[3 cases of atlanto-axial dislocations].
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Adult↗
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Results for “ATLAS AND AXIS”
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[DENS AXIS IMMATURUS: A UNIQUE CERVICAL SPINE, ITS PATHOGENESIS AND SYMPTOMS].
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Ascomycota↗
Occipital-cervical instability.
A retrospective clinicoroentgenographic study was done on 26 patients with atlantoaxial instability, 17 traumatic and nine nontraumatic. All were treated by means of surgical C1-C2 and occipital-C2 stabilization. The traumatic instability was associated with lesions of the odontoid process and the atlas transverse ligament. Instability may be endogenous or associated with fracture of the atlas. Surgical indication was determined by the level of the fracture line, neurologic symptoms, age, and presence of multiple lesions. C1-C2 stabilization by means of wiring and iliac graft was the selected treatment. Fusion between the occipital and C2 segment was indicated in case of irreducible dens pseudoarthrosis. Fracture on the os odontoideum was very unstable and required greater C1-C2 fusion. Nontraumatic C1-C2 instability was either congenital or secondary to pathologic fractures. Rheumatoid arthritis, which produces anterior displacement of the atlas over the dens to more than 10 mm, neurologic symptoms, or untreatable pain must be stabilized by means of C1-C2 fusion. When elevation of the dens or irreducible displacement of the atlas exists, the results were relatively poor. Tumorous instability produced pathologic fracture of the body of the axis and had to be treated with C1-C2 wiring on bone cement. Down's syndrome instability required occipitoaxial fusion and strict postoperative immobilization.
Adolescent↗
Comparison of mandibular growth with other variables during puberty.
The purpose of this investigation was to compare growth characteristics of the mandible during puberty with growth characteristics of the hyoid bone, cervical vertebrae, hand bones and standing height. Data were compiled from serial lateral cephalometric roentgenograms, hand-wrist roentgenograms and body height records of 33 Japanese girls between 9 and 14 years old. Records were updated annually. The mandibular growth rate differed from the other growth rates. The timing of maximum growth velocity of the mandible varied more widely than the timing of maximum growth velocity of the other parameters measured, and the total amount of mandibular growth did not correlate to any other measurement. The timing and magnitude of circumpubertal growth acceleration of various components of the body vary within a certain range of difference. However, the amount and timing of mandibular growth seems to be more variable than the other areas studied.
Adolescent↗
[Hanging with decapitation. Case report--biomechanics].
We report on a 52-year-old man who committed suicide by jumping in a 380 cm long rope with a diameter of 12 mm. The loading forces resulted in complete decapitation. Our biomechanical experiments show that traction-forces of about 12000 Newton lead to complete decapitation irrespectively of the diameter of the used halter. The biomechanical results made it possible to show the possible fall-hights in dependence upon bodymass and distance of negative acceleration "s" graphically. The curves are valid for a constant deceleration during the distance "s", which is determined by lengthening of the rope and circumference of the neck.
Acceleration↗
Mandible and tongue-splitting approach for giant cell tumor of axis.
In two cases with a giant cell tumor of the axis, the mandible and tongue-splitting approach permitted excision of the tumor and anterior fusion of the spine from the atlas to the third cervical vertebra. With this approach, there is no need to extend or rotate the cervical spine during the operation. In addition, the operative field extends from the clivus to the fourth cervical vertebra, and safe and sufficient anterior decompression is possible. Although this approach has some disadvantages, contemporary techniques of intravenous hyperalimentation and postoperative respiratory management provide a solution to these problems. Thus, this approach should always be considered for patients requiring extensive anterior decompression of the craniovertebral junction or upper cervical spine.
Adolescent↗
Location and function of the human frontal eye-field: a selective review.
