Efficacy of interspinous device versus surgical decompression in the treatment of lumbar spinal stenosis: a modified network analysis.

Study designSystematic review using a modified network analysis.ObjectivesTo compare the effectiveness and morbidity of interspinous-device placement versus surgical decompression for the treatment of lumbar spinal stenosis.SummaryTraditionally, the most effective treatment for degenerative lumbar spinal stenosis is through surgical decompression. Recently, interspinous devices have been used in lieu of standard laminectomy.MethodsA review of the English-language literature was undertaken for articles published between 1970 and March 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing surgical decompression with interspinous-device placement for the treatment of lumbar spinal stenosis. First, studies making the direct comparison (cohort or randomized trials) were searched. Second, randomized controlled trials (RCTs) comparing each treatment to conservative management were searched to allow for an indirect comparison through a modified network analysis approach. Comparison studies involving simultaneous decompression with placement of an interspinous device were not included. Studies that did not have a comparison group were not included since a treatment effect could not be calculated. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. The strengths of evidence for indirect comparisons were downgraded. Disagreements were resolved by consensus.ResultsWe identified five studies meeting our inclusion criteria. No RCTs or cohort studies were identified that made the direct comparison of interspinous-device placement with surgical decompression. For the indirect comparison, three RCTs compared surgical decompression to conservative management and two RCTs compared interspinous-device placement to conservative management. There was low evidence supporting greater treatment effects for interspinous-device placement compared to decompression for disability and pain outcomes at 12 months. There was low evidence demonstrating little to no difference in treatment effects between the groups for walking distance and complication rates.ConclusionThe indirect treatment effect for disability and pain favors the interspinous device compared to decompression. The low evidence suggests that any further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. No significant treatment effect differences were observed for postoperative walking distance improvement or complication rates; however, findings should be considered with caution because of indirect comparisons and short follow-up periods

Cellular Calcium Regulation in Hypertension

In vascular muscle cells, two distinct types of functionally important calcium (Ca2++) channels, called transient (T) and sustained (L), are differentiated by dihydropyridine calcium antagonists (CaA). We studied the ratio of T/L Ca2++ channels in isolated, spontaneously contracting azygous venous cells of spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) by quantitating Ca2++ currents and intracellular Ca2++ release. While total transmembranous Ca2++ current was not different between the two strains, the proportion of Ca2++ currents carried by L-type channels was enhanced in vascular muscle cells from SHR. We have recently compared subcellular distribution of intracellular free Ca2++ concentration in the same cells, at rest and during stimulation, by quantitation with a digital photon-counting camera. Fura-2 fluorescence intensity showed that Ca2++ release was principally from sarcoplasmic reticulum and that cells from SHR had higher levels of Ca2++ upon calcium channel stimulation, especially at the cell periphery. These findings suggest fundamental differences in SHR and WKY vascular muscle cells implicating the importance of changes in calcium channels, modulation of Ca2++ release, and Ca2++ uptake in SHR hypertension. Am J Hypertens 1989;2:655-65

Soil physical and hydrological evaluation of aluminum recycling by-product as an infiltration barrier for potash mine tailings = Bodenphysikalisch-hydrologische Bewertung von Rückständen der Aluminium-Kreislaufführung als Infiltrationsbarriere für eine Halde des Kalibergbaus

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Large Eddy Simulation of a Generic Impinging Jet Configuration

The aim of this work is to generate comprehensive numerical data for multiple impinging jets in cross-flow. Therefore, several Reynolds-averaged Navier-Stokes (RANS) simulations and large eddy simulations (LES) are carried out for an in-row arrangement of nine impinging jets with a jet Reynolds number of ≈10,000. This data should contribute to a better understanding of the heat transport processes being involved. The RANS and LES studies are conducted using the computational fluid dynamics (CFD) solver TRACE (Turbomachinery Research Aerodynamic Computational Environment), which is being developed by the German Aerospace Center (DLR). In the RANS study, grid convergence is verified using the grid convergence index (GCI) method. A sensitivity study indicates that changes in the heat flux have only a minor influence on the overall heat transfer characteristics. However, the effects of changes in mass flow are significant. For the LES, sufficient grid resolution is verified by comparing the filter length scales to the Kolmogorov scales. In terms of statistical convergence, the velocity and turbulent kinetic energy show large sampling errors caused by the limited number of through flows. Concerning global heat transfer, the RANS simulations and LES show only small deviations in Nusselt number well matching with empirical correlations reported in the literature. However, the predicted local Nusselt numbers and velocity fields significantly deviate between RANS simulations and LES. In future studies at DLR, the obtained numerical data will be used for the validation of current numerical design methods and turbulence models for impingement cooling

