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Akat Çömden E, Yenmiş M, Kytyr D, Ayaz D, Bayrakci Y. A study on the vertebral column of the dice snake Natrix tessellata (Serpentes, Natricidae) from Denizli (western Anatolia, Turkey). Anat Rec (Hoboken) 2024; 307:1930-1942. [PMID: 37746926 DOI: 10.1002/ar.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
The vertebral anatomy of snakes has attracted the attention of researchers for decades and numerous studies have been made for extinct and extant species. The present study investigated the morphological variations in vertebral structure among different vertebral regions in the dice snake Natrix tessellata, and provides a detailed anatomical and microstructural description of the vertebral column. Vertebrae were analyzed and compared using x-ray imaging, scanning electron microscopy, micro-computed tomography, and histological techniques. The vertebral column of N. tessellata is divided into three regions: precloacal, cloacal, and caudal. Unlike in many other tetrapods and snakes, the atlas of N. tessellata does not form a complete ring. It has a flat and roughly trilobate shape with a prominent middle lobe. The axis has two hypapophyses. The anterior precloacal region of the vertebral column has longer and more paddle-shaped hypapophyses, distinguishing it from the posterior and mid-trunk vertebrae. The anterior cloacal vertebrae have a short hypapophysis rather than a hemal keel, and the lymphapophysis extends outward, curving slightly. The cotyle and condyle of the caudal vertebrae exhibited a closer resemblance to a rounded shape, while the pleurapophysis extended ventrolaterally and curved ventrally near its distal end. Paired hemapophyses were present at the posterior-most point of the centrum instead of a hypapophysis. In light of previous fossil findings, our anatomical comparison of the vertebral and transverse processes indicates that the extant Natrix has a more flexible and less rigid spine than its ancestors. Overall, the vertebral differences among snake anatomical regions or taxa are a testament to the remarkable diversity and adaptability of these fascinating reptiles.
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Affiliation(s)
- Esra Akat Çömden
- Science Faculty, Biology Department, Zoology Section, Ege University, Bornova, Izmir, Turkey
| | - Melodi Yenmiş
- Science Faculty, Biology Department, Zoology Section, Ege University, Bornova, Izmir, Turkey
| | - Daniel Kytyr
- Institute of Theoretical and Applied Mechanics, Czech Academy of Sciences, Prague 9, Czech Republic
| | - Dinçer Ayaz
- Science Faculty, Biology Department, Zoology Section, Ege University, Bornova, Izmir, Turkey
| | - Yusuf Bayrakci
- Science Faculty, Biology Department, Zoology Section, Ege University, Bornova, Izmir, Turkey
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Fisher AT, Lee JT. Diagnosis and management of thoracic outlet syndrome in athletes. Semin Vasc Surg 2024; 37:35-43. [PMID: 38704182 DOI: 10.1053/j.semvascsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024]
Abstract
The physical demands of sports can place patients at elevated risk of use-related pathologies, including thoracic outlet syndrome (TOS). Overhead athletes in particular (eg, baseball and football players, swimmers, divers, and weightlifters) often subject their subclavian vessels and brachial plexuses to repetitive trauma, resulting in venous effort thrombosis, arterial occlusions, brachial plexopathy, and more. This patient population is at higher risk for Paget-Schroetter syndrome, or effort thrombosis, although neurogenic TOS (nTOS) is still the predominant form of the disease among all groups. First-rib resection is almost always recommended for vascular TOS in a young, active population, although a surgical benefit for patients with nTOS is less clear. Practitioners specializing in upper extremity disorders should take care to differentiate TOS from other repetitive use-related disorders, including shoulder orthopedic injuries and nerve entrapments at other areas of the neck and arm, as TOS is usually a diagnosis of exclusion. For nTOS, physical therapy is a cornerstone of diagnosis, along with response to injections. Most patients first undergo some period of nonoperative management with intense physical therapy and training before proceeding with rib resection. It is particularly essential for ensuring that athletes can return to their baselines of flexibility, strength, and stamina in the upper extremity. Botulinum toxin and lidocaine injections in the anterior scalene muscle might predict which patients will likely benefit from first-rib resection. Athletes are usually satisfied with their decisions to undergo first-rib resection, although the risk of rare but potentially career- or life-threatening complications, such as brachial plexus injury or subclavian vessel injury, must be considered. Frequently, they are able to return to the same or a higher level of play after full recovery.
