Traumatic Posterior Atlantoaxial Dislocation With an Associated Fracture: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

To investigate the clinical presentation, mechanism of injury, patients' characteristics, diagnosis, treatment, and prognosis of traumatic posterior atlantoaxial dislocation with fracture (TPAD).

BACKGROUND

TPAD is an extremely rare entity, with a limited number of cases reported in the literature. Although rare, a thorough understanding of the pathogenesis and management of such cases is required due to the high risk of spinal cord compression and the severity of neurological deficits. We conducted a systematic review of all cases of TPAD with fractures reported in the literature.

METHODS

This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. Relevant literature was retrieved from the Pubmed database. All published English-written studies involving human subjects with relevant data regarding TPAD were included.

RESULTS

Two case series and 20 case reports published between 1924 and 2021 describing 28 patients with TPAD were included. The median age at presentation was 51.5 years, with male predominance (83%). The most common fracture pattern was Anderson and D'alonzo type II odontoid fracture (78%). Neurological exam at presentation was intact in 52% of patients. The primary diagnostic imaging was computed tomography employed in 96% of cases. The management consisted of 2 stages protocol, initially, a temporary axial traction was employed (54%), and later definitive surgical treatment was employed (93%). The posterior surgical approach was favored in 82% of cases.

CONCLUSION

TPAD with fracture occurred in the majority of cases with Anderson and D'alonzo type II odontoid fracture, predominantly in males. Diagnosis is usually established based on computed tomography imaging; further imaging may not be indicated as it does not seem to alternate the patient's management course. Surgical intervention was employed in almost all cases, with favored results through posterior C1-C2 fusion.

LEVEL OF EVIDENCE

Level-IV.

Dipalmitoylphosphatidylcholine in the heart of mice with lupus might support the hypothesis of dual causes of autoimmune diseases

Lung surfactant dipalmitoylphosphatidylcholine (DPPC) settles on the luminal aspect of blood vessels and forms an active hydrophobic spot - AHS, at which nanobubbles are formed. We hypothesized that large molecules circulating in the blood will adhere and deformed at the gas phase/plasma interface being recognized as autoantigen. NZB mice are afflicted spontaneously with lupus. If their blood vessels contain high levels of DPPC it may support the theory of dual causes of autoimmunity. Phospholipids were extracted from hearts of 8 LPR (lupus) mice and 5 MJP (control mice), and were tested for presence of DPPC. DPPC mg/g was 0.059 in lupus mice and 0.017 in control mice where for equal variance; P = 0.08 and for unequal variance P = 0.048. This trend of 3.5-fold DPPC in lupus mice, supports our hypothesis of dual causes as the origin of autoimmune diseases. The high potential of the hypothesis should be a drive to further explore its validity.

Screening for gastric cancer using exhaled breath samples

BACKGROUND

The aim was to derive a breath-based classifier for gastric cancer using a nanomaterial-based sensor array, and to validate it in a large screening population.

METHODS

A new training algorithm for the diagnosis of gastric cancer was derived from previous breath samples from patients with gastric cancer and healthy controls in a clinical setting, and validated in a blinded manner in a screening population.

RESULTS

The training algorithm was derived using breath samples from 99 patients with gastric cancer and 342 healthy controls, and validated in a population of 726 people. The calculated training set algorithm had 82 per cent sensitivity, 78 per cent specificity and 79 per cent accuracy. The algorithm correctly classified all three patients with gastric cancer and 570 of the 723 cancer-free controls in the screening population, yielding 100 per cent sensitivity, 79 per cent specificity and 79 per cent accuracy. Further analyses of lifestyle and confounding factors were not associated with the classifier.

CONCLUSION

This first validation of a nanomaterial sensor array-based algorithm for gastric cancer detection from breath samples in a large screening population supports the potential of this technology for the early detection of gastric cancer.

Reduced glutathione increases quercetin stimulatory effects on HDL- or apoA1-mediated cholesterol efflux from J774A.1 macrophages

