Search

The interest in cervical total disc replacement (TDR) as an alternative to the so-far gold standard in the surgical treatment of degenerative disc disease (DDD), e.g anterior cervical discectomy and fusion (ACDF), is growing very rapidly. Many authors have established the fact that ACDF may result in progressive degeneration in adjacent segments. On the contrary, but still theoretically, preservation of motion with TDR at the surgically treated level may potentially reduce the occurrence of adjacent-level degeneration (ALD). The authors report the intermediate results of an undergoing multicentre prospective study of TDR with Mobi-C® prosthesis. The aim of the study was to assess the safety and efficacy of the device in the treatment of DDD and secondary to evaluate the radiological status of adjacent levels and the occurrence of ossifications, at 2-year follow-up (FU). 76 patients have performed their 2-year FU visit and have been analyzed clinically and radiologically. Clinical outcomes (NDI, VAS, SF-36) and ROM measurements were analyzed pre-operatively and at the different post-operative time-points. Complications and re-operations were also assessed. Occurrences of heterotopic ossifications (HOs) and of adjacent disc degeneration radiographic changes have been analyzed from 2-year FU X-rays. The mean NDI and VAS scores for arm and neck are reduced significantly at each post-operative time-point compared to pre-operative condition. Motion is preserved over the time at index levels (mean ROM = 9° at 2 years) and 85.5% of the segments are mobile at 2 years. HOs are responsible for the fusion of 6/76 levels at 2 years. However, presence of HO does not alter the clinical outcomes. The occurrence rate of radiological signs of ALD is very low at 2 years (9.1%). There has been no subsidence, no expulsion and no sub-luxation of the implant. Finally, after 2 years, 91% of the patients assume that they would undergo the procedure again. These intermediate results of TDR with Mobi-C® are very encouraging and seem to confirm the efficacy and the safety of the device. Regarding the preservation of the status of the adjacent levels, the results of this unconstrained device are encouraging, but longer FU studies are needed to prove it. [ABSTRACT FROM AUTHOR]

L’alimentation intervient à différents niveaux dans le déroulement de la maladie cancéreuse : au niveau du risque [1] et au niveau de l’évolution en modifiant le risque de survenue des métastases. L’alimentation influence-t-elle aussi la réponse aux traitements anticancéreux ? À l’appui de cette hypothèse viennent deux observations indirectes réalisées dans le cancer du sein : nos données [2, 3] ainsi que les observations épidémiologiques provenant d’autres travaux [4] ont apporté des arguments supportant l’hypothèse que les lipides alimentaires peuvent influencer la réponse des tumeurs mammaires aux traitements. On sait que la composition des lipides membranaires n’est pas génétiquement déterminée, mais qu’elle dépend des acides gras disponibles aux tissus périphériques. Le type d’acides gras disponibles est influencé par les apports alimentaires. Comme les tumeurs incorporent dans leurs lipides les acides gras disponibles de façon similaire aux autres tissus [5], il est plausible que les habitudes alimentaires (apports alimentaires en acides gras polyinsaturés, vitamines anti ou pro-oxydantes) puissent influencer leur chimiosensibilité en apportant aux cellules tumorales des substrats de peroxydation.

Medical devices are characterized notably by a wide heterogeneity (from tongue depressors to hip prostheses, and from non-implantable to invasive devices), a short life cycle with recurrent incremental innovations (from 18 months to 5 years), and an operator-dependent nature. The objective of the current round table was to develop proposals and recommendations concerning the prerequisites needed in order to meet the French health authorities expectations concerning requests for post-approval studies for medical devices, required in cases where short and long-term consequences are unknown. These studies, which are the responsibility of the manufacturer or the distributor of the medical device, are designed to confirm the role of the medical device in the therapeutic management strategy in a real-life setting. There are currently approximately 150 post-approval studies underway, mainly concerning class III devices, and the majority face difficulties implementing the study or meeting the study objectives. In light of this, the round table endeavored to clearly identify the conditions for implementation of post-approval studies specific to the characteristics of medical devices. Various areas of progress have been envisaged to improve the performance of these studies, and by consequence, the efficiency of reimbursement of medical devices by the national health insurance. These include providing manufacturers with the opportunity to better anticipate post-approval requirements, defining a study-specific primary objective, integrating a phase allowing dialogue between the manufacturer, the health authorities and the scientific committee, and increasing awareness and training of health professionals on the impact of post-approval clinical studies in terms of the reimbursement of medical devices by the national insurance., (© 2014 Société Française de Pharmacologie et de Thérapeutique.)

We study the dynamics of a quantum spin ensemble controlled by trains of ultrashort pulses. To model disturbances of the kicks, we consider that the spins are submitted to different kick trains which follow regular, random, stochastic, or chaotic dynamical processes. These are described by dynamical systems on a torus. We study the quantum decoherence and the population relaxation of the spin ensemble induced by these classical dynamical processes disturbing the kick trains. For chaotic kick trains we show that the decoherence and the relaxation processes exhibit a signature of chaos directly related to the Lyapunov exponents of the dynamical system. This signature is a horizon of coherence, i.e., a preliminary duration without decoherence followed by a rapid decoherence process.

