The authors report a new case of spine tuberculosis of C1-C2 occurred in a 58-year-old negative HIV patient that was responsible of inflammatory cervical pain with multidirectional stiffness and complicated by spastic...The authors report a new case of spine tuberculosis of C1-C2 occurred in a 58-year-old negative HIV patient that was responsible of inflammatory cervical pain with multidirectional stiffness and complicated by spastic quadriplegia. The diagnosis was made on the basis of presumptive elements, including cervical spinal CT scan, which showed atlan-to-axial subluxation (C1-C2) with destruction of the odontoid apophysis and lateral mass of the atlas and favorable evolution under specific antibiotic treatment with ethambutol, isoniazid, rifampicin, pyrazinamide and immobilization with brace cast, despite the absence of bacteriological and anatomo-pathological evidence of certainty. The evolution has been favorable, with the disappearance of cervical pain, progressive motor recovery and resumption of autonomy of walking.展开更多
Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
Objective: Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand fixation technique description. Method: five patients were operated on using free hand technique, X-r...Objective: Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand fixation technique description. Method: five patients were operated on using free hand technique, X-rays were only used after the positioning of the patient in the ventral position with Mayfield and at the end before locking the lateral rods. Results: no complications documented, in all the cases CT scans revealed good screw position. Conclusion: Using these landmarks and with a good preoperative planning, it is easy for experienced surgeons to perform the technique in a free hand manner, that avoids X-ray exposure for the whole team and the patient. This technique is not recommended for common use, especially for surgeons with few experiences in this field.展开更多
Niemann-pick protein C1(NPC1) is a large integral membrane glycoprotein that resides in late endosomes,whereas niemann-pick protein C2(NPC2) is a small soluble protein found in the lumen of lysosomes.NPC1 protein is b...Niemann-pick protein C1(NPC1) is a large integral membrane glycoprotein that resides in late endosomes,whereas niemann-pick protein C2(NPC2) is a small soluble protein found in the lumen of lysosomes.NPC1 protein is believed to facilitate the transport of lipids,particularly cholesterol,from late endosomes/lysosomes to the Golgi apparatus,endoplasmic reticulum and plasma membrane.NPC2 primarily plays a role in the egress of cholesterol and glycolipids from lysosomes.Mutations in either NPC1 or NPC2 result in aberrant lipid transport from endocytic compartments,which results in lysosomal storage of a complex mixture of lipids,primarily cholesterol and glycosphingolipids.The NPC proteins regulate sterol homeostasis through production of LDL cholesterol-derived oxysterols.Oxysterols are endogenous ligands for the liver X receptors(LXRs),which can upregulate ATP binding cassette transporter A1(ABCA1) expression.ABCA1 may have antiatherogenic effects through the efflux of it-mediated cholesterol.Meanwhile,NPC1 heterozygote mutation confers substantial resistance to lesional necrosis and lesional macrophage apoptosis.Study of the NPC proteins will help us for further understanding of the mechanisms involved in atherogenesis.展开更多
Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials a...Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.展开更多
目的观察厄贝沙坦对脉压(PP)≥60 mm Hg(1 mm Hg=0．133 kPa)高血压患者的动脉弹性功能、反射波及PP的影响。方法选取符合入选条件的原发性高血压患者30例,男13例、女17例,平均年龄为(65．2±8．5)岁(51～83岁),随机分成治疗组和对...目的观察厄贝沙坦对脉压(PP)≥60 mm Hg(1 mm Hg=0．133 kPa)高血压患者的动脉弹性功能、反射波及PP的影响。方法选取符合入选条件的原发性高血压患者30例,男13例、女17例,平均年龄为(65．2±8．5)岁(51～83岁),随机分成治疗组和对照组,分别给予厄贝沙坦(150 mg/d)和安慰剂治疗3个月。结果与治疗前相比,对照组治疗后中心和肱动脉收缩压、舒张压及PP轻度下降,但差异无显著性(P＞0．05)；而治疗组显著下降(P＜0．05),治疗组的降幅均显著高于对照组(P值分别＜0．05和0．01)。治疗后,治疗组的反射波增强压(AP)和增强指数(A1)明显下降(P＜0．01),颈-股动脉脉搏波传导速度(CF-PWV)显著变慢(P＜0．01),降幅显著高于对照组；大、小动脉弹性功能指数(Cl、C_2)值均显著增加(P值分别＜0．05和0．01),增幅显著高于对照组。分别以C_1和CF-PWV变化为应变量,收缩压、舒张压降幅为自变量行多元线形回归分析,决定系数(R2)为0．486及0．384(P＜0．05)。结论厄贝沙坦可明显改善PP≥60mm Hg高血压患者的大、小动脉弹性,减弱外周波反射,缩小PP。展开更多
文摘The authors report a new case of spine tuberculosis of C1-C2 occurred in a 58-year-old negative HIV patient that was responsible of inflammatory cervical pain with multidirectional stiffness and complicated by spastic quadriplegia. The diagnosis was made on the basis of presumptive elements, including cervical spinal CT scan, which showed atlan-to-axial subluxation (C1-C2) with destruction of the odontoid apophysis and lateral mass of the atlas and favorable evolution under specific antibiotic treatment with ethambutol, isoniazid, rifampicin, pyrazinamide and immobilization with brace cast, despite the absence of bacteriological and anatomo-pathological evidence of certainty. The evolution has been favorable, with the disappearance of cervical pain, progressive motor recovery and resumption of autonomy of walking.