The location and possible function of the human frontal eye-field (FEF) were evaluated by reviewing results of cerebral blood-flow (CBF) and lesion studies. A remarkable consistency was found regarding the rostro-caudal (Y: from -6 to 1 mm) and dorso-ventral (Z: from 44 to 51 mm) location of the FEF, as defined by the CBF method within a standardized stereotaxic system (the zero point for all X, Y and Z coordinates coinciding with the anterior commissure, Talairach and Tournoux [Co-planar Stereotactic Atlas of the Human Brain, Georg Thieme, Stuttgart, 1988]. In contrast, there was a marked variability along the mediolateral axis (X: from -24 to -40 mm for the left hemisphere and from 21 to 40 mm for the right hemisphere). The human FEF is thus located either in the vicinity of the precentral sulcus and/or in the depth of the caudalmost part of the superior frontal sulcus. In either case, this location challenges the commonly held view of the FEF being located in Broadmann's area 8. With regard to FEF function, the results of CBF studies failed to support a role for the FEF in the cognitive aspects of oculomotor control, such as the execution of anti-saccades. Blood-flow activation data are consistent in this respect with the results of lesion studies. It is proposed that future research on FEF function in human subjects may benefit from focusing on the visuomotor rather than the cognitive aspects of oculomotor control.
Cerebrovascular Circulation↗
A TIGIT nanotrapping-guided STING-activatable immunometabolic strategy overcomes innate immune silence and T cell exhaustion in breast cancer.
Breast cancer exhibits a profoundly immunosuppressive tumor microenvironment (TME), where innate immune silence prevents antigen sensing and persistent T cell exhaustion limits effector responses, rendering most immunotherapies ineffective. Clinical profiling of 1093 The Cancer Genome Atlas (TCGA) cases identified a glucose-fueled glutathione (GSH)-glutathione peroxidase 4 (GPX4)-dihydrolipoamide S-acetyltransferase (DLAT) axis as a dominant metabolic shield that suppresses oxidative stress, and thereby enforces both stimulator of interferon genes (STING) silence and CD8+ T cell exclusion. To dismantle this barrier, we developed an immunometabolic nanotherapy, GOx/ES-CO-LDH@TIGIT-Nanotrap (TNT). In acidic tumors, proton-driven layered double hydroxide (LDH) disassembly releases glucose oxidase (GOx) and extremely small cuprous oxide (ES-CO). GOx depletes glucose and nicotinamide adenine dinucleotide phosphate (NADPH) to induce disulfidptosis, while ES-CO releases cuprous ions (Cu+) that trigger cuproptosis via binding to lipoylated mitochondrial proteins. Their mutual biochemical amplification produces a cycloacclerated disulfidptosis-cuproptosis cascade that collapses the GSH-GPX4-DLAT axis and restores STING activation. Meanwhile, the macrophage-derived T cell immunoreceptor with Ig and ITIM domains (TIGIT) Nanotrap sequesters CD155 to prevent T cell suppression. Together, this coordinated innate reactivation and adaptive rescue converts immune-cold tumors into STING-inflamed and T cell responsive lesions.
Female↗
Backward tilting of the posterior atlantal arch in rheumatoid arthritis.
In a retrospective survey of 450 patients with rheumatoid arthritis on whom cervical spine radiography was performed, one patient was found with a backward tilting of the posterior arch of the atlas. With preserved relations anteriorly, the posterior arch was rotated downward in front of the spinous process of the axis, encroaching on the space of the spinal canal.
Aged↗
Stabilization of atlantoaxial instability.
Eight patients with atlantoaxial instability were treated by arthrodesis of the first and second cervical spine. Internal fixation was achieved by passing two 18 gauge stainless steel wires beneath the posterior arch of the atlas and around a threaded Steinmann pin which was drilled through the base of the spinous process of the axis. The wires were tightened over a preshaped iliac bone graft. A solid fusion was achieved in all patients. The risk of compression of the cord is decreased with this technique because the wires are not passed under the lamina of the axis. The lateral placement of the wires provides an excellent internal fixation and control of the forward flexion and rotation.
Adolescent↗
Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass.