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Affiliation(s)
- Andrea T Fisher
- Division of Vascular Surgery, Stanford University School of Medicine, 780 Welch Road CJ350, Palo Alto, 94304, CA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University School of Medicine, 780 Welch Road CJ350, Palo Alto, 94304, CA.
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Peluso F, Caraffi SG, Contrò G, Valeri L, Napoli M, Carboni G, Seth A, Zuntini R, Coccia E, Astrea G, Bisgaard AM, Ivanovski I, Maitz S, Brischoux-Boucher E, Carter MT, Dentici ML, Devriendt K, Bellini M, Digilio MC, Doja A, Dyment DA, Farholt S, Ferreira CR, Wolfe LA, Gahl WA, Gnazzo M, Goel H, Grønborg SW, Hammer T, Iughetti L, Kleefstra T, Koolen DA, Lepri FR, Lemire G, Louro P, McCullagh G, Madeo SF, Milone A, Milone R, Nielsen JEK, Novelli A, Ockeloen CW, Pascarella R, Pippucci T, Ricca I, Robertson SP, Sawyer S, Falkenberg Smeland M, Stegmann S, Stumpel CT, Goel A, Taylor JM, Barbuti D, Soresina A, Bedeschi MF, Battini R, Cavalli A, Fusco C, Iascone M, Van Maldergem L, Venkateswaran S, Zuffardi O, Vergano S, Garavelli L, Bayat A. Deep phenotyping of the neuroimaging and skeletal features in KBG syndrome: a study of 53 patients and review of the literature. J Med Genet 2023; 60:1224-1234. [PMID: 37586838 DOI: 10.1136/jmg-2023-109141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND KBG syndrome is caused by haploinsufficiency of ANKRD11 and is characterised by macrodontia of upper central incisors, distinctive facial features, short stature, skeletal anomalies, developmental delay, brain malformations and seizures. The central nervous system (CNS) and skeletal features remain poorly defined. METHODS CNS and/or skeletal imaging were collected from molecularly confirmed individuals with KBG syndrome through an international network. We evaluated the original imaging and compared our results with data in the literature. RESULTS We identified 53 individuals, 44 with CNS and 40 with skeletal imaging. Common CNS findings included incomplete hippocampal inversion and posterior fossa malformations; these were significantly more common than previously reported (63.4% and 65.9% vs 1.1% and 24.7%, respectively). Additional features included patulous internal auditory canal, never described before in KBG syndrome, and the recurrence of ventriculomegaly, encephalic cysts, empty sella and low-lying conus medullaris. We found no correlation between these structural anomalies and epilepsy or intellectual disability. Prevalent skeletal findings comprised abnormalities of the spine including scoliosis, coccygeal anomalies and cervical ribs. Hand X-rays revealed frequent abnormalities of carpal bone morphology and maturation, including a greater delay in ossification compared with metacarpal/phalanx bones. CONCLUSION This cohort enabled us to describe the prevalence of very heterogeneous neuroradiological and skeletal anomalies in KBG syndrome. Knowledge of the spectrum of such anomalies will aid diagnostic accuracy, improve patient care and provide a reference for future research on the effects of ANKRD11 variants in skeletal and brain development.