文摘Objective To report five cases of puerile (【9 years) atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach,and to introduce the surgical technique and the key point
文摘Objective: Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand fixation technique description. Method: five patients were operated on using free hand technique, X-rays were only used after the positioning of the patient in the ventral position with Mayfield and at the end before locking the lateral rods. Results: no complications documented, in all the cases CT scans revealed good screw position. Conclusion: Using these landmarks and with a good preoperative planning, it is easy for experienced surgeons to perform the technique in a free hand manner, that avoids X-ray exposure for the whole team and the patient. This technique is not recommended for common use, especially for surgeons with few experiences in this field.
文摘Niemann-pick protein C1(NPC1) is a large integral membrane glycoprotein that resides in late endosomes,whereas niemann-pick protein C2(NPC2) is a small soluble protein found in the lumen of lysosomes.NPC1 protein is believed to facilitate the transport of lipids,particularly cholesterol,from late endosomes/lysosomes to the Golgi apparatus,endoplasmic reticulum and plasma membrane.NPC2 primarily plays a role in the egress of cholesterol and glycolipids from lysosomes.Mutations in either NPC1 or NPC2 result in aberrant lipid transport from endocytic compartments,which results in lysosomal storage of a complex mixture of lipids,primarily cholesterol and glycosphingolipids.The NPC proteins regulate sterol homeostasis through production of LDL cholesterol-derived oxysterols.Oxysterols are endogenous ligands for the liver X receptors(LXRs),which can upregulate ATP binding cassette transporter A1(ABCA1) expression.ABCA1 may have antiatherogenic effects through the efflux of it-mediated cholesterol.Meanwhile,NPC1 heterozygote mutation confers substantial resistance to lesional necrosis and lesional macrophage apoptosis.Study of the NPC proteins will help us for further understanding of the mechanisms involved in atherogenesis.
文摘Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.
文摘目的观察厄贝沙坦对脉压(PP)≥60 mm Hg(1 mm Hg=0．133 kPa)高血压患者的动脉弹性功能、反射波及PP的影响。方法选取符合入选条件的原发性高血压患者30例,男13例、女17例,平均年龄为(65．2±8．5)岁(51～83岁),随机分成治疗组和对照组,分别给予厄贝沙坦(150 mg/d)和安慰剂治疗3个月。结果与治疗前相比,对照组治疗后中心和肱动脉收缩压、舒张压及PP轻度下降,但差异无显著性(P＞0．05)；而治疗组显著下降(P＜0．05),治疗组的降幅均显著高于对照组(P值分别＜0．05和0．01)。治疗后,治疗组的反射波增强压(AP)和增强指数(A1)明显下降(P＜0．01),颈-股动脉脉搏波传导速度(CF-PWV)显著变慢(P＜0．01),降幅显著高于对照组；大、小动脉弹性功能指数(Cl、C_2)值均显著增加(P值分别＜0．05和0．01),增幅显著高于对照组。分别以C_1和CF-PWV变化为应变量,收缩压、舒张压降幅为自变量行多元线形回归分析,决定系数(R2)为0．486及0．384(P＜0．05)。结论厄贝沙坦可明显改善PP≥60mm Hg高血压患者的大、小动脉弹性,减弱外周波反射,缩小PP。
