Carmen ad Urbem Romam in adventu Serenissimi Vladislai Poloniae Principis (1625), tłum. i oprac. Grzegorz Fraczak

Carmen ad Urbem Romam in adventu Serenissimi Vladislai Poloniae Principis (1625). Tłumaczenie i opracowanie Grzegorz Fracza

ACTION DE LA RIBAVIRINE SUR LA VARIABILITE GENETIQUE DE LA REGION HYPERVARIABLE 1 (HVR1) DU VIRUS DE L'HEPATITE C (VHC) ET SUR LA REPONSE IMMUNITAIRE ANTIVHC CHEZ DES PATIENTS ATTEINTS D'HEPATITE C CHRONIQUE (DES BIOL. MED.)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Carmen ad Urbem Romam in adventu Serenissimi Vladislai Poloniae Principis (1625), tłum. i oprac. Grzegorz Fraczak

Carmen ad Urbem Romam in adventu Serenissimi Vladislai Poloniae Principis (1625). Tłumaczenie i opracowanie Grzegorz Fracza

Novartis : Case study : Financial business analysis

FinanceNovartis is the world's leading company in the pharmaceutical industry whose mission is to “discover new ways to improve and extend people’s lives”. In fact, it concentrates its efforts into developing and commercializing new products in sectors where customers’ needs are highly unmet. In order to do so, Novartis maintains a very advanced R-D activity. It indeed supervises nowadays over 200 projects in clinical development worldwide and dedicates USD 9.0 billion to its R-D expenses. Between 2012 and 2016, Novartis averaged a yearly number of US approvals for new molecules increasing 46% in comparison to 2007-2011. Novartis deploys its activities towards three different business units: prescription and generic pharmaceutical products, biosimilars, surgical and eye-care products that are split into 29 different brands. It occupies a leading position with a 5.5% world market share among which 58.4% of the revenues are made from the world’s most powerful economies, which helps comfort the firm's leadership. Moreover, Novartis manages to constantly make both strategic and pragmatic acquisitions to diversify and enlarge its pipeline. The company managed to maintain a tremendous level of revenues (CHF 47.8 billion) despite its vaccine drugs section being dismantled in 2015, on one hand, which led to considerable divestment gains along with temporal slump of the operating margin (-5.64%) and net margin (-40.80%) within the period of 2014-2016. On the other hand, Novartis made huge investments into the development of new innovative drugs through loans, which considerably broadened its level of indebtedness (Debt/Equity Ratio going to 64% in 2016 from 57% in 2014) and consequently affected its Asset turnover ratio (-20.70%) as sales remained quite stable whereas the capital employed increased in 2016. Nonetheless, the company still presents a positive leverage as its after-tax ROCE remained above the WACC within the period even though it nearly dropped by 60% because of a decreasing operating profit (-30%). On the meantime, investors remained optimistic regarding the company’s ability to generate growing revenues in the future as the P/E ratio is still very high at 26.65 in 2016, given that it was at 23.97 in 2014. As a matter of fact, growing share of distributed dividends (going from 68% in 2014 to 96% in 2016) must be very attractive, but the company must be watchful of a potentially weakened liquidity and shortened cash availability. Finally, we conducted a literature review based on the the work of Joseph A. DiMasi, Henry F. Grabowski and Ronald W. Hansen in their new article published in 2016, quantifying an estimate of overall R-D costs in the pharmaceutical industry at USD 2,870 million and the cost of the development of a new drug at USD 802 million in average. The question arising from this is: what are the factors of the evolution in R-D costs in the pharmaceutical industry? The discussion we conducted upon this theme allowed us to assess the intensity of innovation the pharmaceutical sector demands from its stakeholders in order to be competitive. Throughout all the period of our financial analysis, Novartis has proved to be one of the most consistent firms, if not the most, in terms of investments and innovative drug launches

