Locating the Seventh Cervical Spinous Process: Development and Validation of a Multivariate Model Using Palpation and Personal Information

Objective

The aim of this study was to develop and validate a multivariate prediction model, guided by palpation and personal information, for locating the seventh cervical spinous process (C7SP).

Locating the Seventh Cervical Spinous Process: Accuracy of the Thorax-Rib Static Method and the Effects of Clinical Data on Its Performance

Objectives

The aim of this study was to assess the thorax-rib static method (TRSM), a palpation method for locating the seventh cervical spinous process (C7SP), and to report clinical data on the accuracy of this method and that of the neck flexion-extension method (FEM), using radiography as the gold standard.

Intrarater and Inter-rater Reliability of Maximal Voluntary Neck Muscle Strength Assessment Using a Handheld Dynamometer in Women With Headache and Healthy Women

Objective

This study aimed to determine the inter-rater and intrarater reliability, agreement, and minimal detectable change (MDC) of the neck muscle strength test using a handheld dynamometer in healthy women and women with headaches.

A Novel and Accurate Palpation Method for Identification of the L4 Spinous Process: A Preliminary Study of Accuracy

ObjectiveThe purpose of this study was to assess a novel method of lumbar spinous process (SP) palpation by using magnetic resonance imaging (MRI) high-signal marker reference standards for verification.MethodsClinicians (doctors of chiropractic) in this study used either: (1) the standard/traditional method of identifying the L4 SP using the supracristal plane (n = 14) or (2) a novel method that manually induced sacral motion to identify the L5 and then the L4 SP (n = 54). The clinicians, blinded to the results of each other, used a grease pencil to mark the location identified as the L4 SP. An MRI high-signal marker then was taped across this location. The MRI scans were assessed by a radiologist, blinded to the palpation method, who extended a line posteriorly from the superior and inferior extent of the L4 SP and determined whether the high-signal marker was within the lines bordering the L4 SP (ie, “on-target”).ResultsPalpation using the traditional method showed a 35.7% accuracy, with 5 of 14 “on target” and all “off target” being too superior. Palpation using the novel method showed 77.8% accuracy, with 42 of 54 “on target” and 3 “off target” being too superior and 9 “off target” too inferior.ConclusionsThe novel method performed better than the traditional method. The novel method shows promise. Additional prospective research should be conducted to fully assess the accuracy of the novel method compared with traditional methods of palpation.     

Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study

ObjectiveThe purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP).MethodsThis cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined.ResultsThe accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = ?1.1°, 95% CI, ?1.6 to ?0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = ?0.088 and ?0.099, respectively) and disability (ρ = ?0.231 and ?0.249, respectively).ConclusionCraniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.     

Accuracy of Palpation Procedures for Locating the C1 Transverse Process and Masseter Muscle as Confirmed by Computed Tomography Images

ObjectiveThe purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy.MethodsThis was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient.ResultsThe right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r = .219; 95% confidence interval, 0.018-0.403; P = .033).ConclusionPalpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles.     

Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5

The objective was to examine inter-tester reliability and validity of two therapists identifying the spinous processes (SP) of C7 and L5, using one predefined surface palpation procedure for each level. One identification method made it possible to examine the reliability and the validity of the procedure itself. Two manual therapists examined 49 patients (29 women). Aged between 26 and 79 years, 18 were cervical and 31 lumbar patients. An invisible marking pen and ultraviolet light were used, and the findings were compared. X-rays were taken as an objective measure of the correct spinal level. Percentage agreement and kappa statistics were used to evaluate reliability and validity. The best inter-therapist agreement was found for the skin marks. Percentage agreement within 10mm and 20mm was 67% and 85%, respectively. The inter-tester reliability for identifying a radiological nominated SP by palpation was found to be poor for C7 and moderate for L5, with kappa of 0.18 and 0.48, respectively. The results indicated acceptable inter-therapist surface palpation agreement, but the chosen procedures did not identify the correct SP. This indicates that the procedures are not precise enough. Future reliability studies should test other non-invasive palpation procedures, both individually and in combination, and compare these with radiological investigation.     

