929 resultados para sacrospinous fixation


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The objective of this study is to assess the results of labyrinthine fenestration for fixed stapes in chronic ear disease. Using a prospective database, pre- and postoperative audiometric data from patients undergoing labyrinthine fenestration for fixation of the stapes in chronic ear disease others than otosclerosis between 2002 and 2012 were evaluated. Twenty-three labyrinthine fenestrations in chronic ear disease were performed (17 malleo-stapedotomies, 4 incus-stapedotomies, 1 neo-malleus-stapedotomy, 1 TORP-stapedotomy). Overall, the mean short-term (2 months) and long-term (42 months) postoperative air-bone gap (0.5-3 kHz) were 17.5 and 16.5 dB, respectively; long-term air-bone gap of <20 dB was obtained in 73 % of patients. There was no significant difference in air-bone gap closure between tympanosclerotic and post inflammatory osteogenic fixation of the stapes (p = 0.267). Hearing benefit success using the 'Belfast rule of the thumb' was achieved in 48 %. Normal bilateral hearing was achieved in 17 % and bilateral symmetric hearing impairment in 26 %. Only in 4 %, bone conduction worsened by more than 5 dB. Labyrinthine fenestration is an option in selected cases of stapes fixation in chronic ear disease and provides hearing gain without significant risk for sensorineural hearing loss. In those already selected cases, hearing benefit success 'Belfast rule of the thumb' is achieved only in half of the cases. This and the possible alternatives, should therefore be discussed preoperatively.

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Cranial bone reconstructions are necessary for correcting large skull bone defects due to trauma, tumors, infections and craniotomies. Traditional synthetic implant materials include solid or mesh titanium, various plastics and ceramics. Recently, biostable glass-fiber reinforced composites (FRC), which are based on bifunctional methacrylate resin, were introduced as novel implant solution. FRCs were originally developed and clinically used in dental applications. As a result of further in vitro and in vivo testing, these composites were also approved for clinical use in cranial surgery. To date, reconstructions of large bone defects were performed in 35 patients. This thesis is dedicated to the development of a novel FRC-based implant for cranial reconstructions. The proposed multi-component implant consists of three main parts: (i) porous FRC structure; (ii) bioactive glass granules embedded between FRC layers and (iii) a silver-polysaccharide nanocomposite coating. The porosity of the FRC structure should allow bone ingrowth. Bioactive glass as an osteopromotive material is expected to stimulate the formation of new bone. The polysaccharide coating is expected to prevent bacterial colonization of the implant. The FRC implants developed in this study are based on the porous network of randomly-oriented E-glass fibers bound together by non-resorbable photopolymerizable methacrylate resin. These structures had a total porosity of 10–70 volume %, of which > 70% were open pores. The pore sizes > 100 μm were in the biologically-relevant range (50-400 μm), which is essential for vascularization and bone ingrowth. Bone ingrowth into these structures was simulated by imbedding of porous FRC specimens in gypsum. Results of push-out tests indicated the increase in the shear strength and fracture toughness of the interface with the increase in the total porosity of FRC specimens. The osteopromotive effect of bioactive glass is based on its dissolution in the physiological environment. Here, calcium and phosphate ions, released from the glass, precipitated on the glass surface and its proximity (the FRC) and formed bone-like apatite. The biomineralization of the FRC structure, due to the bioactive glass reactions, was studied in Simulated Body Fluid (SBF) in static and dynamic conditions. An antimicrobial, non-cytotoxic polysaccharide coating, containing silver nanoparticles, was obtained through strong electrostatic interactions with the surface of FRC. In in vitro conditions the lactose-modified chitosan (chitlac) coating showed no signs of degradation within seven days of exposure to lysozyme or one day to hydrogen peroxide (H2O2). The antimicrobial efficacy of the coating was tested against Staphylococcus aureus and Pseudomonas aeruginosa. The contact-active coating had an excellent short time antimicrobial effect. The coating neither affected the initial adhesion of microorganisms to the implant surface nor the biofilm formation after 24 h and 72 h of incubation. Silver ions released to the aqueous environment led to a reduction of bacterial growth in the culture medium.

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Plants were regenerated from leaf-derived callus culture of Stylosanthes scabra, a polyploid legume tolerant to drought and adapted to acid soils. A total of 168 regenerants were planted out in Leonard jars in a complete randomized design. Nitrogen fixation and vegetative growth were indirectly evaluated by shoot dry weight, root dry weight, shoot N content and acetylene reduction activity. The results showed higher variation in the regenerants than in controls not submitted to tissue culture. Significant differences were found for all nitrogen fixation related-traits

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NifA protein activates transcription of nitrogen fixation operons by the alternative sigma54 holoenzyme form of RNA polymerase. This protein binds to a well-defined upstream activator sequence (UAS) located at the -200/-100 position of nif promoters with the consensus motif TGT-N10-ACA. NifA of Azospirillum brasilense was purified in the form of a glutathione-S-transferase (GST)-NifA fusion protein and proteolytic release of GST yielded inactive and partially soluble NifA. However, the purified NifA was able to induce the production of specific anti-A. brasilense NifA-antiserum that recognized NifA from A. brasilense but not from K. pneumoniae. Both GST-NifA and NifA expressed from the E. coli tac promoter are able to activate transcription from the nifHDK promoter but only in an A. brasilense background. In order to investigate the mechanism that regulates NifA binding capacity we have used E. coli total protein extracts expressing A. brasilense nifA in mobility shift assays. DNA fragments carrying the two overlapping, wild-type or mutated UAS motifs present in the nifH promoter region revealed a retarded band of related size. These data show that the binding activity present in the C-terminal domain of A. brasilense NifA protein is still functional even in the presence of oxygen.

