Anatomical variations of the foramen transversarium in cervical vertebrae: findings,review of the literature,and clinical significance during cervical spine surgery

Purpose

To describe certain anatomical variations of the foramen transversarium, in spine cervical vertebrae in a contemporary specimen of an Indo-European population and approach their clinical importance during cervical spine surgery.

Methods

102 cervical vertebrae (C₂–C₇) from 17 different skeletons, intact without any degenerative or traumatic disorders, which belonged to the collection of the Department of Anatomy, were examined. The age of specimens at the time of their death was between 25 and 65 years. All foramina were measured with a digital caliper.

Results

The average size of the normal foramina was: 6.49 mm × 5.74 mm on the right side and 6.65 mm × 5.76 mm on the left side. Regarding the variations, we found two cervical vertebrae (1.96 %), one C₃ and one C₆, in which the right foramen transversarium is clearly smaller than the left. The exact dimensions of these foramina are: 2.3 mm × 2.5 mm on the right side and 6.54 mm × 8 mm on the left side in the first vertebra and 2.8 mm × 3.74 mm on the right side and 6 mm × 7.5 mm on the left side, in the second one. We also observed double foramina in 14 vertebrae (13.72 %). In seven vertebrae, the duplication was bilateral (6.86 %). We finally found one vertebra (0.98 %) with triplication of the foramen transversarium on the left side.

Conclusions

Summarizing, 10 out of our 17 skeletons were presented with variations (extremely narrow or multiple foramina). This finding of hypoplastic, duplicated and triplicated foramina transversaria in unexpectedly high rates raises questions about the integrity of the contained structures, the possibility of a different path for them. These variations may induce an extra-osseous position of the vertebra artery, and the ignorance of such an event may have catastrophic consequences during a surgery in the cervical spine.

     

The protein product of the proto-oncogene c-cbl forms a complex with phosphatidylinositol 3-kinase p85 and CD19 in anti-IgM-stimulated human B-lymphoma cells

Multiple signal transduction cascades, consisting of multiple interacting proteins, are activated following stimulation through most cell surface receptors, including the immunoglobulin receptor of B lymphocytes. In this report, we investigated the multimolecular complexes formed following anti-Ig stimulation of a human B-lymphoma cell line, resulting in activation of phosphatidylinositol 3-kinase (PI3K). PI3K is a lipid kinase that consists of an 85-kD regulatory subunit, bound to a 110-kD catalytic subunit. CD19 is a 95-kD B-cell surface marker that contains a consensus binding motif for PI3Kp85 in the cytoplasmic domain and recruits PI3K activity in activated B cells. The protein product of the c-cbl protooncogene is a 120-kD protein that is expressed in early B-lineage cells and in myeloid cells and is phosphorylated on tyrosine following receptor-mediated signaling in T and B lymphocytes. We demonstrate here that phosphorylated c-cbl complexes with CD19 and with PI3Kp85 via its C-terminal SH2 domain, and that both c-cbl and CD19 are associated with active PI3K in anti-Ig- stimulated cells. Although we cannot differentiate between a three- component, c-cbl/CD19/p85 complex and individual two-component complexes, these studies suggest that c-cbl may function as a docking protein, possibly linking distinct signal transduction pathways.     

Protein-tyrosine kinase p72syk in Fc gamma RI receptor signaling

In this report we show that gamma-interferon (IFN) induces the expression of the nonreceptor protein tyrosine kinase, p72syk, and that cross-linking the Fc gamma RI receptor in IFN-differentiated U937 cells (U937IF cells) results in the activation of syk kinase. We show that syk is tyrosine phosphorylated (12-fold increase) after Fc gamma RI cross-linking. In vitro kinase assays demonstrate that the specific kinase activity of syk increased eightfold after Fc gamma RI cross- linking. The activation of signal transduction through the Fc gamma RI receptor, as measured by the respiratory burst, is associated with the tyrosine phosphorylation and catalytic activation of the syk kinase. We show that syk coprecipitates with the gamma subunit of the Fc gamma RI, Fc gamma RI gamma. The data suggest that p72syk is involved in signal transduction through the Fc gamma RI receptor, involving the Fc gamma RI gamma subunit.     

Maternal administration of granulocyte colony-stimulating factor improves neonatal rat survival after a lethal group B streptococcal infection

Maternally administered recombinant human granulocyte colony- stimulating factor (rhG-CSF) has been shown to cross the placenta and induce a peripheral neutrophilia and increases in the marrow and spleen neutrophil storage pools in fetal and newborn rats. In the present study, we have used this model system to investigate the efficacy of prenatally administered rhG-CSF on neonatal defense to a lethal challenge with Group B-beta hemolytic Streptococcus (GBS). Pregnant rats were injected with rhG-CSF twice daily beginning 6 days before parturition. At birth, all pups were infected with a dose of GBS that is lethal for 90% of infected pups (LD90). Survival was monitored daily for 5 days. Survival of infected pups from saline-treated mothers beyond 60 hours after infection was 10%. No difference in survival was observed among pups from mothers treated 2 and 4 days before parturition. In contrast, we determined that survival was 82.5% among infected pups from mothers treated for 6 days before parturition with rhG-CSF. Our results demonstrate that maternal administration of rhG- CSF augments neonatal defenses against a lethal bacterial challenge.     