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

Objectives:

Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Rotatory thrust manipulation applied to the lower cervical segments is associated with controversy and the potential for eliciting adverse reactions (AR). The purpose of this clinical trial was to describe two translatory non-thrust mobilization techniques and evaluate their effect on cervical pain, motion restriction, and whether any adverse effects were reported when applied to the C7 segment.

Methods:

This trial included 30 participants with painful and restricted cervical rotation. Participants were randomly assigned to receive one of the two mobilization techniques. Active cervical rotation and pain intensity measurements were recorded pre- and post-intervention. Within group comparisons were determined using the Wilcoxon signed-rank test and between group comparisons were analyzed using the Mann–Whitney U test. Significance was set at P = 0.05.

Results:

Thirty participants were evaluated immediately after one of the two mobilization techniques was applied. There was a statistically significant difference (improvement) for active cervical rotation after application of the C7 facet distraction technique for both right (P = 0.022) and left (P = 0.022) rotation. Statistically significant improvement was also found for the C7 facet gliding technique for both right (P = 0.022) and left rotation (P = 0.020). Pain reduction was statistically significant for both right and left rotation after application of both techniques. Both mobilization techniques produced similar positive effects and one was not statistically superior to the other.

Discussion:

A single application of both C7 mobilization techniques improved active cervical rotation, reduced perceived pain, and did not produce any AR in 30 patients with neck pain and movement limitation. These two non-thrust techniques may offer clinicians an additional safe and effective manual intervention for patients with limited and painful cervical rotation. A more robust experimental design is recommended to further examine these and similar cervical translatory mobilization techniques.     

Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy

Background: The head-up tilt test (HUT) is widely used to investigate unexplained syncope; however, in clinical practice, it is long and sometimes not well tolerated. Objectives: To compare the sensitivity, specificity, accuracy, and patients' tolerance of a conventional and shortened HUT. Methods: Patients with a history of vasovagal syndrome (VVS) were randomized to a conventional HUT (group I) consisting of 20-minute passive tilt followed by 25 minutes after administration of sublingual isosorbide dinitrate (ISDN), or a shortened HUT (group II) where ISDN was given immediately after tilt and observed for 25 minutes. The control group consisted of age- and gender-matched subjects without VVS symptoms. A specific questionnaire to evaluate tolerance was applied. Results: Sixty patients (29 ± 10 years, 82% female) were included. In group I, 22/30 patients had a positive HUT compared to 21/30 in group II (73% vs 70%, P = 0.77). There was also no difference in the accuracy between the two protocols (63% vs 73%, P = 0.24). The time to positivity was shorter in group II (13.2 minutes vs 30 minutes, P < 0.001). Within the control group (n = 60), the frequency of false-positives was 47% and 23% for the conventional and shortened HUT, respectively (P = 0.058). After conventional HUT, 65.2% subjects reported that the test was too long compared to 25% subjects after the shortened HUT (P = 0.002). Conclusion: In this study, the HUT without passive phase was not inferior to the conventional HUT regarding sensitivity, specificity, and accuracy. Furthermore, the shortened ISDN-potentiated protocol allowed faster diagnosis and was better tolerated. (PACE 2012; 35:1005-1011).     

Relationship between the Degree of Thoracic Deformity and the Angle Formed by a Line Connecting the Sternum and the Spinous Process of the Vertebrae in Individuals with Severe Motor and Intellectual Disorders

[Purpose] The purpose of this study was to examine the relationship between the degree of thoracic deformity (TD) and the angle formed by a line drawn on transverse plane computed tomography (CT) images, connecting the sternum and the spinous process of the vertebrae at the level of the xiphisternum, and the perpendicular line from the floor (ANGLE), in individuals with severe motor and intellectual disorders (SMID). [Subjects] Twenty seven individuals with SMID were examined. [Methods] CT transverse images were acquired at the level of the xiphisternum of each patient. Two protocols were used to measure the anteroposterior (AP) and laterolateral (LL) diameters. The largest AP diameters were measured along a perpendicular line from the floor (protocol 1) and the line from the midline of the sternum to the spinous process of the vertebrae (protocol 2). The largest LL diameters were measured along the lines perpendicular to the AP diameters in each protocol. The ratios of the AP to LL diameters and the difference between the ratios of protocols 1 and 2 (DIFFERENCE) were calculated. [Results] Moderate to good correlation between DIFFERENCE and ANGLE was observed, and DIFFERENCE became larger with increasing ANGLE. [Conclusions] These results show that ANGLE indicates the degree of TD.Key words: Severe motor and intellectual disorders, Thorax, Deformity     

