Inadvertent C2–C3 Union After C1–C2 Posterior Fusion in Adults

Introduction: Some authors pointed out that there were more than a few patients with inadvertent C2–C3 union after C1–C2 posterior fusion, although few detailed studies of C2–C3 union have been reported. The purpose of this study was to clarify whether C2–C3 union accelerated adjacent C3–C4 disc degeneration after C1–C2 posterior fusion and to investigate the related factors for C2–C3 union. Methods: Sixteen patients with rheumatoid arthritis (RA group) (4 males, 12 females, mean age 60 years, mean follow-up period 4 years and 3 months) and fifteen patients without RA (non-RA group) (11 males, 4 females, mean 52 years, mean follow-up period 3 years and 10 months) who underwent C1–C2 posterior fusion were radiologically assessed. The C2–C3 union was defined as trabecular bone formation at C2–C3 interlamina in lateral radiograph. C3–C4 disc height was measured to evaluate the disc degeneration. Results: C2–C3 union rate was 56% and 60% in RA group and non-RA group, respectively. In RA group, postoperative C3–C4 disc height was lower (Students t-test, P = 0.029) and the decrease rate of C3–C4 disc height was higher (Students t-test, P = 0.015) in patients with C2–C3 union than in patients without C2–C3 union. In non-RA group, the age at operation was older (Students t-test, P = 0.0007), and the C1–C2 fusion angle (Students t-test, P = 0.012) was smaller in patients with C2–C3 union than in patients without C2–C3 union. Conclusions: C2–C3 union after C1–C2 posterior fusion occurred in more than half of both groups. Inadvertent C2–C3 union should be considered a radiological complication and a potential risk factor due to acceleration of C3–C4 disc degeneration in RA.     

慎服维生素C

维生素C是一种水溶性维生素,现代医学研究表明,它不仅有疗疾保健的作用,而且对防治有损形体美的常见病症也有良好的效果。口腔疾病是影响容貌的常见病症,人体内若缺乏维生素C,就会引起牙龈充血、肿胀,一旦感染化脓,还会导致牙齿松动或脱落。如果此时每日补充300～500毫克维生素C,则可以有效地防治此类病症,因为维生素C能增强毛细血管壁的韧性和弹性,预防牙龈充血。     

C3～C7与C3～C6节段单开门椎管扩大成形术后轴性痛的差异

目的:研究保留C7棘突、椎板及其附着颈后肌群能否减少单开门椎管扩大成形术后轴性痛的发生。方法:纳入2010年4月～2011年4月在我院接受开门节段为C3～C6(A组,26例)或C3～C7(B组,27例)颈后路单开门椎管扩大成形术的患者53例,记录随访时(通过门诊和电话随访)两组病例神经功能恢复及颈椎活动度变化情况,同时比较两组患者术后轴性痛发生的时间、初始疼痛程度VAS评分及完全缓解所需时间的差异。结果:两组患者术后1年随访时JOA评分、神经功能改善率、颈椎活动度及颈椎活动度改变率均无明显统计学差异(P>0.05)。A组轴性痛的发生率为30.7%(8/26),其中轻度5例,中度3例;B组发生率为33.3%(9/27),其中轻度4例,中度4例,重度1例,两组轴性痛发生率和初始疼痛程度分级均无明显统计学差异(P>0.05)。A组病例初始VAS评分平均为3.0分,B组为4.4分,两组间差异有显著性(P<0.05);A组病例疼痛出现时间平均为术后57.3d,B组为25.4d,两组间差异显著(P<0.05);A组疼痛完全缓解的时间为术后99.1d,B组为165.9d,两组间有统计学差异(P<0.05)。结论:与传统C3～C7颈后路单开门椎管扩大成形术相比,C7棘突、椎板及其后方附着颈后肌群的保留并不影响术后颈椎活动度和神经功能的恢复,且可以降低初始轴性痛的VAS评分,并延迟轴性痛发生时间、减少完全缓解所需时间,可提高患者生活质量。     