Effect of hydralazine on tension and membrane potential in the rat caudal artery

ABSTRAC

Identification and categorisation of safety issues for ESNII reactor concepts. Part I: Common phenomena related to materials

International audience; With the aim to develop a joint proposal for a harmonised European methodology for safety assessment of advanced reactors with fast neutron spectrum, SARGEN-IV (Safety Assessment for Reactors of Gen IV) Euratom coordination action project gathered together twenty-two partners' safety experts from twelve EU Member States. The group consisted of eight European Technical Safety Organisations involved in the European Technical Safety Organisation Network (ETSON), European Commission's Joint Research Centre (JRC), system designers, industrial vendors as well as research and development (RandD) organisations. To support the methodology development, key safety features of four fast neutron spectrum reactor concepts considered in Deployment Strategy of the Sustainable Nuclear Energy Technology Platform (SNETP) were reviewed. In particular, outcomes from running European Sustainable Nuclear Industrial Initiative (ESNII) system projects and related Euratom collaborative projects for Sodium-cooled Fast Reactors, Lead-cooled Fast Reactors, Gas-cooled Fast Reactors, and the lead-bismuth eutectic cooled Fast Spectrum Transmutation Experimental Facility were gathered and critically assessed. To allow a consistent build-up of safety architecture for the ESNII reactor concepts, the safety issues were further categorised to identify common phenomena related to materials. Outcomes of the present work also provided guidance for the identification and prioritisation of further RandD needs respective to the identified safety issues. © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-NDlicense

Review of current Severe Accident Management (SAM) approaches for Nuclear Power Plants in Europe

The Fukushima accidents highlighted that both the in-depth understanding of such sequences and the development or improvement of adequate Severe Accident Management (SAM) measures are essential in order to further increase the safety of the nuclear power plants operated in Europe. To support this effort, the CESAM (Code for European Severe Accident Management) R&D project, coordinated by GRS, started in April 2013 for 4 years in the 7th EC Framework Programme of research and development of the European Commission. It gathers 18 partners from 12 countries: IRSN, AREVA NP SAS and EDF (France), GRS, KIT, USTUTT and RUB (Germany), CIEMAT (Spain), ENEA (Italy), VUJE and IVS (Slovakia), LEI (Lithuania), NUBIKI (Hungary), INRNE (Bulgaria), JSI (Slovenia), VTT (Finland), PSI (Switzerland), BARC (India) plus the European Commission Joint Research Center (JRC). The CESAM project focuses on the improvement of the ASTEC (Accident Source Term Evaluation Code) computer code. ASTEC,, jointly developed by IRSN and GRS, is considered as the European reference code since it capitalizes knowledge from the European R&D on the domain. The project aims at its enhancement and extension for use in severe accident management (SAM) analysis of the nuclear power plants (NPP) of Generation II-III presently under operation or foreseen in near future in Europe, spent fuel pools included. In the frame of the CESAM project one of the tasks consisted in the preparation of a report providing an overview of the Severe Accident Management (SAM) approaches in European Nuclear Power Plants to serve as a basis for further ASTEC improvements. This report draws on the experience in several countries from introducing SAMGs and on substantial information that has become available within the EU “stress test”. To disseminate this information to a broader audience, the initial CESAM report has been revised to include only public available information. This work has been done with the agreement and in collaboration with all the CESAM project partners. The result of this work is presented here.JRC.F.5-Nuclear Reactor Safety Assessmen