The requirement for C3 receptors on the precursors of 19S and 7S antibody-forming cells

The main conclusion from this study is that C3 receptors are not required for the generation from B cells of a thymus-dependent 7S antibody response. The requirement for C3 receptors on the precursors of antibody-forming cells was studied in an adoptive transfer system using thoracic duct lymphocytes (TDL) from primed rats as a source of precursors and irradiated recipients as hosts. 7S precursors were found in both the CR+ and the CR- fractions of TDL and it was established that the response transferred by CR- cells did not arise from either a raidoresistant B cell in the host or from CR+ cells contaminating the CR- population. Thus, the C3 receptor is not obligatory for B-cell-T- cell cooperation in the 7S response. The precursors of 19S antibody- forming cells were found only in the CR+ subpopulation. The CR-Ig+ subpopulation was shown to contain all the B blasts in rat TDL and a very small number (approximately 1% of all TDL) of small lymphocytes. This latter population contained the CR- 7S precursors and contributed approximately 20% of the total adoptive secondary 7S response transferred by CR+ and CR- subpopulations combined. This observation suggests that the percentage of rat TDL committed to carry 7S memory is small, a conclusion which is confirmed and extended in the following paper.     

Plasma levels and mode of excretion of the anaphylatoxins C3a and C4a in renal disease.

Plasma levels of the anaphylatoxins C3a and C4a were examined in patients suffering with various renal diseases. Raised levels were observed in a considerable number of patients; although such elevation could be ascribed to in vivo complement activation in cases of immune complex glomerulonephritis, we found that raised plasma C4a levels appeared to be related to impaired renal function, suggesting that C4a anaphylatoxin is cleared by the kidneys. No such relationship was found in the case of the anaphylatoxin C3a suggesting the possible existence of another mechanism of elimination of C3a.     

Formation of C3a and C5a anaphylatoxins in whole human serum after inhibition of the anaphylatoxin inactivator

Two biologically and chemically distinct anaphylatoxins (ATs) could be generated in whole human serum after removal of the AT inactivator (AI) by immune-absorption or after inhibition of AI with 1 M epsilon-aminocaproic acid (EACA). Both human ATs could be generated by treatment of serum with antigen-antibody complexes, which activate the classical complement pathway, and with inulin or yeast, both of which trigger the alternate pathway. The ATs were isolated from serum in active form and characterized as C3a and C5a. Although human C3a had been characterized previously, C5a had not. The molecular weight of human C5a AT was 17,500; its electrophoretic mobility at pH 8.5 was –1.7 x 10^–5 cm² V^–1 s^–1. The minimal effective concentration in vitro was 7.5 x 10^–10 M. The minimal effective doses of human C5a in producing a wheal and erythema in the human skin was 1 x 10^–15 mol. The results strongly suggest a biological function for both ATs and indicate that the expression of their activity is controlled by the AI of normal blood plasma.     

Reference distributions for complement proteins C3 and C4: a comparison of a large cohort to the world's literature

The lack of credible reference materials and satisfactory methods for quantifying serum levels has limited the bedside use of complement protein (C3 and C4) measurements. However, great technological strides have been made in the last few years. The remaining barrier to a more relevant and cost-effective use of serum protein data for diagnosis and prognosis is the availability of reliable reference intervals from birth to old age for both males and females. Fifty-one publications reporting reference intervals were identified that meet the criteria used in our prior four studies, and these were analyzed statistically. Previous small studies with constrained age ranges agree, on average, with our larger series of life-long reference ranges. This meta-analysis provides support for our reference ranges and places them in the context of previous publications.     