Active immunization of murine allogeneic bone marrow transplant donors with B-cell tumor-derived idiotype: a strategy for enhancing the specific antitumor effect of marrow grafts

Persistence of the underlying malignancy remains the major obstacle limiting the success of high-dose chemoradiotherapy with allogeneic bone marrow transplantation (BMT) for lymphomas and multiple myeloma. We used the C3H 38C13 murine B-cell lymphoma, which expresses and secretes clonally derived Ig, the idiotype of which can serve as a tumor-specific antigen, to test the principle of transfer of tumor idiotype-specific immunity with BM. BALB/c marrow donors were twice immunized with 38C13-derived Ig, or with an isotype-matched control Ig, conjugated to keyhole limpet hemocyanin. Lethally irradiated C3H recipients reconstituted with marrow from idiotype immune, but not nonspecifically immune, donors demonstrated protection against subsequent lethal tumor challenge. The immunoprotective effect of immune allogeneic marrow was abrogated by T-cell depletion of the marrow graft before infusion. Low levels of serum anti-idiotypic antibody remained unaltered in recipients of T-cell-depleted immune marrow, consistent with a primary role for T-cell immunity in the cellular mechanism of this phenomenon. A modest therapeutic effect of immune allogeneic marrow was observed against 10 day, 1 cm established subcutaneous tumors, but only in combination with a booster immunization of the recipient post-BMT. These results provide the rationale for a novel strategy for enhancing the specific antitumor effect of allogeneic marrow grafts.     

Response to 2'-deoxycoformycin after failure of interferon-alpha in nonsplenectomized patients with hairy cell leukemia

Two patients with hairy cell leukemia with massive splenomegaly and severe pancytopenia were treated with recombinant alpha-A interferon (IFN-alpha-2a). There was no significant response to a trial of IFN- alpha-2a (11 and 20 weeks) with respect to blood counts or spleen size. Subsequent treatment with 2'-deoxycoformycin (dCF) for 8 consecutive weeks (4 mg/m2/wk) resulted in normalization of spleen size and a normalization of peripheral blood counts and bone marrow in one patient. The second patient demonstrated a reduction in spleen size and improved blood counts following 9 weeks of dCF therapy but eventually became refractory. This demonstrates that dCF is non-cross-resistant with interferon and confirms the efficacy of dCF in nonsplenectomized patients.     

【特刊综述】雄激素对骨骼肌的作用：对乏力的发展和治疗的意义

雄激素对骨骼肌合成有明显影响,随着年龄增大,雄激素的下降常伴随肌量和肌力的下降。这种肌量和肌功能的下降,被称为少肌症或肌体老化,是老年人体质弱化（男性化减退）进展的关键事项。也是导致快速机能衰退及其不良后果的关键。雄激素水平下降对老年男性体质弱化（男性化减退）的潜在影响和对躯体功能的促进治疗作用无疑已经引起了相当的关注。本综述概述了近期关于肌肉老化、少肌症、老年体质弱化的概念、定义,并评估了关于雄激素和老年体质弱化的研究进展。近期源于观测性和介入性研究的证据强烈支持雄激素对老年男性肌量的作用,但雄激素对肌力和特有的躯体功能的效用并不明确。研究显示,雄激素治疗在老年男性中通常有良好的耐受性,而近期的研究则关注于雄激素的高剂量治疗和对于心血管风险较高人群的治疗。雄激素受体调节剂（SARMs）的初期试验研究显示传统雄激素治疗对于老年患者在肌量和肌功能方面有相同的效用。将来的重要研究方向包括利用这类雄激素治疗并结合适用于不同老年患者群体促进躯体功能的运动训练,同时将更多地关注近期关于激素水平、身体成分及躯体功能间关系的观测性（回顾性）研究。     