Although in theory, the differences in design between fixed-core and mobile-core prostheses should influence motion restoration, in vivo kinematic differences linked with prosthesis design remained unclear. The aim of this study was to investigate the rationale that the mobile-core design seems more likely to restore physiological motion since the translation of the core could help to mimic the kinematic effects of the natural nucleus. In vivo intervertebral motion characteristics of levels implanted with the mobile-core prosthesis were compared with untreated levels of the same population, levels treated by a fixed-core prosthesis, and normal levels (data from literature). Patients had a single-level implantation at L4L5 or L5S1 including 72 levels with a mobile-core prosthesis and 33 levels with a fixed-core prosthesis. Intervertebral mobility characteristics included the range of motion (ROM), the motion distribution between flexion and extension, the prosthesis core translation (CT), and the intervertebral translation (VT). A method adapted to the implanted segments was developed to measure the VT: metal landmarks were used instead of the bony landmarks. The reliability assessment of the VT measurement method showed no difference between three observers (p < 0.001), a high level of agreement (ICC = 0.908) and an interobserver precision of 0.2 mm. Based on this accurate method, this in vivo study demonstrated that the mobile-core prosthesis replicated physiological VT at L4L5 levels but not at L5S1 levels, and that the fixed-core prosthesis did not replicate physiological VT at any level by increasing VT. As the VT decreased when the CT increased (p < 0.001) it was proven that the core mobility minimized the VT. Furthermore, some physiologic mechanical behaviors seemed to be maintained: the VT was higher at implanted the L4L5 level than at the implanted L5S1 level, and the CT appeared lower at the L4L5 level than at the L5S1 level. ROM and motion distribution were not different between the mobile-core prosthesis and the fixed-core prosthesis implanted levels. This study validated in vivo the concept that a mobile-core helps to restore some physiological mechanical characteristics of the VT at the implanted L4L5 level, but also showed that the minimizing effect of core mobility on the VT was not sufficient at the L5S1 level.

Background: High incidence of subsidence in cervical stand-alone cages was reported in the literature., Purpose: The goal of this study was to assess the radiological outcomes of a PEEK anchored stand-alone cage (MC+®) with a minimum of 1 year follow-up., Study Design: A retrospective radiological evaluation., Patient Sample: The study was conducted in 4 hospitals and involved 28 patients (37 levels) treated by ACDF (Anterior Cervical Discectomy and Fusion) for spondylotic radiculopathy and/or myelopathy., Outcome Measures: We analyzed fusion, disc height, cage or anchor micro plate migration, discal and segmental lordosis and subsidence., Methods: All the patients were controlled at least one year after surgery with an average of 31 months. Antero-posterior and lateral X-rays were performed pre-operatively, immediate post-operatively, and at final follow up. The different radiographic measurements were performed with the assistance of software (SpineView®). CT-scans were performed for each case at final follow-up to assess the fusion., Results: No migration or breakage was reported for either the cage or the anchor micro plate. The fusion rate was 94.1% at the final follow-up. No subsidence was observed. The disc height increased between preop and final follow-up from 23.3% to 44.3%, from 22.1% to 35.1% and from 38.3% to 51.5% for anterior, posterior and midline disc height respectively. Mean Functional Spinal Unit Lordosis increased from 0.9° preop to 3.0° at final follow-up. No new kyphotic situation could be noticed. At the final follow-up, 96% of the patients stated they would undergo the procedure again., Conclusion: With a high rate of proven fusion, restoration of disc height and spinal alignment in most cases, and absence of subsidence or migration, our radiological results with MC+® at more than 1 year of follow-up show the implanted device to be safe and effective for use in treating degenerative conditions of the cervical spine.

Background: An artificial disc prosthesis is thought to restore segmental motion in the lumbar spine. However, it is reported that disc prosthesis can increase the intervertebral translation (VT). The concept of the mobile-core prosthesis is to mimic the kinematic effects of the migration of the natural nucleus and therefore core mobility should minimize the VT. This study explored the hypothesis that core translation should influence VT and that a mobile core prosthesis may facilitate physiological motion., Methods: Vertebral translation (measured with a new method presented here), core translation, range of motion (ROM), and distribution of flexion-extension were measured on flexion-extension, neutral standing, and lateral bending films in 89 patients (63 mobile-core [M]; 33 fixed-core [F])., Results: At L4-5 levels the VT with M was lower than with F and similar to the VT of untreated levels. At L5-S1 levels the VT with M was lower than with F but was significantly different compared to untreated levels. At M levels a strong correlation was found between VT and core translation; the VT decreases as the core translation increases. At F levels the VT increases as the ROM increases. No significant difference was found between the ROM of untreated levels and levels implanted with either M or F. Regarding the mobility distribution with M and F we observed a deficit in extension at L5-S1 levels and a similar distribution at L4-5 levels compared to untreated levels., Conclusion: The intervertebral mobility was different between M and F. The M at L4-5 levels succeeded to replicate mobility similar to L4-5 untreated levels. The M at L5-S1 succeeded in ROM, but failed regarding VT and mobility distribution. Nevertheless M minimized VT at L5-S1 levels. The F increased VT at both L4-5 and L5-S1., Clinical Relevance: This study validates the concept that the core translation of an artificial lumbar disc prosthesis minimizes the VT.

The interaction between the estrogen receptor and 5-hydroxy-7-methoxyflavanone (pinostrobin) was studied in the presence or absence of estradiol or dehydroepiandrosterone sulfate (DHEAS), respectively, using a stably transfected human breast cancer cell line (MVLN). We also evaluated its action on the proliferation in estrogen-dependent (MCF-7) human breast cancer cells in the same conditions than the estrogen receptor assay. On the other hand pinostrobin was evaluated for their effects on the human placental aromatase, 3beta-hydroxysteroid dehydrogenase Delta(4)/Delta(5) isomerase and 17beta-hydroxysteroid dehydrogenase activities. Pinostrobin did not possess antiestrogenic activity but presented anti-aromatase activity and decreased the growth of MCF-7 cells induced by DHEAS and E(2). This study provides particularly evidence of the potential biological interest of pinostrobin among the flavonoids.