Photovaporisation prostatique au laser chez les patients à haut risque hémorragique

Introduction: Les patients sous traitement anticoagulant sont à risque  élevé de saignement lors de la résection transurétrale de la prostate ou del'adénomectomie par taille vésicale et ils se voient souvent récuser pour la chirurgie de l'hyperplasie bénigne de la prostate symptomatique. En Utilisant la photovaporisation de la prostate, les patients à haut risque peuvent subir en toute sécurité la chirurgie. Nous avons évalué l'innocuité et l'efficacité de la photovaporisation de la prostate (PVP) chez les patients sous anticoagulants en cours avec les dérivés de la coumarine, l'aspirineou le clopidogrel, se plaignant de symptômes d'hypertrophie bénigne de la prostate.Méthodes: Entre janvier 2009 et mai 2010, 47 hommes sous  anticoagulation systémique ont subi une photovaporisation de la prostate. Les données ont été recueillies sur les caractéristiques démographiques,les comorbidités, les complications, la natrémie, l'hémoglobine, le débit urinaire maximal, le résidu post-mictionnel, l'IPSS et les complications.Résultats: L'âge moyen était de 78 ans, le volume prostatique moyen était de 44g et le PSA était de 3.4ng/ml. Parmi les 10 patients (21.2%)étaient sous AVK, 27 (57.4%) étaient sous aspirine, 2 (4.2%) étaient sous clopidogrel, un sous fondaparinux et 6 (12.7%) étaient sous 2  anticoagulants ou plus. Le score ASA moyen était de 3. La durée moyenne de fonctionnement de l'appareil était de 38 minutes, l'énergie moyenneutilisée était de 200kJ. La durée moyenne d'hospitalisation était de 2 jours. Les complications survenant dans les 30 jours comprenaient uneinfection urinaire chez 5 patients (10.6%), une dysurie chez 4 patients et une hémorragie retardée chez 4 autres (8.5%). Un seul de ces patients anécessité une transfusion sanguine et aucun patient n'a nécessité une réintervention. En 3 mois de suivi un seul patient a nécessité une incision du col vésical pour sclérose du col. Aucune incontinence ou sténose urétrale n'a été rapportée. Des améliorations significatives ont été notées dans l'IPSS, le débit urinaire maximal et le résidu post-mictionnel. Conclusion: La PVP est caractérisé par d'excellentes propriétés  hémostatiques et taux très faible de complications peropératoires même chez les patients sous 2 ou plusieurs agents anticoagulants. Sur la base de nos résultats péri-opératoires, nous recommandons la PVP comme traitement chirurgical de première intention chez les patients à haut risque de hémorragique souffrant de symptômes d'hypertrophie bénigne de la prostate

Frequency and Interrelations of Risk Factors for Chronic Low Back Pain in a Primary Care Setting

INTRODUCTION: Many risk factors have been identified for chronic low back pain (cLBP), but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs) for cLBP. METHODS: A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA) was performed to study their interrelations. RESULTS: A total of 2068 GPs (68.9%) included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1%) and initial limitation of activities of daily living (66.4%). For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0%) and frequent heavy lifting at work (65.5%). On MCA, we identified 3 risk-factor dimensions (axes) for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension. DISCUSSION: Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a "work-related" dimension are the most important cLBP risk factors in the working population

The CCR4-NOT Complex Physically and Functionally Interacts with TRAMP and the Nuclear Exosome

BACKGROUND: Ccr4-Not is a highly conserved multi-protein complex consisting in yeast of 9 subunits, including Not5 and the major yeast deadenylase Ccr4. It has been connected functionally in the nucleus to transcription by RNA polymerase II and in the cytoplasm to mRNA degradation. However, there has been no evidence so far that this complex is important for RNA degradation in the nucleus. METHODOLOGY/PRINCIPAL FINDINGS: In this work we point to a new role for the Ccr4-Not complex in nuclear RNA metabolism. We determine the importance of the Ccr4-Not complex for the levels of non-coding nuclear RNAs, such as mis-processed and polyadenylated snoRNAs, whose turnover depends upon the nuclear exosome and TRAMP. Consistently, mutation of both the Ccr4-Not complex and the nuclear exosome results in synthetic slow growth phenotypes. We demonstrate physical interactions between the Ccr4-Not complex and the exosome. First, Not5 co-purifies with the exosome. Second, several exosome subunits co-purify with the Ccr4-Not complex. Third, the Ccr4-Not complex is important for the integrity of large exosome-containing complexes. Finally, we reveal a connection between the Ccr4-Not complex and TRAMP through the association of the Mtr4 helicase with the Ccr4-Not complex and the importance of specific subunits of Ccr4-Not for the association of Mtr4 with the nuclear exosome subunit Rrp6. CONCLUSIONS/SIGNIFICANCE: We propose a model in which the Ccr4-Not complex may provide a platform contributing to dynamic interactions between the nuclear exosome and its co-factor TRAMP. Our findings connect for the first time the different players involved in nuclear and cytoplasmic RNA degradation

Nucleolus: the fascinating nuclear body

Nucleoli are the prominent contrasted structures of the cell nucleus. In the nucleolus, ribosomal RNAs are synthesized, processed and assembled with ribosomal proteins. RNA polymerase I synthesizes the ribosomal RNAs and this activity is cell cycle regulated. The nucleolus reveals the functional organization of the nucleus in which the compartmentation of the different steps of ribosome biogenesis is observed whereas the nucleolar machineries are in permanent exchange with the nucleoplasm and other nuclear bodies. After mitosis, nucleolar assembly is a time and space regulated process controlled by the cell cycle. In addition, by generating a large volume in the nucleus with apparently no RNA polymerase II activity, the nucleolus creates a domain of retention/sequestration of molecules normally active outside the nucleolus. Viruses interact with the nucleolus and recruit nucleolar proteins to facilitate virus replication. The nucleolus is also a sensor of stress due to the redistribution of the ribosomal proteins in the nucleoplasm by nucleolus disruption. The nucleolus plays several crucial functions in the nucleus: in addition to its function as ribosome factory of the cells it is a multifunctional nuclear domain, and nucleolar activity is linked with several pathologies. Perspectives on the evolution of this research area are proposed