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Affiliation(s)
- Francesca Peluso
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Stefano G Caraffi
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Gianluca Contrò
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Lara Valeri
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
- Department of Pediatrics, University of Modena and Reggio Emilia Faculty of Medicine and Surgery, Modena, Emilia-Romagna, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Giorgia Carboni
- Radiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Alka Seth
- Radiology, Rigshospitalet, Kobenhavn, Denmark
| | - Roberta Zuntini
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Emanuele Coccia
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Anne-Marie Bisgaard
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ivan Ivanovski
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Silvia Maitz
- Service of Medical Genetics, IOSI, EOC, Lugano, Switzerland
| | | | - Melissa T Carter
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Maria Lisa Dentici
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Koenraad Devriendt
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Melissa Bellini
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Cristina Digilio
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Asif Doja
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - David A Dyment
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Stense Farholt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Carlos R Ferreira
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Lynne A Wolfe
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - William A Gahl
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Maria Gnazzo
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Himanshu Goel
- Hunter Genetics, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sabine Weller Grønborg
- Center for Rare Diseases, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Trine Hammer
- Department of Clinical Genetics, Copenhagen University Hospital, Kobenhavn, Denmark
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Tjitske Kleefstra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - David A Koolen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Francesca Romana Lepri
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Gabrielle Lemire
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Pedro Louro
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal
| | - Gary McCullagh
- Royal Manchester Children's Hospital and University of Manchester, Royal Manchester Children's Hospital, Manchester, Manchester, UK
| | - Simona F Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Annarita Milone
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Roberta Milone
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Jens Erik Klint Nielsen
- Department of Pediatrics, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Gelderland, Netherlands
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Tommaso Pippucci
- U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia-Romagna, Italy
| | - Ivana Ricca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
| | - Stephen P Robertson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Sander Stegmann
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Constanze T Stumpel
- Department of Clinical Genetics and School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Amy Goel
- University of Newcastle, Callaghan, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Juliet M Taylor
- Genetic Health Service - Northern Hub, Genetic Health Service - Northern Hub, Aukland, New Zealand
| | - Domenico Barbuti
- Radiology and Bioimaging Unit, Bambino Gesu Pediatric Hospital, Roma, Lazio, Italy
| | - Annarosa Soresina
- Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Ex-perimental Sciences, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | | | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Toscana, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Anna Cavalli
- Child Neurology and Psychiatry Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Maria Iascone
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Lionel Van Maldergem
- Centre de génétique humaine, Université de Franche-Comté, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | - Orsetta Zuffardi
- Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
| | - Samantha Vergano
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Livia Garavelli
- Medical Genetics Unit, Maternal and Child Health Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Allan Bayat
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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Bint I Bilal A, Gul MI, Ata F, Ibrahem RE, Danjuma MI. Exercise‐induced thoracic outlet syndrome and concomitant osteomyelitis in cervical rib with a possible familial origin: A case report. Clin Case Rep 2022; 10:e05514. [PMID: 35474983 PMCID: PMC9033646 DOI: 10.1002/ccr3.5514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
Cervical ribs are rare and usually asymptomatic. Occasionally, they can cause nerve impingements and compressive symptoms. In cervical ribs, osteomyelitis secondary to trauma is unheard of. We report such a case made more interesting by the familial presence of bilateral cervical ribs in two generations, indicating a familial origin.
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Affiliation(s)
| | | | - Fateen Ata
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | | | - Muhammad I. Danjuma
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
- College of Medicine Qatar University Doha Qatar
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Depaoli A, Zarantonello P, Gallone G, Di Gennaro GL, Ferrari D, Marchesini Reggiani L, Manca A, Trisolino G. Congenital Pseudarthrosis of the Clavicle in Children: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:147. [PMID: 35204869 PMCID: PMC8870275 DOI: 10.3390/children9020147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
(1) Background: Congenital pseudoarthrosis of the clavicle is a rare condition due to the failure of the union process of the ossification nuclei of the clavicle. The aim of this study was to conduct a systematic review of relevant case series about the argument to find an up-to-date base of evidence for treatment choice. (2) Methods: an electronic literature research of Ovid, MEDLINE and the Cochrane Library databases was conducted, and articles were selected based on inclusion criteria. Demographic data, clinical features, treatment options, outcomes and complications were analyzed. (3) Results: 21 articles met the inclusion criteria, showing a poor overall study quality; 231 pediatric patients (240 clavicles) were analyzed. The condition was typically right sided, showed no sex predominance and no clear predisposing factors. 156 patients underwent surgical treatment, mainly open debridement and refresh of bony ends, fixation with pin or plate and bone graft, with a successful union rate of 87.4%. The nonunion rate was significantly higher in the allograft group (44.4%, p = 0.019). (4) Conclusions: this paper presents an updated systematic review about treatment of congenital pseudoarthrosis of the clavicle. We confirm the generally satisfactory results of surgery, demonstrating that successful union is achievable in 87.4% of cases with a prevalence of 15.7% of major complications. Nonetheless our results should be interpreted with caution due to several limitations.