Upper cervical spine chordoma of C2–C3

Chordoma is a rare low-grade malignant neoplasm derived from the remnants of the embryonic notochord. This locally invasive neoplasm is subject to recurrence after treatment. The median survival time is estimated to be 6.3 years. Various treatment approaches have been attempted, including radical excision, radiotherapy and chemotherapy. Treatment outcome is significantly influenced by the size and site of the chordoma. Recently, Imatinib, a molecular-targeted agent, has been shown to have antitumor activity in chordoma. Proton radiotherapy, stereotactic radiotherapy and intensity-modulated radiotherapy have also been used. Surgical treatment is still the primary choice for chordoma. It has become more aggressive in recent years, evolving from intralesional or partial excision to en bloc resection. However, upper cervical localizations make such en bloc resection in most cases not possible. We present and discuss the therapeutic challenges of a young female with large retropharyngeal chordoma who presented to our institution after conventional photon beam radiotherapy. This C2/3 tumor was classified IB according to the Enneking classification. It distributed to layers A–D and sectors 1–6 according to the Weinstein Boriani Biagini Classification. The left vertebral artery (VA) was encapsulated and displaced. One stage intralesional extracapsular tumor excision and reconstruction was achieved by combined bilateral high anterior cervical approaches and posterior approach. No recurrence or metastasis was observed 3 years after the operation. She returned to her previous occupation as office worker.     

C2、C3型Pilon骨折的手术治疗

AO对胫腓骨远端骨折分为3型3亚型：A型为胫骨远端关节外骨折，B型胫骨远端部分关节面骨折，C型为Pilon骨折即累及关节面的干骺端完全骨折；有3个亚型：C1较少移位，C2关节面明显移位但粉碎程度轻，C3为严重的关节面粉碎骨折和移位。其中C2和C3型骨折因关节软骨及软骨下骨移位，     

膝关节骨性关节炎患者尿液中C2C水平检测

目的观察并探讨尿液中Ⅱ型胶原羧基末端3/4片段(C2C)水平与膝关节骨性关节炎(KOA)患者病变程度的关系。方法收集90例膝关节骨性关节炎患者及20例非膝关节骨性关节炎患者清晨尿液标本5 mL及膝关节正侧位影像学资料,尿液标本置-80℃冰箱保存,影像学资料根据Kellgren-Lawrence放射学分级标准对膝关节骨性关节炎患者的影像学表现进行分级,实验分为五组,对照组,I级组,II级组,III级组及IV级组。各组间年龄及性别构成比较没有显著性差异,无统计学意义。尿液标本收齐后采用酶联免疫吸附试验(ELISA)检测尿液中C2C水平。结果与对照组(261.235±39.944 pg/mL)相比,膝关节骨性关节炎组C2C水平(218.341±22.270 pg/mL)明显升高,差异有统计学意义(P0.01)。各组C2C水平比较:IV组(311.872±18.759 pg/mL)III组(273.753±18.595 pg/mL)II组(256.251±23.379 pg/mL)I组(219.009±13.431pg/mL)或正常组(218.341±22.270 pg/mL)(P=0.000)。I级膝关节骨性关节炎组患者尿液C2C与对照组水平相差无统计学意义(P0.05)。结论骨性关节炎患者C2C水平较正常对照组高,C2C升高水平与膝关节骨性关节炎病变程度平行,且二者呈高度正相关。     

时尚美容维他命C

水嫩素白的肌肤,美丽细致的脸庞总是让人忍不住的多看一眼。其实这种吹弹可破的白嫩肌肤,除了天生丽质外,日常的维护保养最为重要,而好的化妆品就是功不可没的大功臣。     

浅谈胱抑素C

目前血清胱抑素C在临床上运用的越来越多,为加强临床医师对其的认识,浅谈一下血清胱抑素c临床价值.     

补体C3、C3c和C3d在IgA肾病肾组织中的表达

IgA肾病中补体C3激活导致肾小球损伤,但C3c和C3d对其影响还不清楚。本研究对C3、C3c和C3d分子特点进行分析,探讨它们在IgA肾病发病机制中的作用。     

C3肾小球病

C3肾小球病较罕见,因补体旁路途径过度激活,导致C3沉积于肾小球而致病。半数以上患者10年进展至肾衰竭。C3肾小球病占肾活检1%~2%,可见于各年龄阶段,男女发病率无明显差异,有家族聚集倾向。免疫荧光肾小球C3显性染色,免疫球蛋白或免疫复合物等沉积很少或没有,C3沉积比后者高至少2个数量级。电镜可进一步分为C3肾小球肾炎(C3GN)和致密物沉积病(DDD),C3GN沉积物主要沉积于系膜区、上皮下或内皮下,DDD沿肾小球基底膜形成致密暗带。     