Trapeziometacarpal osteoarthritis: pyrocarbon interposition implants

Purpose: the aim of this study was to evaluate the effectiveness of interposition arthroplasty of the trapeziometacarpal (TMC) joint with pyrolitic carbon implants for the treatment of TMC osteoarthritis. Methods: we evaluated two groups of patients surgically treated for TMC osteoarthritis: group 1 (34 patients - 36 TMC joints) treated with PyroDisk implantation and group 2 (25 patients - 25 TMC joints) treated with the Pyrocardan implant. All these patients were clinically evaluated at follow-up using the DASH score, Mayo Wrist score and VAS pain score. Results: the mean follow-up was 42 months in group 1 and 12 months in group 2. Both groups showed good clinical outcomes in terms of pain relief, range of motion, and pinch and grasp strength. Revision surgery was needed in only one case in group 1 (2.8%) and in three cases (12%) in group 2. Conclusions: prosthetic replacement of the TMC joint was found to be a good solution for low-demand patients. However, the PyroDisk could be a good solution in selected patients (Eaton stage I-III, non-subluxated joint): it provides good pain relief, good range of motion, good pinch and grasp strength, and stable results at more than three-years of follow-up. Level of evidence: Level IV, therapeutic case series

Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease

OBJECTIVE In this study the authors compared the anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) techniques in a homogeneous group of patients affected by single-level L5-S1 degenerative disc disease (DDD) and postdiscectomy syndrome (PDS). The purpose of the study was to analyze perioperative, functional, and radiological data between the two techniques. METHODS A retrospective analysis of patient data was performed between 2015 and 2018. Patients were clustered into two homogeneous groups (group 1 = ALIF, group 2 = TLIF) according to surgical procedure. A statistical analysis of clinical perioperative and radiological findings was performed to compare the two groups. A senior musculoskeletal radiologist retrospectively revised all radiological images. RESULTS Seventy-two patients were comparable in terms of demographic features and surgical diagnosis and included in the study, involving 32 (44.4%) male and 40 (55.6%) female patients with an average age of 47.7 years. The mean follow-up duration was 49.7 months. Thirty-six patients (50%) were clustered in group 1, including 31 (86%) with DDD and 5 (14%) with PDS. Thirty-six patients (50%) were clustered in group 2, including 28 (78%) with DDD and 8 (22%) with PDS. A significant reduction in surgical time (107.4 vs 181.1 minutes) and blood loss (188.9 vs 387.1 ml) in group 1 (p < 0.0001) was observed. No significant differences in complications and reoperation rates between the two groups (p = 0.561) was observed. A significant improvement in functional outcome was observed in both groups (p < 0.001), but no significant difference between the two groups was found at the last follow-up. In group 1, a faster median time of return to work (2.4 vs 3.2 months) was recorded. A significant improvement in L5-S1 postoperative lordosis restoration was registered in the ALIF group (9.0 vs 5.0, p = 0.023). CONCLUSIONS According to these results, interbody fusion is effective in the surgical management of discogenic pain. Even if clinical benefits were achieved earlier in the ALIF group (better scores and faster return to work), both procedures improved functional outcomes at last follow-up. The ALIF group showed significant reduction of blood loss, shorter surgical time, and better segmental lordosis restoration when compared to the TLIF group. No significant differences in postoperative complications were observed between the groups. Based on these results, the ALIF technique enhances radiological outcome improvement in spinopelvic parameters when compared to TLIF in the management of adult patients with L5-S1 DDD

Body shape rather than facial emotion of others alters interpersonal distance in patients with anorexia nervosa