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Yadav AK, Shrestha S, Shrestha SR, Karmacharya RM, Vaidya S. Cervical rib, case series from a university hospital of Nepal. Ann Med Surg (Lond) 2021; 72:103061. [PMID: 34888041 PMCID: PMC8636984 DOI: 10.1016/j.amsu.2021.103061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Cervical rib is a rare anatomical anomaly with an incidence of 0.2%-1% and is an important cause of thoracic outlet syndrome. We present a case series of five female patients with a mean age of 20.6 (15-26) years, symptoms present were neck pain, neck mass, tingling sensation and weakness in the affected side. Symptoms develop in adolescence probably due to sagging of the shoulders and a disproportion between chest and neck growth at this age. X-rays of cervical spine was a common mode of diagnosis and showed bilateral cervical rib in three cases and unilateral in two cases. They were managed by performing surgeries under supraclavicular approach with resection of cervical rib of affected side. There was improvement of symptoms with restoration of limb function with a mean time of recovery of 9 weeks. Early diagnosis is important as differential diagnosis of such symptoms may be cervical stenosis and myelopathy which differ in management and have a greater risk of morbidity. In absence of intervention, cervical ribs can lead to compression of neurovascular structures leading to worsening of symptoms, thrombosis of subclavian artery or cerebral emboli.
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Affiliation(s)
| | - Sneha Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | | | - Robin Man Karmacharya
- Unit Chief, Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
| | - Satish Vaidya
- Unit Chief, Cardio Thoracic and Vascular Surgery Unit, Department of Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, 45210, Nepal
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Chang MC, Kim DH. Essentials of thoracic outlet syndrome: A narrative review. World J Clin Cases 2021; 9:5804-5811. [PMID: 34368299 PMCID: PMC8316950 DOI: 10.12998/wjcc.v9.i21.5804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Thoracic outlet syndrome (TOS) is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region. TOS results in pain, numbness, paresthesia, and motor weakness in the affected upper limb. We reviewed the pathophysiology, clinical evaluation, differential diagnoses, and treatment of TOS. TOS is usually classified into three types, neurogenic, venous, and arterial, according to the primarily affected structure. Both true neurogenic and disputed TOS are considered neurogenic TOS. Since identifying the causative lesions is complex, detailed history taking and thorough clinical investigation are needed. Electrodiagnostic and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic TOS. The existence of a disputed TOS remains controversial. Neuromuscular physicians tend to be skeptical about the existence of disputed TOS, but thoracic surgeons argue that disputed TOS is under-diagnosed. Clinicians who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, South Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
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8
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Kaderi SAA, Shinde P, Tilloo R, Chetan S, Dalal T, Vaghmare S, Bhesaniya D, Shah S, Rege S. A Never Described Variant of the Cervical Rib Causing Arterial Thoracic Outlet Syndrome: World's First Case. Surg J (N Y) 2021; 7:e179-e183. [PMID: 34307875 PMCID: PMC8298134 DOI: 10.1055/s-0041-1731654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2021] [Indexed: 11/04/2022] Open
Abstract
Cervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.
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Affiliation(s)
| | - Pravin Shinde
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Raviraj Tilloo
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sonewane Chetan
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Tanvi Dalal
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sahil Vaghmare
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Dhaval Bhesaniya
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sulay Shah
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
| | - Sameer Rege
- Department of General Surgery, Seth GSMC and KEMH, Mumbai, Maharashtra, India
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Goeteyn J, Pesser N, van Nuenen B, van Sambeek M, Teijink J. Familial predisposition of thoracic outlet syndrome: does a familial syndrome exist? Report of cases and review of literature. Acta Chir Belg 2021; 121:211-214. [PMID: 31587610 DOI: 10.1080/00015458.2019.1675970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Neurogenic thoracic outlet syndrome (NTOS) is caused by compression of the brachial plexus. The clinical presentation of NTOS is characterized by symptoms of pain, paresthesia, numbness or muscle weakness in the neck, arm or hand. METHODS In this case report, five patients were diagnosed with NTOS. They all had a first degree relative with NTOS as well. CONLUSIONS These cases show familial predisposition in thoracic outlet syndrome. Could a form of familial TOS exist?