Activation of the third complement component (C3) and C3a generation in cardiac anaphylaxis: histamine release and associated inotropic and chronotropic effects

Activation of the complement system with generation of C3a and C5a anaphylatoxins occurs during immediate hypersensitivity reactions; furthermore, the administration of C3a and/or C5a into isolated hearts causes a dysfunction that closely resembles cardiac anaphylaxis. To determine whether complement is activated and anaphylatoxins are generated in the course of immediate hypersensitivity reactions of the heart, we have challenged presensitized isolated guinea pig atria and papillary muscles with the specific antigen in the presence of a source of complement. We have found that the anaphylactic reaction of these cardiac preparations is characterized by complement activation and C3a generation, as well as by histamine release and positive inotropic and chronotropic effects. The amounts of C3a generated and histamine released directly correlated with the extent of C3 consumption. Furthermore, when C3a and C5a inactivation by serum carboxypeptidase N was prevented by DL-2-mercapto-methyl-3-guanidino-ethylthiopropanoic acid, anaphylactic histamine release was enhanced, and chronotropic and inotropic responses were potentiated and prolonged. Notably, the administration of C3a to nonsensitized guinea pig atria and papillary muscles caused positive chronotropic and inotropic effects, which were associated with histamine release and were antagonized by the H2 receptor blocker cimetidine, thereby mimicking the effects of anaphylaxis. Our findings indicate that complement activation and anaphylatoxin generation are typical of cardiac anaphylaxis and suggest that anaphylatoxins function as mediator-modulators of immediate hypersensitivity reactions of the heart.     

Synthesis,structural and electrical characterization of a new organic inorganic bromide: [(C3H7)4N]2CoBr4

A new organic inorganic hybrid [TPA]₂CoBr₄, where TPA = [(C₃H₇)₄N]⁺ (i.e., tetra-propyl-ammonium) compound has been synthesized by slow evaporation method at room temperature. Single crystal X-ray diffraction (SC-XRD), X-ray powder diffraction (XRPD), thermal analyses, vibrational and complex impedance spectroscopy have been used to characterize both structural, thermal, electrical properties. [TPA]₂CoBr₄ crystallizes in the monoclinic system (C2/c space group) with the following cell parameters: a = 33.145 (5) Å, b = 14.234 (3) Å, c = 15.081 (2) Å and β = 110.207 (5)°. In the crystal structure, the organic TPA cations which form layers stacked along the a-axis, are separated from each other by inorganic tetrahedral [CoBr₄]²⁻ anions. The XRPD pattern confirms both the high purity of the sample and the crystalline nature of the powder. The differential scanning calorimetry (DSC) analysis shows an endothermic peak at 394 K upon heating which is ascribed to a structural phase transition since no decomposition of the titled compound is evidenced by thermogravimetric analysis. The ac conductivity and the dielectric properties confirm the presence of the phase transition. At the structural phase transition around 394 K, a change from a quantum mechanical tunneling to a correlated barrier hopping conduction models is determined from the temperature dependence of the exponent s of the Jonscher''s power law. The analysis of complex impedance spectra shows that the electrical properties of the material are heavily dependent on frequency and temperature, indicating a relaxation phenomenon and semiconductor-type behavior. One single semicircle is detectable in the Nyquist plots of the complex impedance spectra which can be satisfactorily fitted with a combination R//CPE elements assigned to the bulk response. This behavior suggests that the sample is electrically homogeneous. Capacitance analysis proves the high effective permittivity at radio frequencies in the sample.

A new organic inorganic hybrid [TPA]₂CoBr₄, where TPA = [(C₃H₇)₄N]⁺ (i.e., tetra-propyl-ammonium) compound has been synthesized by slow evaporation method at room temperature.     

