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Garching bei Munchen, Germany

The first clinical results of the Disc-FX® (elliquence, LLC) provide encouraging findings showing that this method can be included among treatment options for intervertebral disc pathologies. The Disc-FX procedure is at least equivalent to other minimally invasive procedures with the aim of avoiding open surgical procedures. It lies in the area between conservative and semi-invasive therapy and open surgery in the array of treatment options for disc pathologies. The combination of different techniques has been demonstrated as beneficial and appears to be one of the superior percutaneous techniques, as other combinations in studies have shown. The possibility for complications is reduced compared with invasive techniques. Specific problems with post-operative epidural scarring and fibrosis are avoided. As a minimally invasive procedure it leads to quicker rehabilitation, an earlier return to work and lower medical costs. © Touch Briefings 2011. Source

Stone G.W.,Columbia University Medical Center | Stone G.W.,Cardiovascular Research Foundation | Abizaid A.,Dante Pazzanese Institute of Cardiology | Silber S.,ISaR GmbH | And 11 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: This study sought to evaluate the potential utility of a novel polyethylene terephthalate micronet mesh-covered stent (MGuard) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Background: Suboptimal myocardial reperfusion after PCI in STEMI is common and results in increased infarct size and mortality. The MGuard is a novel thin-strut metal stent with a polyethylene terephthalate micronet covering designed to trap and exclude thrombus and friable atheromatous debris to prevent distal embolization. Methods: A total of 433 patients with STEMI presenting within 12 h of symptom onset undergoing PCI were randomized at 50 sites in 9 countries to the MGuard (n = 217) or commercially available bare metal or drug-eluting stents (n = 216). The primary endpoint was the rate of complete (<70%) ST-segment resolution measured 60 to 90 min post-procedure. Results: Baseline characteristics were well matched between the groups. The primary endpoint of post-procedure complete ST-segment resolution was significantly improved in patients randomized to the MGuard stent compared with control patients (57.8% vs. 44.7%; difference: 13.2%; 95% confidence interval: 3.1% to 23.3%; p = 0.008). By core laboratory analysis, the MGuard stent compared with control stents also resulted in superior rates of Thrombolysis In Myocardial Infarction 3 flow (91.7% vs. 82.9%, p = 0.006) with comparable rates of myocardial blush grade 2 or 3 (83.9% vs. 84.7%, p = 0.81). Mortality (0% vs. 1.9%, p = 0.06) and major adverse cardiac events (1.8% vs. 2.3%, p = 0.75) at 30 days were not significantly different between patients randomized to the MGuard stent and control stent, respectively. Conclusions: Among patients with acute STEMI undergoing emergent PCI, the MGuard micronet mesh-covered stent compared with conventional metal stents resulted in superior rates of epicardial coronary flow and complete ST-segment resolution. A larger randomized trial is warranted to determine whether these benefits result in reduced infarct size and/or improved clinical outcomes. (Safety and Efficacy Study of MGuard Stent After a Heart Attack [MASTER]; NCT01368471) © 2012 American College of Cardiology Foundation. Source

Nabahungu N.L.,Wageningen University | Nabahungu N.L.,ISaR GmbH | Visser S.M.,Wageningen University
Land Degradation and Development | Year: 2013

Most of Rwanda's wetlands are being reclaimed under government schemes with the aim of growing rice as the main crop. In the present study, information on farmers' knowledge and perceptions of agricultural wetland management was collected in Cyabayaga and Rugeramigozi wetlands. The two wetlands were selected as representatives for typical reclaimed wetland agriculture in Rwanda. They provide contrasts in both environmental and social terms. Three tools were used to investigate farmers' knowledge and perception of agricultural wetland management: (i) household survey; (ii) focus group discussions; and (iii) transect walk. The major constraints identified by farmers in the two wetlands were water shortage and lack of availability of improved seeds and high prices of fertilisers. The primary benefits from wetlands for farmers are income generation in Cyabayaga and food security in Rugeramigozi. The most commonly reported concern about the wetlands in the Cyabayaga and Rugerameragozi was that they are a source of malaria. Rice is an important crop in both wetlands, whereas farmers in Cyabahaga wish to continue cultivating rice, Rugeramigozi farmers prefer to grow rice only after it has been tested for its adaptability. Farmers have sufficient knowledge on the causes and the potential solutions to overcome most constraints. They know that soil suitability is closely related to relief. They classify soils by a number of criteria and choose crops accordingly. Any programme designed to address wetland management in the region will have to take account of farmers' knowledge and adopt a holistic view of wetland management. © 2011 John Wiley & Sons, Ltd. Source

As a bridge between open and percutaneous therapy, endoscopy of the cervical spine started to be used at the beginning of the 1990s, following good experiences on the lumbar spine. The principle of microsurgery is combined with the minimally invasive principles by bringing the optical level to the forefront of pathology. Access morbidity has been significantly reduced by the percutaneous access technique. However, this procedure cannot be applied in patients with cervical disc herniation accompanied by segmental instability. In further developing these endoscopic techniques, in view of the experiences with the classical "Cloward procedure", the aim was to do a bony fusion of the intervertebral space of the cervical spine by endoscopic access. Material: A female patient with postraumatic instability of the cervical segments C4/5 underwent a fullendoscopic bony fusion. The technique will be described. The fusional process has been documented by CT and clinical assessment over 3 months. Result: Having preoperative pain of VAS 8, it diminished to VAS 1 after surgery. The Ct-controls demonstrated a good placement of the bony dowel through the endoscopic sheath in the intervertebral space. After 3 months a bony fusion was documented by CT and in bending X-ray. Conclusion: The result of this method displays that a fullendoscopic fusion of the cervical spine with a bone dowel is possible. The clinical result seems to be comparable to the classical Cloward procedure. To the best of my knowledge, this is the first report of a fullendoscopic osseous fusion on the cervical spine. © 2011 Springer-Verlag/Wien. Source

There is little evidence on the optimal mode of clopidogrel discontinuation. Epidemiological studies observed clustering of thrombotic events after cessation of chronic clopidogrel therapy. The underlying mechanism has been ascribed to transient platelet hyper-reactivity. Gradual tapering of clopidogrel may have the potential to attenuate this phenomenon. The objective of the present study was to assess whether in patients with drug-eluting stents (DES) gradual discontinuation of clopidogrel maintenance therapy is superior to conventional, abrupt discontinuation. Patients with planned discontinuation of chronic clopidogrel therapy after DES implantation were randomised in a double-blinded fashion to either gradual discontinuation (according to a tapering schema over four weeks) or abrupt discontinuation (after continued clopidogrel therapy for additional four weeks). The primary endpoint was the composite of cardiac death, myocardial infarction, stroke, stent thrombosis, major bleeding or rehospitalisation due to an acute coronary syndrome at 90 days. Enrollment of 3,000 patients was planned. The study was stopped prematurely due to slow recruitment after enrollment of 782 patients. At 90 days, nine of 392 patients (2.3%) with tapered cessation reached the primary endpoint compared to five of 390 patients (1.3%) with abrupt cessation (p=0.284). The composite of death or myocardial infarction occurred in three patients with tapered and three patients with abrupt discontinuation (p=0.764). In conclusion, tapered discontinuation of chronic clopidogrel therapy is not superior to abrupt discontinuation regarding the primary endpoint in this study. However, the results must be interpreted in view of the premature termination of the trial and low event rates. Source

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