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Affiliation(s)
- Jens Goeteyn
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Niels Pesser
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Bart van Nuenen
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Joep Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Lahiri R, Chauhan U, Kumar A, Puliyath N. Undiagnosed bilateral complete cervical rib with subclavian artery aneurysm presenting as acute ischaemic limb following high-altitude expedition. BMJ Case Rep 2021; 14:14/2/e241194. [PMID: 33637509 PMCID: PMC7919562 DOI: 10.1136/bcr-2020-241194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Arterial thoracic outlet syndrome is relatively rare and often exclusively seen in the presence of bony anomalies. High-altitude (HA) travel is commonly associated with thrombosis; however, arterial thromboembolism is less frequently described. We describe a case of a young man with undiagnosed bilateral cervical rib, who went for an HA trek, subsequent to which developed acute limb ischaemia of right arm. Diagnostic workup revealed a subclavian artery aneurysm as well along with complete bony bilateral cervical ribs. Thoracic outlet syndrome should be kept as a differential diagnosis in a case of acute limb ischaemia in a healthy adult.
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Affiliation(s)
- Raja Lahiri
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Udit Chauhan
- Intervention Radiology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Cardiac Anaesthesia, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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11
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Proks P, Johansen TM, Nývltová I, Komenda D, Černochová H, Vignoli M. Vertebral Formulae and Congenital Vertebral Anomalies in Guinea Pigs: A Retrospective Radiographic Study. Animals (Basel) 2021; 11:ani11030589. [PMID: 33668174 PMCID: PMC7995982 DOI: 10.3390/ani11030589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Guinea pigs are popular pets, but there is still a lack of information about their morphology. Variable morphology of the vertebral column can lead to incorrect localization of spinal diseases or the site of surgical intervention. This study aimed to determine the numerical variants of vertebral column and prevalence, localization, and type of congenital anomalies of the vertebral column. Vertebral column radiographs were reviewed in 240 guinea pigs, and nine numerical variants of the vertebral column were noticed. The most common vertebral formula, seven cervical, 13 thoracic, six lumbar, four sacral, and five to seven caudal vertebrae, was found in 75% of guinea pigs. Congenital anomalies were also found as incidental findings in 12.5% of guinea pigs, mostly in the thoracolumbar and lumbosacral regions. The most common congenital anomalies were a variable morphology of the last pair of ribs in the thoracolumbar region and transitional vertebra with a mixed morphological characteristic of lumbar and sacral vertebrae in the lumbosacral region. The cervical region was the least common region for congenital anomalies of the vertebral column. Our results contribute to the knowledge of clinical morphology in guinea pigs applicable in both, research and clinical practice. Abstract The objectives of this retrospective study of 240 guinea pigs (148 females and 92 males) were to determine the prevalence of different vertebral formulae and the type and anatomical localization of congenital vertebral anomalies (CVA). Radiographs of the cervical (C), thoracic (Th), lumbar (L), sacral (S), and caudal (Cd) part of the vertebral column were reviewed. Morphology and number of vertebrae in each segment of the vertebral column and type and localization of CVA were recorded. In 210/240 guinea pigs (87.50%) with normal vertebral morphology, nine vertebral formulae were found with constant number of C but variable number of Th, L, and S vertebrae: C7/Th13/L6/S4/Cd5-7 (75%), C7/Th13/L6/S3/Cd6-7 (4.17%), C7/Th13/L5/S4/Cd6-7 (2.50%), C7/Th13/L6/S5/Cd5-6 (1.67%), C7/Th12/L6/S4/Cd6 (1.25%), C7/Th13/L7/S4/Cd6 (1.25%), C7/Th13/L7/S3/Cd6-7 (0.83%), C7/Th12/L7/S4/Cd5 (0.42%), C7/Th13/L5/S5/Cd7 (0.42%). CVA were found in 30/240 (12.5%) of guinea pigs, mostly as a transitional vertebra (28/30), which represents 100% of single CVA localised in cervicothoracic (n = 1), thoracolumbar (n = 22) and lumbosacral segments (n = 5). Five morphological variants of thoracolumbar transitional vertebrae (TTV) were identified. Two (2/30) guinea pigs had a combination of CVA: cervical block vertebra and TTV (n = 1) and TTV and lumbosacral transitional vertebra (LTV) (n = 1). These findings suggest that guinea pigs’ vertebral column displays more morphological variants with occasional CVA predominantly transitional vertebrae.
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Affiliation(s)
- Pavel Proks
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic; (T.M.J.); (I.N.); (D.K.)
