59 research outputs found

    Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis

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    Item does not contain fulltextINTRODUCTION: Despite an increasing implantation rate of interspinous process distraction (IPD) devices in the treatment of intermittent neurogenic claudication (INC), definitive evidence on the clinical effectiveness of implants is lacking. The main objective of this review was to perform a meta-analysis of all systematic reviews, randomized clinical trials and prospective cohort series to quantify the effectiveness of IPDs and to evaluate the potential side-effects. METHODS: Data from all studies prospectively describing clinical results based on validated outcome scales and reporting complications of treatment of patients with INC with IPD placement. We searched MEDLINE, EMBASE, Web of Science, Cochrane (CENTRAL), CINAHL, Academic Search Premier, Science Direct up to July 2010. Studies describing patients with INC caused by lumbar stenosis, reporting complication rate and reporting based on validated outcome scores, were eligible. Studies with only instrumented IPD results were excluded. RESULTS: Eleven studies eligible studies were identified. Two independently RCTs and eight prospective cohorts were available. In total 563 patients were treated with IPDs. All studies showed improvement in validated outcome scores after 6 weeks and 1 year. Pooled data based on the Zurich Claudication Questionnaire of the RCTs were more in favor of IPD treatment compared with conservative treatment (pooled estimate 23.2, SD 18.5-27.8). Statistical heterogeneity after pooled data was low (I-squared 0.0, p = 0.930). Overall complication rate was 7%. CONCLUSION: As the evidence is relatively low and the costs are high, more thorough (cost-) effectiveness studies should be performed before worldwide implementation is introduced

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    A potential novel mechanism involving connexin 43 gap junction for control of Sertoli cell proliferation by thyroid hormones

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    There is strong evidence that thyroid hormones through triiodothyronine (T3) regulate Sertoli cell proliferation and differentiation in the neonatal testis. However, the mechanism(s) by which they are able to control Sertoli cell proliferation is unclear. In the present study in vivo approaches (PTU-induced neonatal hypothyroidism known to affect Sertoli cell proliferation) associated with in vitro experiments on a Sertoli cell line were developed to investigate this question.We demonstrated that the inhibitory effect of T3 on Sertoli cell growth, analyzed by evaluating DNA-incorporated [3H] thymidine, was associated with a time and dose-dependent increase in the levels of Cx43, a constitutive protein of gap junctions, known to participate in the control of cell proliferation and the most predominant Cx in the testis. These Cx43 changes were associated with increased gap junction communication measured by gap FRAP. Consistent with these results two specific inhibitors of gap junction coupling, AGA and oleamide, were able to significantly reverse the T3 inhibitory effect on Sertoli cell proliferation. The present data also revealed a nongenomic effect of T3 on Cx43 Sertoli cells that was evidenced by a rapid up-regulation of gap junction plaque number as identified in Cx43-GFP transfected cells exposed to the hormone. This process appears mediated through actin cytoskeleton since incubation of the cells with cytochalasin D totally reversed the T3 stimulatory effect on Cx43-GFP gap junction plaques. Based on these data, we propose a working hypothesis in which Cx43 could be an intermediate target for T3 inhibition of neonatal Sertoli cell proliferation

    LES DÉPÔTS HOLOCÈNES DE LA BASSE VALLÉE DE L'OUED ASSAKA, SUD-MAROC: RÉSULTATS PRÉLIMINAIRES

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    International audienceAt the southem side of the Anti-Atlas mountains, the lower section of the Assaka wadi valley joins the Atlantic ocean by crossing an Appalachian basin and range area. Holocene deposits of the lower section of the Assaka wadi show two main sedimentary formations: the upper sheet-fans and the lower terraces. The upper sheet-fans are probably from the lower Rharbian (Holocene) age, they are located above the Soltanian (Wünnian) formations at the outlets of tributaries. They consist of accumulations with silts, aeolian quartz and high palygorskite contents. After this period, a trench cut through the older formations took place between 8 000 years BP and 4 200 years BP. The lower river terraces, 5 to Il metres thick, are inset in the trench cut through the Soltanian formations and show four superimposed and fining upwards (from pebble to silt) cross-bedded units. This study shows many geodynamic and palaeoclimatic conditions. Lower Rharbian fans indicate that the climate was sufficiently arid to denude the slopes, where, during big storms, gullies and run-off supplied the Assaka wadi with silts and sands. Torrential floods eut the Soltanian formations and then created the Middle Rharbian low terrace. Finally, the Historie terrace, superimposed onto the Middle Rharbian one, shows that important flood events took place during the XVIIO and XVIIIo centuries, but nevertbeless with low frequency. However. this sequence indicates wetter conditions during an arid episode. The 14C age is contemporary with the "cold winters" in Western Europe; this fact proves that the synoptic conditions in South Morocco were the same at 280±30 years B.P. as at present.L'oued Assaka, exutoire d'un vaste bassin versant (7 000 km2) rejoint l'océan Atlantique sur le versant sud de l' Anti-Atlas en recoupant une zone de relief appalachien. Des cônes attribuables au Pléistocène supérieur ou au Rharbien ancien (Holocène ancien) surmontent les formations alluviales et colluviales soltaniennes (Würm), avant que celles-ci soient entaillées sur 20 à 25 mètres; ils sont circonscrits aux débouchés des foums que déterminent les affluents de l'oued Assaka. Ils sont constitués de limons sableux riches en grains de quartz éoJisés et par des teneurs en palygorskite qui s'accentuent de la base vers le sommet. Aux environs de 8 000 BP, une phase d'incision linéaire importante entailla les dépôts plus anciens sur une épaisseur de 20 mètres. De basses terrasses sont emboîtées dans les dépôts soltaniens. D'une épaisseur variant de 5 à Il mètres, elles sont constituées de séquences granoclassées qui mettent en évidence des géodynamiques et des ambiances climatiques contrastées. Le Rharbien ancien reflète une sécheresse suffi-sante pour dénuder en partie les versants, qui lors d'orages probablement assez localisés, alimentent les affluents de l'oued principal en limons sableux. Les crues torrentielles (charriant des blocs surdimensionnés) ont incisé les formations soltaniennes -essentiellement limoneuses-et ont mis en place les basses terrasses du Rharbien moyen. Enfin, la terrasse historique étagée sur celle du Rharbien moyen montre la permanence de crues importantes durant les XVIIème et XVIIIème siècles avec une fréquence cependant moins élevée. En outre, cette séquence indique l'existence de conditions humides durant un épisode aride sous cette latitude contemporaines des "hivers froids" de l'Europe de l'Ouest; ce qui prouve que les situations synoptiques dans le Sud du Maroc étaient les mêmes à 280±30 ans BP qu'aujourd'hui
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