家兔失神经支配腓肠肌肌纤维退行性变与修复性再生的超微结构观察

目的:观察家兔腓肠肌失神经支配后肌纤维在退行性变与修复性再生过程中超微结构的变化,探讨失神经支配骨骼肌修复性再生障碍的机制。方法:实验于2005-04/2006-04在南方医科大学中心实验室完成。选择成年新西兰大白兔20只,切断一侧胫神经腓肠肌肌支,术后1,4,8,12,16周分别采用耳缘静脉注射空气处死4只。取实验侧和对照侧腓肠肌内侧头肌组织少许,用于制备超薄切片标本,透射电镜观察各时间点兔失神经腓肠肌肌纤维形态。结果:纳入动物20只,均进入结果分析。①正常家兔腓肠肌肌原纤维排列整齐,肌小节和Z线清晰,线粒体均匀分布在肌原纤维之间,排列规则,细胞核位于质膜周边,未见溶酶体。②失神经支配1周,肌原纤维排列基本整齐,线粒体增多,无明显肿胀。③失神经支配4周,线粒体明显增多肿胀,部分线粒体空泡样变,溶酶体增多,Z线模糊,肌原纤维间隙增大。④失神经支配8周,肌纤维明显萎缩退行性变,大部分肌原纤维消失,残留的肌原纤维变得模糊,间隙增大,肌小结丧失正常的结构,胞浆内含有大量空泡变性的细胞器,可发现畸形核,染色质浓缩、边集,肌细胞膜极度皱缩。镜下发现较多的位于基膜下活化的肌卫星细胞,细胞内含有发达的粗面内质网和丰富的胞浆。一些肌卫星细胞直接与肌纤维融合。同时在间质中可发现一些形态上很象成纤维细胞的细胞,不过这些细胞含有大量的粗面内质网,胞浆内有颗粒和微丝,少量的圆形的线粒体。在退行性变的肌纤维基膜下也可发现肌管样结构的再生肌细胞,在这些肌管内一些肌丝在一起聚集成束,没有组装成肌原纤维,没有正常的肌小结结构。在它们周围有细小的空肌管样结构,可能是以往再生的肌细胞退行性变后的残余体。在间质中可发现一些细小的肌纤维。⑤失神经支配12周,大部分肌纤维萎缩退行性变,但是仍可发现没有萎缩的肌纤维,这些肌纤维细胞核位于周边,有良好的收缩系统,纤维排列规则,Z线清晰,有完整的肌膜。⑥失神经支配16周,肌卫星细胞的数量明显减少,并可发现大量细小的肌纤维,多分布在较大的肌纤维附近,肌膜完整平滑,无皱褶。可发现核位于中央的肌纤维,胞浆内肌原纤维结构清楚,但是肌原纤维的排列远不如核位于周边的肌纤维整齐,说明其收缩系统发育不良。结论:失神经支配后肌细胞退行性变和修复性再生同时存在,再生的肌细胞不能,化发育为成熟的肌纤维,进而发生退行性变。长时间失神经支配,肌卫星细胞的耗竭是失神经支配骨骼肌晚期的主要超微结构变化。     

How reliable is MRCP with an SS-FSE sequence at 3.0 T: comparison between SS-FSE BH and 3D-FSE BH ASSET sequences

PurposeThe purpose of the present study was to evaluate the visibility and the image quality of the biliary and pancreatic duct system on magnetic resonance cholangiopancreatography (MRCP) images based on two breath-hold (BH) methods using array spatial sensitivity technique: a single-shot fast spin-echo (SS-FSE) sequence and a three-dimensional single slab fast spin-echo (3D-FSE) sequence.Materials and methodsIn the present prospective comparative study, 47 patients (22 male and 25 female, mean age=50 years, age range=22–82 years) that were referred for MRCP during a 12-month period are included. All of them were referred with suspected pancreaticobiliary disease. All patients underwent MRCP with both a SS-FSE BH sequence and a 3D-FSE BH sequence. Qualitative evaluation regarding the depiction of three segments of the pancreaticobiliary tree and the frequency of artifacts was performed. Two radiologists graded each sequence of the obtained studies in a blinded fashion. Quantitative evaluation including calculation of relative signal intensity (rSI) and relative contrast (RC) ratios at seven segments of the pancreaticobiliary tree between fluid-filled ductal structures and organ parenchyma at the same ductal segments was performed. In order to evaluate the parameters' differences of the two sequences, either in qualitative or in quantitative analysis, the Wilcoxon paired signed-rank test was performed.ResultsOn quantitative evaluation, both rSI and RC ratios of all segments of the pancreaticobiliary tree at SS-FSE BH sequence were higher than those at 3D-FSE BH sequences. This finding was statistically significant (P< .01). On qualitative evaluation, the two radiologists found intrahepatic ducts and pancreatic ducts to be better visualized with SS-FSE BH than with 3D-FSE BH sequence. This finding was statistically significant (P< .02). One of them found extrahepatic ducts to be significantly better visualized with SS-FSE BH sequence. Moreover, the frequency of artifacts was lower in the SS-FSE sequence, a finding that was of statistical significance. Interobserver agreement analysis found at least substantial agreement (κ>0.60) between the two radiologists.ConclusionThe SS-FSE sequence is performed faster and significantly improves image quality; thus, it should be included into the routine MRCP sequence protocol at 3.0 T. Furthermore, we recommended SS-FSE BH MRCP examination to be applied to uncooperative patients or patients in emergency because of its short acquisition time (1 s).     

A 40‐Year‐Old Male with An Intraventricular Tumor

Combined tumors showing histologic features of both ependymoma and subependymoma have been described. In this report we present a case of combined tanycytic ependymoma with foci of subependymoma (WHO grade II), occurring in a 40 year‐old male, which arose in the wall of the lateral ventricle. The tanycytic ependymoma component showed elongated fibrillary cells with a fascicular pattern of growth, while the subependymoma component showed clustered cell bodies surrounded by a fibrillary stroma with a microcystic appearance. We consider the present case to be an unusual example of tanycytic ependymoma; which to the best of our knowledge has not been associated with a subependymoma.