STUDY DESIGN: This study is a result of manual and radiologic measurements of 50 isolated anatomic specimens of C1 and five patients of atlantoaxial instability treated by screw fixation via posterior arch and lateral mass. OBJECTIVES: To investigate the feasibility of screw placement via posterior arch and lateral mass in atlas. SUMMARY OF BACKGROUND DATA: Several types of posterior approaches have been adopted for stabilization and fusion of atlantoaxial complex. Before this study, Gallie in 1939 gave a report on a posterior wiring technique that depended on a structural bone graft. Since then, double-looped wiring with two bone grafts and Halifax clamp technique had been introduced. A transarticular screw fixation technique was introduced by Magerl and Seeman in 1987, and a C1 lateral mass screw fixation technique was described by Harms in 2001. However, the feasibility of screw fixation in atlas via posterior arch and lateral mass has not been addressed until now. METHODS: Fifty dry samples of atlas were measured manually and radiologically with vernier calipers, protractors, and CT. The parameters of posterior arch, lateral mass, vertebral artery groove, axis length of screw path via posterior arch and lateral mass, the entry point, and screw direction were measured. Five patients of atlantoaxial instability were treated with this technique and the radiographs and CT scans were evaluated after surgery. RESULTS: The longest trajectory distance of the screw path was about 30 mm. The outer thickness at the thinnest part of groove was 4.58 mm, and it was found to be <4 mm in four cases (8%). The entry point is 18-20 mm lateral to the midline and 2 mm superior to the inferior border of posterior arch. The direction of screw placement is perpendicular to the coronal plane and about 5 degrees cephalad to the transverse plane. Ten screws via posterior arch and lateral mass were placed properly, without incidence of nerve or blood vessel injury in clinical practice. CONCLUSION: Atlas is capable for screw fixation via its posterior arch and lateral mass.
Adult↗
Cerebellar infarction secondary to os odontoideum.
A 43-year-old man developed cerebellar infarction due to atlantoaxial dislocation associated with os odontoideum. Cervical X-ray films confirmed os odontoideum, and conventional angiography revealed irregular narrowing of the right vertebral artery at the axis level. A correlation between the vertebral artery lesion and atlantoaxial instability was shown with 3-dimensional (3-D) computed tomographic (CT) angiography. This is the first case of atlantoaxial dislocation with vertebral artery stenosis demonstrated 3-D CT angiography. 3-D CT angiography can support the conventional angiography with respect to the diagnosis and management of vertebral artery insufficiency associated with occipitocervical deformity.
Adult↗
Bony abnormalities at the cranio-spinal junction.
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Adolescent↗
Case-control study comparing the efficacy of surgical techniques for C1-C2 arthrodesis.
Atlantoaxial fusion rates between 85% and 98% using C1-C2 transarticular screw (TAS) fixation have been reported; however, all of these studies are class III data. As such, these studies carry little or no statistical significance. The authors thus designed a case-control study (class II data) to evaluate the efficacy of C1-C2 TAS fixation as compared with posterior wiring techniques (PWTs). Records of adult subjects were reviewed for fusions isolated to C1-C2. Immobilization requirements were a collar for patients treated with TAS fixation and a halo for those treated by PWT. The minimum acceptable interval of radiographic follow-up was 12 months, and the outcome (fusion or nonunion) was determined through independent interpretation by a radiologist. Twenty-seven of 72 patients undergoing a posterior atlantoaxial arthrodesis met enrollment criteria. Sixteen males and 11 females combined for an average age of 54.1 years and mean follow-up of 31 months. Successful fusions (n = 18) were defined as controls, and cases represented nonunions (n = 9). Successful fusion was achieved in 13 of 14 patients treated with the TAS technique as compared with 5 of 13 subjects who underwent a PWT. Patients with a radiographically solid fusion were 21 more times likely to have undergone TAS than PWT (P = 0.004). This study demonstrated a statistically increased rate of arthrodesis as determined by specific radiographic criteria with the use of TAS fixation as compared with PWT.
Arthrodesis↗
Traumatic dissection of the internal carotid artery at the atlantoxial level, secondary to nonpenetrating injury.
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Adult↗
Upward subluxation of the axis in ankylosing spondylitis. A clinical pathologic report.
Upward subluxation of the axis associated with cord compression and death was noted in a patient with a long history of idiopathic ankylosing spondylitis. Upward subluxation of the axis has been recognized in up to 8 per cent of patients with rheumatoid arthritis but it is an exceedingly rare complication of ankylosing spondylitis. In this patient psoriasis and then psoriatic dactylitis developed 26 years after the onset of his ankylosing spondylitis. It is tempting to speculate that the unusual destruction of the joints around the atlas might be due to an added effect of psoriasis on idiopathic ankylosing spondylitis.
