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Дисертації з теми "Prothèses – Dissertation universitaire":
Rignon-Bret, Jean-Marie. "Étude comparative de différents systèmes d'enregistrement du rapport intermaxillaire chez des édentés totaux présentant une pathologie acquise mais réversible des articulations temporo-mandibulaires : matérialisation et visualisation des résultats grâce à l'articulateur R.B. et une étude tomographique." Paris 5, 1986. http://www.theses.fr/1986PA05A001.
Hertault, Adrien. "Conception et évaluation d’un stent actif pro-cicatrisant basé sur la polydopamine, un polymère biocompatible et bioinspiré." Thesis, Lille 2, 2019. http://www.theses.fr/2019LIL2S031.
Introduction: In-stent restenosis (ISR) is induced by an uncontrolled smooth muscular cells (SMC) proliferation after bare metal stent (BMS) implantation. It is associated with recurrence of symptoms and additional health costs. Drug-eluting stents have demonstrated efficiency on ISR but induce a high risk of late acute thrombosis due to a delayed struts reendothelialization. Polydopamine (PDA), a biocompatible polymer inspired from mussels byssus, has been reported to promote endothelial cells (EC) and inhibit SMC proliferation in-vitro, thus suggesting a potential pro-healing effect on the vascular wall. Furthermore, polydopamine expresses amine, catechol and quinone functions on its surface and can be used as an anchor for another therapeutic agent. This study aimed at 1) evaluating the impact of a PDA-coated stent on in-stent restenosis (ISR), 2) designing a vascular stent with a potential additional pro-healing drug, hemin, immobilized via the PDA layer.Methods: In the first part of this study, PDA coatings were obtained by dip coating of cobalt-chromium disks or stents in a dopamine solution. Disk samples were used to evaluate biocompatibility and hemocompatibility. The pro-healing potential was investigated in-vitro by seeding human EC and SMC on the different samples. In-vivo experimentations were conducted to assess the pro-healing effect in a rat model. ISR was evaluated in optic microscopy with quantification of the neointima/media (n/m) ratio after eosin/hematoxillin coloration. Quality of the struts reendothelialization was assessed with transmission electron microscopy (TEM). Molecular pathways involved in a potential pro-healing effect were investigated with western blot analyses.In the second part of this work, PDA-coated surfaces were modified with polyethylenimine (PEI) to enhance the expression of amine functions. This modified coating was characterized and cytocompatibility was assessed in-vitro. This modified surface was used to immobilized hemin, a therapeutic agent, on the sample surfaces. Functionalized surfaces were characterized, and presence of the therapeutic agent was assessed and quantified. The potential healing effect of the hemin-stent was evaluated in-vitro and in-vivo.Results: PDA surfaces demonstrated a pro-healing effect in-vitro compared to bare chromium-cobalt. PDA stents demonstrated a significant reduction in ISR compared to bare metal stents (ratio n/m = 0.48 (+/- 0.26) versus 0.83 (+/- 0.42), p<0.001) in the rat model. TEM analyses confirmed the presence of neointima surrounding the struts in each group and revealed a thinner neointima layer in the PDA-stent group compared to BMS, with similar ultrastructures of the cells facing the arterial lumen. Western blot analyses identified a trend to an increased activation of p38 MAPK phosphorylation and its anti-proliferative effects on vascular SMC which could explain the results observed in the histomorphometric analyses.Immobilization of PEI was achieved through Michael addition and Shift base reaction on PDA coatings, and successfully enriched the surfaces with amino groups without decreasing cytocompatibility. Hemin was successfully grafted on the PDA-PEI surfaces via amide bounds (approximately 10ng of hemin per cm²). Hemin-coated surfaces demonstrated no superiority in-vitro or in-vivo to PDA alone.Conclusion: The expected pro-healing effect of PDA-coating on the arterial wall seems to be confirmed in this in-vivo model. This biocompatible polymer could intrinsically limit in-stent restenosis. Additionally, it also offers the possibility to immobilize many relevant drugs on its surface through amine functions providing potential synergistic effects
Laurent, Thomas. "Imperméabilisation, traitement antiseptique et teinture d'une prothèse vasculaire fonctionnalisée par la cyclodextrine." Thesis, Lille 1, 2008. http://www.theses.fr/2008LIL10157/document.