In our in vitro study, we analyzed the effects of incubation of J774A.1 macrophages with reduced glutathione (GSH) and quercetin on the extent of cellular cholesterol efflux by high-density lipoprotein (HDL) or apolipoprotein A1 (apoA1). This combination was the most potent one among other exogenous and endogenous antioxidant combinations, since it significantly increased the extent of HDL-mediated cholesterol efflux from macrophages by 47% versus control cells, whereas quercetin (20 μM) or GSH (200 μM) alone increased it by only 37% or 17%, respectively. Similarly, apoA1-mediated cholesterol efflux was increased by 11% or 22% in quercetin or quercetin + GSH-treated cells, respectively, versus control cells. These stimulatory effects were noted only after 20 h of cell incubation. The combination of quercetin + GSH demonstrated high scavenging capacity of free radicals versus quercetin or GSH alone. In addition, quercetin + GSH significantly decreased macrophage oxidative stress as measured by the scavenging capacity of free radicals in the cells, the formation of reactive oxygen species, and the levels of cellular glutathione and lipid peroxides. There was no significant effect of quercetin + GSH on cellular HDL binding, on ATP-binding cassette A1 (ABCA1) activity, or on ABCG1 messenger RNA (mRNA) levels. In contrast, mRNA levels for ABCA1 and peroxisome proliferator-activated receptor alpha (PPARα) were both significantly increased by 89% and 93%, respectively, in quercetin + GSH-treated cells versus control cells. Quercetin alone increased the mRNA levels for ABCA1 or PPARα by 42% or 77%, respectively, whereas GSH alone increased it by 22% or 28%, respectively. Mass spectra analysis revealed that oxidized quercetin reacts with GSH to form a new adduct product. We thus conclude that the stimulatory effects of quercetin + GSH on apoA1- or HDL-mediated macrophage cholesterol efflux are related to the ability of GSH to preserve quercetin in its reduced form.

Neural HO-1/sterol interactions in vivo: implications for Alzheimer's disease

BACKGROUND

Up-regulation of heme oxygenase-1 (HO-1) and altered cholesterol (CH) metabolism are characteristic of Alzheimer-diseased (AD) neural tissues. We previously provided evidence of significant HO-1/sterol interactions in vitro (cultured rat astroglia) and in post-mortem human AD brain (Religious Orders Study).

METHODS

The current experiments were designed to further delineate these interactions in vivo by comparing the behavior of HO-1/sterol interactions in two mouse models; (1) a novel HO-1 transgenic mouse (GFAP.HMOX1) engineered to selectively express human HO-1 in the astrocytic compartment and (2) the previously described triple transgenic AD mouse (3xTg-AD). In samples of frontal cortex, total CH, CH precursors and relevant oxysterols were quantified by gas chromatography-mass spectrometry (GC-MS) and HO-1 protein expression was assessed by ELISA. The relationships of HO-1 expression to total CH, CH precursors and total oxysterols were determined for both mouse models using linear regression analysis.

RESULTS

HO-1 expression is increased in GFAP.HMOX1 mice relative to wild type and in 11-12-month-old 3xTg-AD mice (with AD-like phenotype) relative to control mice and 5-6-month-old 3xTg-AD mice (no AD-like phenotype). Total oxysterols significantly decreased as HO-1 expression increased in GFAP.HMOX1 mice expressing high levels of HO-1, whereas total oxysterols increased as HO-1 expression increased in aged 3xTg-AD mice. Total CH and total CH precursors increased as HO-1 protein expression increased in 11-12-month-old 3xTg-AD mice relative to 5-6-month old 3xTg-AD mice.

CONCLUSIONS

Our findings indicate a differential impact of HO-1 on patterns of brain sterol and redox homeostasis that is contingent on the presence or absence of AD-like neuropathology. These data provide fresh insight concerning the regulation of sterol homeostasis within the aging and degenerating CNS which may inform the development of novel therapeutic and preventive strategies for the management of AD and related conditions.

Alterations in striatal oxidative stress level produced by pharmacological manipulation of dopamine as shown by a novel synthetic marker molecule

Oxidative stress (OS) is thought to participate in neurodegenerative diseases such as Parkinson's disease, but the contribution of dopamine metabolism and auto-oxidation to OS in Parkinson's and other diseases is not clear. Oxidative stress in rat striatum was measured by microdialysis using a novel synthetic compound composed of tyrosine and linoleic acid (LT), and determination of the oxidation products LT-OOH and LT-epoxy by HPLC-MS. Since LT is non-diffusible through the microdialysis membrane, the oxidized products formed in microdialyzate reflect oxidation state in the extracellular compartment. The extracellular oxidative stress (OS(ec)) was compared with intracellular oxidative stress (OS(ic)) as measured by tissue levels of oxidized and reduced glutathione and 7-ketocholesterol. Reserpinization caused an increase in OS(ic) but a reduction in OS(ec). Inhibition of both subtypes of monoamine oxidase (MAO-A and MAO-B) with tranylcypromine caused a reduction in both OS(ic) and OS(ec) whereas selective inhibition of MAO-A with clorgyline caused a reduction in Os(ic) but no change in OS(ec). A high dose (10 mg/kg) of amphetamine caused an increase in OS(ec) whereas a smaller dose (4 mg/kg) caused a reduction in OS(ec). Both doses of amphetamine reduced OS(ic). The present findings are consistent with a role of monoamine oxidase as well as dopamine auto-oxidation in production of striatal OS.