- Central European Institute of Technology (CEITEC), University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic
- Correspondence:
| | - Trude Maria Johansen
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic; (T.M.J.); (I.N.); (D.K.)
| | - Ivana Nývltová
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic; (T.M.J.); (I.N.); (D.K.)
| | - Dominik Komenda
- Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic; (T.M.J.); (I.N.); (D.K.)
| | - Hana Černochová
- Avian and Exotic Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic;
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, Piano D’Accio, 64100 Teramo, Italy;
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12
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Mota S, Rodrigues CF, Moreira C. Radiologic confirmation of bilateral cervical ribs in an adolescent. Radiol Case Rep 2021; 16:798-800. [PMID: 33552328 PMCID: PMC7846893 DOI: 10.1016/j.radcr.2021.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022] Open
Abstract
A previously healthy 14-year-old girl presented to an unscheduled consultation with recent symptoms of myalgias, sore throat, and rhinorrhea. Her physical examination was unremarkable except for bilateral, firm supraclavicular masses. Concern for malignancy lead to investigation and the radiologic diagnosis of bilateral, asymptomatic cervical ribs was made.
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Affiliation(s)
- Sílvia Mota
- Pediatrics Department, Hospital de Braga, Braga, Portugal
| | | | - Carla Moreira
- Pediatrics Department, Hospital de Braga, Braga, Portugal
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13
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Roy S, Jain N, Narang E, Singh J. Cervical Rib: A Rare Differential of a Supraclavicular Mass. EAR, NOSE & THROAT JOURNAL 2020; 101:192-193. [PMID: 32791903 DOI: 10.1177/0145561320950495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Suparna Roy
- Department of Otorhinolaryngology, 75299Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Neha Jain
- Department of Otorhinolaryngology, 75299Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Ekta Narang
- Department of Otorhinolaryngology, 75299Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
| | - Jyoti Singh
- Department of Otorhinolaryngology, 75299Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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14
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Ramasamy K, Saniasiaya J, Gani NA. A hard left supraclavicular mass in a young boy-is it cancer? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:53-55. [PMID: 32843947 PMCID: PMC7430310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K Ramasamy
- MBBS (Malaya) MRCSI (ENT) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia E-mail:
| | - J Saniasiaya
- MMed (ORL-HNS)(USM) Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
| | - N A Gani
- MMed (ORL-HNS)(UKM) Department of OtorhinolaryngologyHead & Neck Surgery, Hospital Tuanku Ja'afar Seremban Malaysia
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15
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Shah M, Halalmeh DR, Sandio A, Tubbs RS, Moisi MD. Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine. Cureus 2020; 12:e8667. [PMID: 32699667 PMCID: PMC7370673 DOI: 10.7759/cureus.8667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors. These anomalies include craniocervical junction abnormalities, cervical ribs, hemivertebrae, and block/fused vertebrae. In addition, patient characteristics, such as tumors, infection, previous cervical spine surgery, obesity, and osteoporosis, play an important role in the development of cervical surgery at the wrong level. These were described, and several effective techniques to prevent this error were provided. A thorough review of the English-language literature was performed in the database PubMed between 1981 and 2019 to review and summarize these risk factors. Compulsive attention to these factors is essential to ensure patient safety. Therefore, the surgeon must carefully review the patient's anatomy and characteristics through imaging and collaborate with radiologists to reduce the likelihood of performing cervical spine surgery at the wrong level.
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Affiliation(s)
- Manan Shah
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
| | | | - Aubin Sandio
- Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA
| | - R Shane Tubbs
- Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.,Anatomical Sciences, St. George's University, St. George's, GRD.,Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
| | - Marc D Moisi
- Neurosurgery, Detroit Medical Center, Detroit, USA
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16
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Partiot C, Guillon M, Peressinotto D, Castex D, Maureille B. Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population. J Anat 2020; 237:119-132. [PMID: 32187701 DOI: 10.1111/joa.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24 weeks of amenorrhoea and 2 years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.