Post operative infections occur in 1 to 6% of patients implanted with a vascular prosthesis. To solve this problem, we functionalised the polyester prostheses by a method developed in our laboratory. This method can be used to coat the fibre by a cyclodexrin polymer, which allows the complexation of drugs like antiseptics. DSC, SEM and TGA results showed that cyclodextrin polymer was physically fixed onto the prosthesis and that no properties of the prosthesis were modified. Degradation tests revealed that cyclodextrin coating was eliminated after about 10 weeks in human blood plasma and that degradation products were non-toxic. Finally, in vivo histopathological tests and in vitro hemocompatibility tests confirmed that this new prosthesis was perfectly biocompatible. This coating allows us to impregnate methylen-blue known in the medical field to have antiseptic properties. Bacteriological in vitro tests have shown a prolonged efficiency of the functionalised prosthesis against gram(+) and gram(-) bacteria compared to the virgin prosthesis. Moreover, this dye allows to solve the problem met in coelioscopie surgery avoiding the interference phenomena by reducing white light reflection onto the prosthesis wall. The operating conditions can subsequently be improved. A second component of our work was to blood proof the prosthesis by replacing the still widely used hydrogels of animal origin by synthetic polymers. These investigations have allowed us to fulfil the specifications requires by elaborating the best compromise between flexibility and blood proofing of the synthetic graft. Cytocompatibility and hemocompatibility results also ensure a higher safety against cells and blood of the functionalised prosthesis compared to the collagen-treated prosthesis used as the control. ln conclusion, our work has allowed us to develop a vascular prosthesis, which provides three additional qualities an therefore three advantages with respect to the currently used products, i.e. an antiseptic activity, improved surgical conditions, and a total reduction of risks induced by pathogenic agents (viruses, prions...) from products of animal origin
Loisel, François. "Analyse cinématique et biomécanique de la main et du poignet par modélisation personnalisée. Effet de lésions et d’instrumentations." Electronic Thesis or Diss., Paris, HESAM, 2023. http://www.theses.fr/2023HESAE097.
The architecture of the hand and wrist is a complex set of articulations enabling the efficient execution of all the gestures of daily life.Precision of movement and transmission of effector forces require optimal joint congruence and bone cohesion ensured by an organized ligament system.Any trauma resulting in articular step off (fracture) or loss of bone cohesion (ligament rupture) is likely to produce pathological kinematics within these joints. The result is pain, decrease range of motion and impaired overall function. Knowledge of the pathophysiological mechanisms leading to these disorders is essential on several levels: firstly, in a diagnostic context, to be able to identify and treat any injury, even a partial one. Secondly, to improve overall knowledge of the physiological and pathological kinematics of the hand and wrist. And lastly, as part of an innovation drive to propose new solutions (implants) to unresolved problems.The design of customized geometric and biomechanical models in the general context of the study of human joints provides answers to these types of questions. In preliminary work, linked to my Master's research and Stan Durand's thesis, biomechanical tests were carried out on anatomical parts to analyze the effect of a specific implant on the kinematic behavior of the wrist, and to design a method for personalized modeling of the hand and wrist using low-dose biplane X-rays.Following on from this project, this thesis has several objectives.The first objective is to validate our method of personalized hand and wrist modeling in living subjects, by comparing it with the reference technique of TDM segmentation.Secondly, we will apply this method to create a corridor of physiological displacement of certain carpal bones of interest (scaphoid, lunate, triquetrum), between two reference positions (wrist in neutral position or closed fist) among a population of volunteers free of ligament lesions. This corridor of normality is useful for comparing physiological and pathological displacements in clinical practice.Indeed, the third objective is to compare carpal kinematic data from patients with infra-radiological ligament lesions with this corridor of normality. The aim is to assess the diagnostic capabilities of the customized model. By analyzing pre- and post-operative data, a feasibility study will also investigate the field of objective follow-up of surgical restoration by suture or ligament re-anchoring.The aim of such a study is therefore to use geometric, kinematic and biomechanical models of the hand and wrist to assess normal and pathological kinematics (diagnosis), and to analyze current surgical implants in order to propose areas for improvement
Martz, Pierre. "Effet de l’obésité sur la récupération fonctionnelle de la marche après prothèses totales de hanche et de genou : analyse biomécanique et clinique." Thesis, Bourgogne Franche-Comté, 2018. http://www.theses.fr/2018UBFCI009/document.