Cancer incidence in Jordan, 1996-2005

Cancer causes 14% of all deaths in Jordan. This paper presents the incidence of cancer in Jordan from 1996 to 2005. Over the 10-year period there were 33 661 cases of cancer. The average crude incidence rate was 66.2 per 100 000 for males and 70.0 per 100 000 for females (age-standardized rates: 119 per 100 000 adult males and 116 per 100 000 adult females). The 5 most frequently reported cancers among adult males were: lung (10.6%), colorectal (9.8%), leukaemia (9.3%), urinary and bladder (8.6%) and prostate (7.4%). For adult females these were: breast (32.0%), colorectal (9.0%), leukaemia (6.7%), thyroid (4.9%) and corpus uteri (4.6%). Cancer rates have changed little since 1996.

A novel compound JPM8: in vivo penile activity promotion in rats, effect on the relaxation and cGMP/cAMP accumulation in isolated rabbit corpora cavernosa

JPM8 is a novel sildenafil-like PDE5 inhibitor. Its efficacy was tested in vivo by the oral administration of drugs to a rat model and recording penile activity changes. Effect on the relaxation of the rabbit cavernosa was tested in vitro using an organ bath were drugs are added to the tissue media and relaxation was recorded using a transducer connected to a chart recorder. The accumulation of cGMP and cAMP was measured by incubation of cavernosa strips and then extracting the produced cGMP and cAMP in the incubation mixture, then quantitating it using ELISA. JPM8 showed increased and promoted sexual and penile activity in rats in a similar but slightly higher trend than the positive control sildenafil. JPM8 was more efficient in relaxing the rabbit corpora cavernosa than sildenafil. The cGMP and cAMP accumulation showed a similar trend for both drugs. We concluded that JPM8 was very effective in promoting sexual activity in rats, relaxing the corpora cavernosa and promoting cGMP accumulation in rabbits.

Effects of Crystal Packing on Photoinduced Proton-Transfer Processes of 2,4-Dinitrobenzylpyridine Derivatives

Photoinduced and thermally activated proton-transfer processes taking place in crystals of 2-(2,4-dinitrobenzyl)pyridine and some of its derivatives are highly sensitive to molecular packing. Small differences in the way the molecules are packed in the crystal are found to dominate molecular properties in controlling the photoactivity of the different phototautomers, leading, for example, to photoactive or photoinert systems. Three compounds, 2-(2,4-dinitrobenzyl)-4-methylpyridine, 1-(2,4-dinitrophenyl)-l-(2-pyridine)ethane and 4′-(2,4-dinitrobenzyl)-4-methyl-2,2′-bipyridine, having different photochemical properties, were prepared and their crystal structures characterized by means of X-ray analysis. In the photoinert crystals the 2,4-dinitrophenyl group is π-stacked with other aromatic rings of neighboring molecules. This arrangement may open some deactivation channels to the excited state which are faster than the proton-transfer process, leading to photoinert crystals. The absence of π-stacking between the chromophore and other aromatic rings leads to photoactive systems. An O atom of the o-nitro group is the only basic atom that is systematically found to interact with the abstracted proton. It seems that this atom is responsible for the photoinduced proton abstraction of the benzylic H atom, while the role of the N atom of the pyridine ring in the proton-abstraction process is mainly inductive.

Effects of propofol and thiopentone on picrotoxin convulsive threshold in the rabbit

The purpose of the present study was to examine the effect of intravenous administration of propofol and thiopentone on picrotoxin-induced seizures using the picrotoxin convulsive threshold test in the rabbit. Neither propofol nor thiopentone at a dose of 1.25 mg/kg had any significant effect on picrotoxin seizure threshold. However, at higher doses (2.5, 5, 10 mg/kg) both propofol and thiopentone produced a significant and dose-dependent increase in the picrotoxin convulsive threshold. These findings suggest that propofol is an effective anticonvulsant against picrotoxin-induced seizures in the rabbit.

Coagulase-negative staphylococci in multiple blood cultures: strain relatedness and determinants of same-strain bacteremia

The frequency of strain relatedness was determined among randomly selected patients with coagulase-negative staphylococcal infections as determined in multiple blood cultures by plasmid typing, determination of species, and antibiotyping. Strain relatedness was demonstrated in 21 of 47 episodes of bacteremia (44.7%) among 34 patients, with a similar percentage among patients with two or one positive blood culture in 24 h (14 of 30 [46.7%] versus 7 of 17 [41.2%], respectively). Same-strain bacteremia was more frequent in cases of infection among patients with a corresponding fever (15 of 21 [71.4%]), among patients infected with organisms from an identifiable source (7 of 9 [77.8%]) and with non-Staphylococcus epidermidis species (9 of 11 [81.8%]), and among patients with nosocomially acquired infections (18 of 36 [50%]). Comparing episodes with or without strain relatedness, no difference was noted in the time to growth (2.1 +/- 1.4 versus 1.9 +/- 0.9 days, respectively), in bacterial growth in two culture bottles (5 of 14 [35.7%] versus 8 of 24 [33.3%], respectively), and in the presence of additional negative blood cultures (9 of 21 [42.9%] versus 11 of 26 [42.3%], respectively). The antibiotypes of all related strains and 7 of 44 (15.9%) unrelated pairs were identical. These findings demonstrate that coagulase-negative staphylococci from multiple blood cultures are frequently unrelated, suggesting a high prevalence of contamination. In the absence of precise measures for demonstrating strain relatedness, the combination of a clinical assessment with antibiotype determination appears to be a suitable alternative.