Adult↗
CT evaluation of the pattern of odontoid fractures in the elderly--relationship to upper cervical spine osteoarthritis.
Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one particular joint may affect the biomechanics of loading of the upper cervical spine. We aimed to analyse the relationship of odontoid fractures to the pattern of upper cervical spine osteoarthritis in the elderly. We studied the CT-scan images of the cervical spine in 23 patients who were over the age of 70 years and had odontoid fractures. In each patient, the type of odontoid fracture and the characteristics of the degenerative changes in each joint were analysed. Twenty-one of 23 patients had Type-II odontoid fractures. The incidence of significant atlanto-odontoid degeneration in these individuals was very high (90.48%), with relative sparing of the lateral atlantoaxial joints. Osteoporosis was found in 13 of 23 patients at the dens-body junction and in seven of 23 patients at the odontoid process and body of the axis. With ageing, progressively more severe degenerative changes develop in the atlanto-odontoid joint. These eventually obliterate the joint space and fix the odontoid to the anterior arch of the atlas. In contrast, the lateral atlantoaxial joints are hardly affected by osteoarthritis. Thus, ultimately, atlantoaxial movements including atlantoaxial rotation are markedly limited by osteoarthritis of the atlanto-odontoid joint. However, there is still potential for movement in the lateral atlantoaxial joints, as they remain relatively free of degenerative change. The vulnerability of the atlantoaxial segment is further increased by markedly limited rotation below the axis vertebra due to severe facet-joint degeneration. As a consequence, a relatively low-energy trauma to the lateral part of the face, for instance by a fall, will induce forced atlantoaxial rotation. This, with the marked limitation of movement at the atlanto-odontoid joint, will produce a torque force at the base of the odontoid process leading to a Type II fracture.
Aged↗
Targeting the Fatty Acid Binding Protein 5-Specificity Protein 1 Axis Restores Enzalutamide Sensitivity by Suppressing Androgen Receptor/Androgen Receptor Splice Variant 7 Signaling: Implications for Prostate Cancer Therapy.
BACKGROUND: Castration-resistant prostate cancer (CRPC) remains a major clinical challenge driven by persistent androgen receptor (AR) signaling and constitutively active splice variants such as androgen receptor splice variant 7 (AR-V7), which confer resistance to therapies including enzalutamide. Although metabolic reprogramming contributes to disease progression, the integration of metabolic and transcriptional regulators sustaining therapeutic resistance remains incompletely understood. METHODS: We integrated clinical transcriptomic analysis of The Cancer Genome Atlas Prostate Adenocarcinoma (TCGA-PRAD) cohort with mechanistic and functional validation in 22RV1 CRPC cells to investigate the role of the fatty acid binding protein 5-specificity protein 1 (FABP5-Sp1) regulatory axis. RESULTS: Transcriptomic analysis revealed that FABP5 is significantly upregulated in prostate tumors compared with normal tissue and increases with higher Gleason score. In contrast, AR and Sp1 exhibited heterogeneous expression patterns. Mechanistically, genetic ablation of FABP5 markedly reduced AR-V7 expression and restored sensitivity to enzalutamide, leading to suppression of AR signaling. Conversely, FABP5 overexpression increased Sp1 protein levels. Pharmacological inhibition of Sp1 using mithramycin A resulted in coordinated downregulation of FABP5, AR, and AR-V7, along with suppression of peroxisome proliferator-activated receptor gamma (PPARγ) signaling and downstream vascular endothelial growth factor A (VEGFA) expression. Functionally, Sp1 inhibition significantly reduced anchorage-independent growth and invasion. CONCLUSION: These findings define a FABP5-Sp1-AR/AR-V7 transcriptional-metabolic axis driving enzalutamide resistance in CRPC. Targeting FABP5 restores therapeutic sensitivity and represents a promising biomarker and therapeutic strategy in advanced prostate cancer.
AR-V7↗