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Affiliation(s)
- Caroline Partiot
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Mark Guillon
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Inrap, Boulevard de Verdun, Le Grand Quevilly, France
| | - David Peressinotto
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France.,Hades Archéologie, Balma, France
| | - Dominique Castex
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
| | - Bruno Maureille
- UMR 5199 PACEA, CNRS, Université de Bordeaux, Pessac Cedex, France
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17
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Kudlicki A. Why a Constant Number of Vertebrae? Digital Control of Segmental Identity during Vertebrate Development: The Somite Cycle Controls a Digital, Chromatin-Based Counter That Defines Segmental Identity and Body Plans in Vertebrate Animals. Bioessays 2019; 42:e1900133. [PMID: 31755133 DOI: 10.1002/bies.201900133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Indexed: 11/06/2022]
Abstract
It is not understood how the numbers and identities of vertebrae are controlled during mammalian development. The remarkable robustness and conservation of segmental numbers may suggest the digital nature of the underlying process. The study proposes a mechanism that allows cells to obtain and store the segmental information in digital form, and to produce a pattern of chromatin accessibility that in turn regulates Hox gene expression specific to the metameric segment. The model requires that a regulatory element be present such that the number of occurrences of the motif between two consecutive Hox genes equals the number of segments under the control of the anterior gene. This is true for the recently discovered hydroxyl radical cleavage 3bp-periodic (HRC3) motif, associated with histone modifications and developmental genes. The finding not only allows the correct prediction of the numbers of segments using only sequence information, but also resolves the 40-year-old enigma of the function of temporal and spatial collinearity of Hox genes. The logic of the mechanism is illustrated in the attached animated video. How different aspects of the proposed mechanism can be tested experimentally is also discussed.
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Affiliation(s)
- Andrzej Kudlicki
- Institute for Translational Sciences, Department of Biochemistry and Molecular Biology, University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, USA
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18
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Brocal J, De Decker S, José-López R, Manzanilla EG, Penderis J, Stalin C, Bertram S, Schoenebeck JJ, Rusbridge C, Fitzpatrick N, Gutierrez-Quintana R. C7 vertebra homeotic transformation in domestic dogs - are Pug dogs breaking mammalian evolutionary constraints? J Anat 2018; 233:255-265. [PMID: 29761492 DOI: 10.1111/joa.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/20/2022] Open
Abstract
The number of cervical vertebrae in mammals is almost constant at seven, regardless of their neck length, implying that there is selection against variation in this number. Homebox (Hox) genes are involved in this evolutionary mammalian conservation, and homeotic transformation of cervical into thoracic vertebrae (cervical ribs) is a common phenotypic abnormality when Hox gene expression is altered. This relatively benign phenotypic change can be associated with fatal traits in humans. Mutations in genes upstream of Hox, inbreeding and stressors during organogenesis can also cause cervical ribs. The aim of this study was to describe the prevalence of cervical ribs in a large group of domestic dogs of different breeds, and explore a possible relation with other congenital vertebral malformations (CVMs) in the breed with the highest prevalence of cervical ribs. By phenotyping we hoped to give clues as to the underlying genetic causes. Twenty computed tomography studies from at least two breeds belonging to each of the nine groups recognized by the Federation Cynologique Internationale, including all the brachycephalic 'screw-tailed' breeds that are known to be overrepresented for CVMs, were reviewed. The Pug dog was more affected by cervical ribs than any other breed (46%; P < 0.001), and was selected for further analysis. No association was found between the presence of cervical ribs and vertebral body formation defect, bifid spinous process, caudal articular process hypoplasia/aplasia and an abnormal sacrum, which may infer they have a different aetiopathogenesis. However, Pug dogs with cervical ribs were more likely to have a transitional thoraco-lumbar vertebra (P = 0.041) and a pre-sacral vertebral count of 26 (P < 0.001). Higher C7/T1 dorsal spinous processes ratios were associated with the presence of cervical ribs (P < 0.001), supporting this is a true homeotic transformation. Relaxation of the stabilizing selection has likely occurred, and the Pug dog appears to be a good naturally occurring model to further investigate the aetiology of cervical ribs, other congenital vertebral anomalies and numerical alterations.
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Affiliation(s)
- J Brocal
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S De Decker
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - R José-López
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - E G Manzanilla
- Teagasc Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - J Penderis
- Vet-Extra Neurology, Broadleys Veterinary Hospital, Stirling, UK
| | - C Stalin
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S Bertram
- Department of Veterinary Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - J J Schoenebeck
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - C Rusbridge
- Fitzpatrick Referrals, Eashing, Surrey, UK.,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | | | - R Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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