Thyroid function in children with beta-thalassemia major in north Jordan

Basal thyroid function was assessed by serum thyroxine, tri-iodothyronine and thyroid-stimulating hormone levels in 90 patients 2-10 years old with beta-thalassaemia major. Based on measured serum ferritin levels, patients were classified into two groups: group (I) which included 63 patients with ferritin concentrations ranging from 300 to 7000 ng/ml (mild iron overload) and group (II) which included 27 patients with ferritin concentrations higher than 7000 ng/ml (severe iron overload). The results of thyroid function in both groups were compared with those of 50 control subjects. In group (I), the mean concentrations of all measured hormones were not significantly different from those of the controls. In group (II), the mean concentrations of thyroxine and tri-iodothyronine decreased by 29 and 35 per cent (P < 0.05), respectively, and the mean concentration of thyroid-stimulating hormone showed a 2.6-fold increase (P < 0.01) in comparison with those of the controls. The data clearly demonstrate the occurrence of impaired thyroid function and its possible association with iron overload in a considerable proportion of transfusion-dependent beta-thalassaemic patients.

Effects of glyburide on ischemia-induced changes in extracellular potassium and local myocardial activation: a potential new approach to the management of ischemia-induced malignant ventricular arrhythmias

The increase in extracellular potassium [K+]o levels during the early phase of myocardial ischemia may result in part from activation of adenosine triphosphate-sensitive K+ channels. Glyburide, a second-generation hypoglycemic sulfonylurea, is a potent blocker of these channels. We studied the effects of glyburide on [K+]o and on intramyocardial conduction delay during a 10-minute occlusion of the left anterior descending artery in the dog. K(+)-sensitive electrodes and bipolar plunge electrodes were introduced to record, respectively, [K+]o and local electrograms from close sites in midmyocardial regions in normal, border, and ischemic zones. Recordings were obtained before (control ischemia [CI]) and 20 minutes after intravenous administration of 0.15 mg/kg of glyburide (glyburide plus ischemia [G + I]). During G + I the extent of the increase in [K+]o was less compared to that during CI, and the difference was statistically significant during the first 7 minutes of ischemia in the ischemic zone and during the first 4 minutes of ischemia in the border zone. On the other hand, the degree of local intramyocardial conduction delay was significantly reduced during G + I compared to CI during the entire 10 minutes of ischemia in both the ischemic and border zones. In summary, our results have shown that glyburide significantly reduced the rise of [K+]o and intramyocardial delay during the early phase of acute ischemia and could thus attenuate the electrophysiologic consequences of ischemia that underlie the initial phase of malignant tachyarrhythmias. Although the effects of glyburide may result in part from a direct action of the drug on cardiac adenosine triphosphate-sensitive K+ channels, other metabolic antiischemic effects cannot be ruled out.

Determination of polycyclic aromatic hydrocarbons in environmental samples by high performance thin-layer chromatography and fluorescence scanning densitometry

High performance thin-layer chromatography (HPTLC) with fluorescence scanning densitometry was used for the quantitative determination of polycyclic aromatic hydrocarbons in the soluble organic fraction of air particulate samples. A method using normalized emission response ratios was developed to determine sample identity and to test for peak homogeneity. To preserve the high sample throughput of HPTLC, the two-point calibration method was used for quantitation. The principal advantages of HPTLC as a screening technique for environmental samples are its low cost, methodological simplicity, high sample throughput, and the ability to analyze crude samples with a minimum amount of sample cleanup.

Comparison of methods for separating polycyclic aromatic hydrocarbons by high-performance thin-layer chromatography

A comparison is made of different stationary phases (silica gel, cellulose, acetylated cellulose, and 3-aminopropyl-, ethyl-, octyl-, octadecyl-, and diphenylsilanized silica gel), mobile phases, and development techniques (conventional, continuous, and multiple) for the separation of environmentally important polycyclic aromatic hydrocarbons by high-performance thin-layer chromatography. Reversed-phase separations using octadecylsilanized silica gel and methanol-water or methanol-water-based ternary solvent systems were found to give the best separations. A new development technique, multiple development with application of the mobile phase further up the plate at each successive development, provided superior resolution of the polycyclic aromatic hydrocarbons compared with conventional multiple development.