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The Niagara P e n i n s u l a Supports a f l o u r i s h i n g grape and wine i n d u s t r y , where much of the potassium f e r t i l i z e r a p p l i e d to the vineyard s o i l s may not show up in the f r u i t or vines but is fixed by the clay m i n e r a l s in the s o i l . Soil samples were c o l l e c t e d on a n o r t h - s o u t h l i ne through a high d e n s i t y of v i n e y a r d s and examined by x - r a y d i f f r a c t i o n to determine the r e l a t i o n s h i p of potassium with r e s p e c t to c l a y minerals p r e s e n t . The i n v e s t i g a t i o n shows the p h y l l o s i l i c a t e m i n e r a l s present t o be i l l i t e , c h l o r i t e and v e r m i c u l i t e . The v e r m i c u l i t e p r e s e n t is not t h e usual M g - v e r m i c u l i t e , but a K - v e r m i c u l i t e which can be c o n s i d e r e d as a degraded i l l i t e - - t h a t i s , an i l l i t e which has l o s t potassium i o n s . The r e s u l t i n g K - d e f i c i e n t mineral possesses a very l i m i t e d expansion l a t t i ce and is capable of c a p t u r i n g potassium ions and c o n v e r t i n g back t o the i l l i t e form. A g r i c u l t u r a l l y , t h i s causes potassium d e f i c i e n c y in p l a n t s.

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La situation d’un patient trop malade pour une transplantation et qui est maintenu à long terme aux soins intensifs (SI) avec l’aide d’un dispositif d'assistance ventriculaire (DAV) peut évoluer de multiples façons. Malheureusement, plusieurs soignants vivent un malaise lorsque ce patient survit avec des complications, sans possibilité de transplantation cardiaque ni de retour à domicile. Par conséquent, différents buts thérapeutiques sont poursuivis au sein de l’équipe soignante. L’étude avait pour objectifs de cerner les buts poursuivis par les professionnels de la santé œuvrant auprès de ce type de patient, de clarifier les facteurs influençant les buts poursuivis et de mieux connaître les difficultés éprouvées par l’équipe soignante dans l’élaboration d’un but commun. La phénoménologie a été utilisée comme méthodologie de définition de la problématique. L’échantillon comprenait 12 participants représentant les infirmières, médecins et perfusionnistes d'une unité de SI, travaillant auprès de ce type de patient. Chacun des participants a fait l’objet d’une entrevue individuelle, semi-dirigée et enregistrée sur appareil audio. Il leur a d’abord été présenté une vignette à partir de laquelle ont été posées un certain nombre de questions identiques pour tous. Dans leurs réponses à ces questions, les participants ont eu la possibilité de s’exprimer autant sur leur expérience que sur le contexte du phénomène. Une seconde rencontre a été nécessaire afin de valider ou de corriger l’interprétation de ce que chacun avait exprimé durant l’entrevue. L'analyse des données témoigne d’un manque d’harmonie quant au but à poursuivre à l’égard du patient en question. Environ la moitié des participants visent la transplantation, alors que les autres poursuivent d’autres buts comme la sortie des SI, la limitation des traitements ou les soins palliatifs. Les participants sont influencés majoritairement par les volontés du patient, l'absence de mécanisme formel de communication entre eux et les facteurs professionnels tels que : les valeurs, les pratiques et l’environnement, sans oublier les rapports de pouvoir. Un certain nombre de barrières empêchent l’équipe de déterminer un but commun. Pour vaincre ces obstacles et s’entendre sur les buts à poursuivre en équipe, le développement de la communication multidisciplinaire s’impose. Pour y arriver, deux prérequis doivent être développés : l’intention éthique et l’engagement.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

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Ce mémoire analyse l’espérance du temps de fixation conditionnellement à ce qu’elle se produise et la probabilité de fixation d’un nouvel allèle mutant dans des populations soumises à différents phénomènes biologiques en uti- lisant l’approche des processus ancestraux. Tout d’abord, l’article de Tajima (1990) est analysé et les différentes preuves y étant manquantes ou incomplètes sont détaillées, dans le but de se familiariser avec les calculs du temps de fixa- tion. L’étude de cet article permet aussi de démontrer l’importance du temps de fixation sur certains phénomènes biologiques. Par la suite, l’effet de la sé- lection naturelle est introduit au modèle. L’article de Mano (2009) cite un ré- sultat intéressant quant à l’espérance du temps de fixation conditionnellement à ce que celle-ci survienne qui utilise une approximation par un processus de diffusion. Une nouvelle méthode utilisant le processus ancestral est présentée afin d’arriver à une bonne approximation de ce résultat. Des simulations sont faites afin de vérifier l’exactitude de la nouvelle approche. Finalement, un mo- dèle soumis à la conversion génique est analysé, puisque ce phénomène, en présence de biais, a un effet similaire à celui de la sélection. Nous obtenons finalement un résultat analytique pour la probabilité de fixation d’un nouveau mutant dans la population. Enfin, des simulations sont faites afin de détermi- nerlaprobabilitédefixationainsiqueletempsdefixationconditionnellorsque les taux sont trop grands pour pouvoir les calculer analytiquement.