International audienceAbstract Objective The study investigated interpersonal distance in patients with anorexia nervosa (AN), focussing on the role of other's facial expression and morphology, also assessing physiological and subjective responses. Method Twenty‐nine patients with AN and 30 controls (CTL) were exposed to virtual characters either with an angry, neutral, or happy facial expression or with an overweight, normal‐weight, or underweight morphology presented either in the near or far space while we recorded electrodermal activity. Participants had to judge their preferred interpersonal distance with the characters and rated them in terms of valence and arousal. Results Unlike CTL, patients with AN exhibited heightened electrodermal activity for morphological stimuli only, when presented in the near space. They also preferred larger and smaller interpersonal distances with overweight and underweight characters respectively, although rating both negatively. Finally, and similar to CTL, they preferred larger interpersonal distance with angry than neutral or happy characters. Discussion Although patients with AN exhibited behavioural response to emotional stimuli similar to CTL, they lacked corresponding physiological response, indicating emotional blunting towards emotional social stimuli. Moreover, they showed distinct behavioural and physiological adjustments in response to body shape, confirming the specific emotional significance attached to body shape

Video-assisted anterior retroperitoneal approach to the lumbar spine. A minimally invasive technique improved by the use of an endoscopic camera to treat lumbar spinal diseases. Consideration over 269 patients.

We describe the technique we routinely use to perform the retroperitoneal anterior approach using a rigid endoscope coupled to a HDD screen to assist mini-open retroperitoneal anterior approach. Our experience was compared to those reported in the literature for the standard mini-open retroperitoneal approach. We retrospectively analyzed a total of 269 consecutive patients, 109 males and 160 females, underwent anterior lumbar approach in our department, using video-assisted anterior retroperitoneal approach to the lumbar spine. 202 patients had a single L5-S1 or L4-5 ALIF (75.09%), 14 patients received a double level ALIF (5.3%), while 53 patients underwent a double anterior and posterior approach (19.8%). The average preoperative VAS and Oswestry Disability Index (ODI) scores were 9.1±6.3 and 79.3±11.9. At least 16 months follow-up (from 16 months to 5 years), the average VAS and ODI values had improved to 1.6±1.5 and 13.1±13.2, respectively (p <0.05). The mean length of stay was 4.3±3.5 days. There were 6 major complications (2.2%) related to the approach: major vascular injuries (iliac vein injury) occurred in a total of 3 patients (1.1% of cases), whereas retrograde ejaculation occurred in 3 patients (2,75% of male cases in the series). No wound or deep infections occurred. In our opinion, this technique, compared with other mini-open approach, potentially reduces perioperative morbidity, length of surgery, surgical approach-related complications, and hospitalization

Use of lordotic cages in L5-S1 Anterior Lumbar Interbody Fusion (ALIF) procedures.

Anterior Lumbar Interbody Fusion (ALIF) has gained popularity in the last few years, thanks to its numerous advantages. Recently the use of lordotic cages has been described, allowing theoretically a better lordosis restoration of the lumbar disc space. We described the results obtained with the use of lordotic cages in 27 patients who underwent ALIF procedure for L5-S1 disc degenerative disease, in terms of segmental lordosis and global lumbar lordosis changes

A new “keyhole” approach for multilevel anterior lumbar interbody fusion: the perinavel approach—technical note and literature review

Purpose: The purpose of this study is to evaluate the feasibility and the safety of a new skin incision for minimally invasive anterior lumbar interbody fusion (ALIF): the perinavel incision. Methods: Demographic and clinical data from patients who underwent ALIF with the perinavel incision were collected. Indications to surgery, preoperative symptoms, radiological data, number of treated levels, intraoperative and early postoperative complications and wound-related problems were analysed. Result: Ninety-seven patients underwent ALIF with this new skin incision. One hundred fifty-seven levels were treated (mean 1.7 level per patient) being L4–L5 the most frequently treated. Intraoperative complications were represented only by the venous injury with a rate of 3.09% (3 cases). Postoperative complications were all linked to skin incision issues: a case of wound dehiscence and a case of superficial infection. No case of skin necrosis occurs at 3-month follow-up. Conclusions: In this paper, the perinavel skin incision was demonstrated to be as safe as traditional approaches for ALIF. Furthermore, with this incision it is possible to perform multilevel (L3–S1) ALIF, which means a good option in minimally invasive surgery as well as revision surgery. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]