丝裂霉素C与C2-神经酰胺联合应用治疗膀胱癌

目的 观察丝裂霉素C（MMC）与C2-神经酰胺（C2-cer）联合应用对人膀胱癌细胞的作用效果，并探讨其机制。方法 不同浓度MMC与C2-cer单独及联合作用于人膀胱癌BIU-87细胞后，应用噻唑蓝（MTT）比色法检测细胞生长抑制率，计算合用指数（CI），流式细胞仪（FCM）检测BIU-87细胞凋亡率，吖啶橙（AO）荧光染色观察凋亡形态学变化，Western blot检测细胞色素C在细胞内分布变化，并检测Caspase-3活性改变。结果 单独应用时MMC与C2-cer的中效浓度分别是159和28μmol／L，联合用药时下降为55和11μmol／L，CI=0．74。MMC与C2-cer单独及联合应用均可导致BIU-87细胞出现凋亡的形态学变化。两种药物联合应用时的凋亡率高于各自单用（P＜0．05）。线粒体细胞色素C含量在MMC与C2-cer单独及联合应用时均较对照组减少，联合用药时减少最为明显，细胞质内细胞色素C含量在联合用药时增加也最为明显（P＜0．05）。Caspase-3活性在MMC与C2-cer单独及联合应用时均较对照组升高，联合用药时升高最为明显（P＜0．05）。结论 MMC与C2-cer联合应用可以通过共同诱导细胞凋亡，协同抑制膀胱癌细胞生长。线粒体细胞色素C释放和Caspase-3活性变化可能发挥重要作用。     

补体C3a/C3aR与肾脏疾病

补体系统（Complement system）是由补体及其调节因子和相关膜蛋白组成的机体免疫反应系统.补体可由经典激活途径、凝集素激活途径及旁路激活途径（替代激活途径）三条途径被激活,从而产生溶细胞、清除免疫复合物、介导炎症[1]等效应.C3是补体固有成分之一,同时也是人体正常血清中含量最多的补体成分.     

甲状旁腺素通过磷脂酶C非依赖途径激活蛋白激酶C

目的利用基于荧光共振能量转移(Fluorescence resonance energy transfer,FRET)技术的检测PKC激活或PKC-delta激活的报告分子来确定PTH是否可以通过PLC非依赖途径激活PKC和PKC-delta。方法将表达PKC激活报告分子(CKAR)的质粒和表达PKC-delta激活报告分子的质粒转染HEK293细胞,培养72h后通过共聚焦显微镜检测FRET的改变,并以此判断佛波酯(TPA)是否激活PKC和PKC-delta。将表达甲状旁腺素1型受体(PTHR1)的质粒与CKAR质粒或PKC-delta质粒共转染HEK293细胞,培养72h后通过共聚焦显微镜检测FRET的改变,并判断PTH(1-34)、G1R19(1-34)和0.1%的三氟乙酸(TFA)对PKC和PKC-delta的作用。结果在转染CKAR质粒或PKC-delta质粒的HEK293细胞,TPA均使青色荧光与黄色荧光的强度之比(C/Y)增加。在共转染PTH1R质粒与CKAR质粒或PKC-delta质粒的HEK293细胞,PTH(1-34)和G1R19(1-34)均增加了C/Y的值,而0.1%TFA未引起C/Y的改变。结论 PTH与PTHR1结合后通过PLC非依赖途径激活PKC/PKC-delta。     

磷脂酶C与生殖

磷脂酶C(PLC)是磷脂酰肌醇信号转导途径中一个关键酶。目前确认的哺乳类PLC共有PLC β、PLC γ、PLC δ、PLC ε和最近新发现的PLC ζ 5种亚型 ,12种同工酶。不同亚型的结构、调控和组织分布各有差异。PLC在调控信号转导通路中的特性使其在顶体反应、卵子激活中发挥了巨大的作用。本文综述了PLC家族 5种亚型的结构、调控机制及PLC在男性生殖领域的相关内容 ,包括PLC引起卵子发生Ca2 + 振荡、激活卵子、促进胚胎发育等 ,并进一步探讨了PLC在临床上可能的应用前景。     

C3肾小球病

C3肾小球病是一组新近被认可的发病率较低的原发性肾小球疾病。1974年有学者首次描述了一组经免疫荧光检查肾小球内仅有C3沉积、而无免疫球蛋白及C1q沉积的肾小球疾病。     

C2 translaminar screw as the optimal choice for atlantoaxial dislocation with C2–C3 congenital fusion

Objective and importance  

The entry point and trajectory are very important for transarticular screw (TAS) and C2 pedicle screw (PDS) plantation. When the physical size is not large enough for the screw passing through, an accurate entry point is the most important point for successful screw insertion without vertebral artery (VA) injury and spinal cord injury. Once the laminas of C2 and C3 are fused, the normal anatomic mark might disappear and the insertion point would be hard to find. As a result, the complication of TAS or PDS implantation increases rapidly. We used C2 translaminar screws (TLSs) with C1 lateral mass screws as the optimal fixation for atlantoaxial dislocation in order to reduce the risk of VA injury and spinal cord injury.