. cacao qualities: the flavonoid and the terpene pathways. Most of the enzymes described in other crops for these two metabolic pathways were found in our EST collection. A large collection of new genetic markers was provided by this ESTs collection. This EST collection displays a good representation of the T. cacao transcriptome, suitable for analysis of biochemical pathways based on oligonucleotide microarrays derived from these ESTs. It will provide numerous genetic markers that will allow the construction of a high density gene map of T. cacao. This EST collection represents a unique and important molecular resource for T. cacao study and improvement, facilitating the discovery of candidate genes for important T. cacao trait variation. (Résumé d'auteur

Discovery and mapping of a new expressed sequence tag-single nucleotide polymorphism and simple sequence repeat panel for large-scale genetic studies and breeding of Theobroma cacao L.

Theobroma cacao is an economically important tree of several tropical countries. Its genetic improvement is essential to provide protection against major diseases and improve chocolate quality. We discovered and mapped new expressed sequence tag-single nucleotide polymorphism (EST-SNP) and simple sequence repeat (SSR) markers and constructed a high-density genetic map. By screening 149 650 ESTs, 5246 SNPs were detected in silico, of which 1536 corresponded to genes with a putative function, while 851 had a clear polymorphic pattern across a collection of genetic resources. In addition, 409 new SSR markers were detected on the Criollo genome. Lastly, 681 new EST-SNPs and 163 new SSRs were added to the pre-existing 418 co-dominant markers to construct a large consensus genetic map. This high-density map and the set of new genetic markers identified in this study are a milestone in cocoa genomics and for marker-assisted breeding. The data are available at http://tropgenedb.cirad.fr

Deciphering the genome structure and paleohistory of _Theobroma cacao_

We sequenced and assembled the genome of _Theobroma cacao_, an economically important tropical fruit tree crop that is the source of chocolate. The assembly corresponds to 76% of the estimated genome size and contains almost all previously described genes, with 82% of them anchored on the 10 _T. cacao_ chromosomes. Analysis of this sequence information highlighted specific expansion of some gene families during evolution, for example flavonoid-related genes. It also provides a major source of candidate genes for _T. cacao_ disease resistance and quality improvement. Based on the inferred paleohistory of the T. cacao genome, we propose an evolutionary scenario whereby the ten _T. cacao_ chromosomes were shaped from an ancestor through eleven chromosome fusions. The _T. cacao_ genome can be considered as a simple living relic of higher plant evolution

Research response to coronavirus disease 2019 needed better coordination and collaboration: a living mapping of registered trials

Objectives: Researchers worldwide are actively engaging in research activities to search for preventive and therapeutic interventions against coronavirus disease 2019 (COVID-19). Our aim was to describe the planning of randomized controlled trials (RCTs) in terms of timing related to the course of the COVID-19 epidemic and research question evaluated. Study Design and Setting: We performed a living mapping of RCTs registered in the WHO International Clinical Trials Registry Platform. We systematically search the platform every week for all RCTs evaluating preventive interventions and treatments for COVID-19 and created a publicly available interactive mapping tool at https://covid-nma.com to visualize all trials registered. Results: By August 12, 2020, 1,568 trials for COVID-19 were registered worldwide. Overall, the median ([Q1–Q3]; range) delay between the first case recorded in each country and the first RCT registered was 47 days ([33–67]; 15–163). For the 9 countries with the highest number of trials registered, most trials were registered after the peak of the epidemic (from 100% trials in Italy to 38% in the United States). Most trials evaluated treatments (1,333 trials; 85%); only 223 (14%) evaluated preventive strategies and 12 postacute period intervention. A total of 254 trials were planned to assess different regimens of hydroxychloroquine with an expected sample size of 110,883 patients. Conclusion: This living mapping analysis showed that COVID-19 trials have relatively small sample size with certain redundancy in research questions. Most trials were registered when the first peak of the pandemic has passed