Introduction : Body Mass Index (BMI) impact on gait recovery after total hip and total knee arthroplasty (THA and TKA) remains misunderstood. Few studies have analyzed the influence of BMI on the recovery of hip and knee range of motion (ROM) during gait or walking speed after THA and TKA. Our objective was to assess this impact preoperatively and post-operatively using both 3D gait analysis and clinical assessment. Our hypothesis was that obesity (BMI> 30kg /m2) would be a negative factor in the recovery of gait parameters.Material and methods: After conducting a systematic review of the literature on functional recovery after total prostheses of the lower limb (THA and TKA) to ensure the originality of this work and its relevance we conducted 2 independent prospective studies: including 76 THA in hip osteoarthritis patients on the one hand and 79 TKA in knee osteoarthritis patients on the other hand. All patients had a quantified gait analysis of preoperatively and postoperatively (at 6 months for THA and 1 year for TKA). A control group of matched healthy people followed the same protocol. The gait speed, ROM hip and knee, as well as functional and quality of life scores were evaluated, for all parameters the gain was calculated. Patients were divided into 2 groups in each cohort: non-obese patients (G1): BMI <30kg/m2 and obese patients (G2): BMI≥30kg/m2. Paired t-tests were used to evaluate the pre- and post-operative differences between G1 and G2, then the differences in gain between G1 and G2. Finally, a uni- and multivariate linear regression sought associations between BMI, gait speed, and ROM.Results: In both cohorts: preoperatively, gait speed and ROM were significantly lower in obese patients. Postoperatively, walking speed and ROM were significantly lower for all patients undergoing TKA or THA compared with the control group. Preoperatively obese patients were more symptomatic. A significant difference was found between G1 and G2 regarding pain improvement in favor of the obese (on the gain of WOMAC pain for TKA and analogic pain scale for THA). For all other parameters the gains were not different between G1 and G2. Uni- and multivariate regression showed no significant relationship between gait speed, ROM and BMI.Conclusion: BMI has no direct negative effect on recovery of walking parameters after THA or TKA. Indeed despite a higher preoperative symptomatology obese patients show a comparable improvement in terms of gain to non-obese patients clinically and biomechanically. However, postoperative gait parameters after THA or TKA remain significantly lower than those of controls, regardless of the BMI of patients without full clinical or biomechanical recovery. Though, obesity appears to have a similar effect on the gait parameters recovery after THA or TKA
Hannetel, Henri. "Connaissances nécessaires pour la confection d'une prothèse fixée esthétique sur pilier naturel." Reims, 2012. http://www.theses.fr/2012REIMO048.
Sinno, Solara. "Contribution du test de Dumas par vibrations crâniennes au dépistage des troubles de l'équilibre et de l'oreille interne chez l'enfant. Interprétation physiopathologique et applications cliniques." Thesis, Université de Lorraine, 2019. http://www.theses.fr/2019LORR0289.