Combination of a hepatitis C virus NS3-NS4A protease inhibitor and alpha interferon synergistically inhibits viral RNA replication and facilitates viral RNA clearance in replicon cells

The present standard of care for hepatitis C virus (HCV) infection is pegylated alpha interferon (IFN-alpha) in combination with ribavirin. However, specific antivirals such as HCV NS3-NS4A protease inhibitors are now in clinical development, and these agents can potentially be used in combination with the present treatments. Therefore, it is important to investigate the potential benefits or adverse effects of these new combinations by using available in vitro HCV culture systems first. In the present study we demonstrate that the combination of a specific HCV NS3-NS4A protease inhibitor and IFN-alpha synergistically inhibits HCV RNA replication in replicon cells, with little or no increase in cytotoxicity. Furthermore, the benefit of the combination was sustained over time, such that a greater than 3-log reduction in HCV RNA levels was achieved following 9 days of treatment. The viral RNA appeared to be cleared from the replicon cells after 14 days of treatment, and no viral RNA rebound was observed upon withdrawal of the inhibitors. In each case, the antiviral effects obtained with higher concentrations of either the protease inhibitor alone or IFN-alpha alone can be achieved by a combination of both agents at lower concentrations, which may potentially reduce the risk of possible adverse effects associated with high doses of either agent.     

探讨性别和年龄在慢性丙型肝炎患者 外周血Toll样受体3和7基因表达中的影响

目的 观察不同性别和年龄慢性丙型肝炎(CHC)患者外周血单个核细胞(PBMC)中Toll样受体3(TLR3)和Toll样受体7(TLR7)mRNA表达,探讨性别和年龄在CHC患者外周血TLR3和TLR7基因表达中的影响。方法 选择CHC患者115例,健康人群113例,取抗凝全血,实时荧光定量PCR检测TLR3和TLR7 mRNA表达。结果 CHC患者TLR3和TLR7表达量与健康人群相比,差异均有统计学意义(t=38.73,6.16,P<0.05)。CHC患者中非绝经期女性TLR3和TLR7表达量与绝经期女性和青年男性相比,差异均有统计学意义(t=61.210,6.464,P<0.05; t=24.166,26.266,P<0.05)。CHC患者中老年男性TLR3和TLR7表达量与青年男性相比,差异均有统计学意义(t=86.349,19.583,P<0.05),而与绝经期女性相比,仅TLR3表达量差异有统计学意义(t=122.941,P<0.05)。不同性别和年龄CHC患者的TLR3,TLR7基因表达量与HCV-RNA载量均无相关性(|r|<0.40,P>0.05),但是青年女性CHC患者HCV含量均比青年男性和老年女性低,差异有统计学意义(t=3.49,2.51,P<0.05),老年男性患者HCV含量比青年男性低,差异有统计学意义(t=2.35,P<0.05),老年男性和女性CHC患者HCV-RNA含量差异无统计学意义(t=1.20,P>0.05)。结论 性别和年龄与CHC患者TLR的表达有一定的关系,为临床合理有效治疗CHC提供理论依据和新方法。     

Structure-activity relationships between linkage style at the C-3 position and nuclear analogues of C(7)-hydroxyminoaminothiazol cephalosporins against methicillin-resistantStaphylococcus aureus

We have previously shown that hydroxy-imino-aminothiazol at the 7-position was important to the antimethicillin-resistantStaphylococcus aureus (MRSA) activity of isocephems. In this study, in order to optimize the linkage style at the C-3 position and cephem backbones, 9 compounds were prepared by combining 3 cephem backbones with 3 different linkage styles at the C-3 position. The compounds had thiopyridinum-N-carbamoylmethyl fixed as the C-3 side chain and hydroxy-imino-aminothiazol at the C-7 position on the cephem backbones. The cephem backbones tested were cephem, isocephem, and 2-oxaisocephem. The linkage styles at the C-3 position were methylene, vinyl, and propylene linkages. Clinically isolated strains of MRSA were used to determine the MICs of the 9 compounds with different combinations of cephem backbones and linkage styles at the C-3 position. The compounds with vinyl linkage styles were more active against MRSA than the compounds with other linkage styles at the C-3 position, and among the cephem backbones with vinyl linkages, the cephem backbone exhibited the strongest anti-MRSA activity. MIC₉₀s for cephem (1-S-V), isocephem (2-S-V), and 2-oxaisocephem (2-O-V) compounds were 1.56, 6.25, and 12.5 μg/mL, respectively, and the 1-S-V compound had the highest affinity to penicillin-binding protein 2′ among the 3 compounds with the vinyl-style linkage. Thus, the combination of cephem and a vinyl linkage at the C-3 position was shown to be optimal for anti-MRSA activity.