Introduction: Sensorineural hearing loss in children is often accompanied by vestibular dysfunction. The evaluation of the vestibular system in the pediatric population requires adapting techniques used in adults. Skull-Vibration-Induced-Nystagmus Test (SVINT), also known as Dumas’ Test, a non-invasive first-line examination test, stimulates both otolith and canal structures and shows instantaneously a vestibular asymmetry in adults. This study aimed to evaluate the use of this test in healthy children and further explore its clinical value in children with hearing loss (HL) amplified with hearing aids (HA) or cochlear implant (CI). Material and Methods: A case-control study compared the results of SVINT, oculomotor testing (saccade and smooth pursuit), caloric test (CaT) and video head-impulse-test (VHIT) and posturography (SOT) in 120 controls to 30 children with HA and 30 with CI, aged 5-17 years old. SVINT was recorded with videonystagmography after very high frequency (VHF 100 Hz) stimulation of mastoids and vertex. Result: SVINT was easy to perform in children and its’ result was not affected by age. However, saccade latency decreased, and smooth pursuit gain increases as age increased. Similarly, SOT data showed a significant age-associated improvement in performance and a gender difference. SVINT was easily performed by the tester and with a sensitivity of 86 % and a specificity of 96 % in detecting unilateral vestibular lesion (UVL). In the case of a bilateral deficit, the SVINT is non-discriminatory. In amplified participants, a UVL was equally detected whether using SVINT, CaT or VHIT. The comparisons between tests permitted to assume that SVINT stimulates the phasic cells (type I), which equip the apices of the ampullary crests and the vicinity of the striola of the utricular and saccular maculae. Conclusion: SVINT is a well-tolerated and useful test to screen vestibular asymmetry in children with HL when combined with other vestibular tests and shows its complementary at very high frequencies. It confirms its role as a “vestibular Weber” test
Le, Port Isabelle. "Abord morphopsychologique du patient demandeur de prothèse." Nantes, 1994. http://www.theses.fr/1994NANT053D.
Jean, Baptiste Elixène. "Amélioration des propriétés antibactériennes et anticoagulantes des prothèses vasculaires en polyester par immobilisation et libération contrôlée de principes actifs." Thesis, Lille 2, 2012. http://www.theses.fr/2012LIL2S043/document.
Synthetic vascular prosthesis likewise vascular endoprosthesis are prone to several complications after implantation into the human body. Infections, thromboses and late occlusions are the most challenging and the most common, leading to serious clinical consequences that are sometimes lethal. Management of those complications is still fraught with tremendous difficulties justifying the economic burden and the continuous efforts in research development for improving vascular prosthetic materials. This research investment is, however, yet to yield any great clinical advance. Previous studies conducted in our research laboratory have led to the development of polyester vascular prostheses coated with a polymer of hydroxypropyl-β-cyclodextrin. This was achieved in order to increase the loading and eluting capacities of these vascular prostheses towards several antibiotics. In the current works, we sought to determine the optimal conditions for effective controlled release of three antibiotics from those prosthetic platforms. We have also evaluated their efficacy in both in vitro and in vivo models of vascular infections. This was carried-out against nine different bacteria strains that are among the most common in human vascular infections. Moreover, we have assessed in vivo their safety, their healing properties, their systemic toxicity and their biocompatibility in the prospect of clinical application.The above-mentioned drug delivery system has been proved to be effective in releasing in situ the selected antibacterial agents over a seven-day desorption period in human plasma. Optimal batch concentration and time for prosthetic immersion into the antibiotic solutions were well compatible with current surgical practice standards. A bactericidal activity evidenced by significant reduction of bacterial adhesion, growth and proliferation was revealed when compared to appropriate controls in the various tested vascular infection models. We have also studied antibacterial molecules alone or in combination. In this latter setting, no antagonistic effects were depicted. This provides a unique opportunity to customize local antibiotic treatment delivered in situ from vascular device fabrics and to adapt it to the evolving ecology of both monomicrobial and polymicrobial vascular prosthetic infection. The polyester vascular prostheses coated with a polymer of hydroxypropyl-β-cyclodextrin were proved in vivo safe and demonstrated excellent biocompatibility, healing properties and tissue integration without any signs of systemic toxicity. [...]
Hurteaux, Reynald. "Activités biologiques d'un peptide et mise au point d'un système de libération prolongée par microcapsulation en vue de la foctionnalisation de biomatériaux." Reims, 2003. http://www.theses.fr/2003REIMO201.
@The first part of this work was to study the effects of an activator of the TGF-beta. This peptide named KRFK, conserved its activator properties of the TGF-beta in the osteoblast. The second part of this work was to prepare and characterise a sustained release system, and then associate it to a prosthetic coating. This sustained release is called microcapsules. Their characterization allowed us to demonstrate their perfect biocompatibility and to obtain a sustained release of the peptide. Moreover, we created an alginate film in order to associate the release system to a CaP coating. Thus, we obtain a new biomaterial for bone implantation which is able to release an active peptide. This will lead to improve the bone regeneration