78 research outputs found
Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review
No full textPurpose: Isolated spinal aneurysms (iSAs) are rare, with an uncertain natural history and no established treatment guidelines. Multiple iSAs are even more uncommon, complicating treatment decisions. Methods: This study reports a case of a ruptured radiculo-pial artery aneurysm in a patient with multiple iSAs, treated with surgical excision, assisted by intraoperative neurophysiological monitoring (IONM). Further, we review and analyze all previously reported cases of multiple iSAs. Results: A 67-year-old woman with spinal subarachnoid hemorrhage and spinal cord compression due to a ruptured radiculo-pial artery aneurysm was treated surgically. Digital subtraction angiography (DSA) showed three spinal aneurysms. Intraoperative indocyanine green video-angiography (ICG-VA) revealed an aneurysm contributing to the left posterior spinal artery. The aneurysm was excised after proximal inflow occlusion under IONM. The other aneurysms spontaneously regressed, and the patient had a good functional outcome. Through a systematic literature review, we analyzed 13 multiple iSAs including our case, involving 34 aneurysms in total. Conclusions: There is no standardized treatment approach for multiple iSAs. These aneurysms are often fusiform and clustered in contiguous metameric regions. They can be classified into flow-related and wall-weakening aneurysms. Surgery offers definitive treatment for ruptured iSAs and relieves spinal cord compression. Due to the common fusiform shape, parent vessel sacrifice may be necessary, and should include IONM and ICG-VA to minimize complications. Conservative treatment is viable as spontaneous regression often occurs
The comparison of outcome after arthroplasty or fusion in single level cervical disc disease
No full textMagnetic resonance imaging evaluation after implantation of a titanium cervical disc prosthesis: a comparison of 1.5 and 3 Tesla magnet strength
No full textPurpose Cervical disc prostheses induce significant amount of artifact in magnetic resonance imaging which may complicate radiologic follow-up after surgery. The purpose of this study was to investigate as to what extent the artifact, induced by the frequently used Discover® cervical disc prosthesis, impedes interpretation of the MR images at operated and adjacent levels in 1.5 and 3 Tesla MR.
Methods Ten subsequent patients were investigated in both 1.5 and 3 Tesla MR with standard image sequences one year following anterior cervical discectomy with arthroplasty.
Outcome measures Two neuroradiologists evaluated the images by consensus. Emphasis was made on signal changes in medulla at all levels and visualization of root canals at operated and adjacent levels. A “blur artifact ratio” was calculated and defined as the height of the artifact on T1 sagittal images related to the operated level.
Results The artifacts induced in 1.5 and 3 Tesla MR were of entirely different character and evaluation of the spinal cord at operated level was impossible in both magnets. Artifacts also made the root canals difficult to assess at operated level and more pronounced in the 3 Tesla MR. At the adjacent levels however, the spinal cord and root canals were completely visualized in all patients. The “blur artifact” induced at operated level was also more pronounced in the 3 Tesla MR.
Conclusions The artifact induced by the Discover® titanium disc prosthesis in both 1.5 and 3 Tesla MR, makes interpretation of the spinal cord impossible and visualization of the root canals difficult at operated level. Adjusting the MR sequences to produce the least amount of artifact is important.
© The Author(s) 2013 Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited
Transcription factor LSF binds two variant bipartite sites within the SV40 late promoter.
No full textThe effects of an intronic polymorphism in TOMM40 and APOE genotypes in sporadic inclusion body myositis.
No full textA previous study showed that, in carriers of the apolipoprotein E (APOE) genotype ε3/ε3 or ε3/ε4, the presence of a very long (VL) polyT repeat allele in "translocase of outer mitochondrial membrane 40" (TOMM40) was less frequent in patients with sporadic inclusion body myositis (sIBM) compared with controls and associated with a later age of sIBM symptom onset, suggesting a protective effect of this haplotype. To further investigate the influence of these genetic factors in sIBM, we analyzed a large sIBM cohort of 158 cases as part of an International sIBM Genetics Study. No significant association was found between APOE or TOMM40 genotypes and the risk of developing sIBM. We found that the presence of at least 1 VL polyT repeat allele in TOMM40 was significantly associated with about 4 years later onset of sIBM symptoms. The age of onset was delayed by 5 years when the patients were also carriers of the APOE genotype ε3/ε3. In addition, males were likely to have a later age of onset than females. Therefore, the TOMM40 VL polyT repeat, although not influencing disease susceptibility, has a disease-modifying effect on sIBM, which can be enhanced by the APOE genotype ε3/ε3
240 GENDER DIFFERENCES IN RADIOGRAPHIC OA PHENOTYPES IN A GENETIC ASSOCIATION STUDY: THE GENETICS OF OSTEOARTHRITIS
No full textThe PPARy ligand rosiglitazone influences triacylglycerol metabolism in non-obese males, without increasing the transcriptional activity of PPARy in the subcutaneous adipose tissue
No full textPPAR¿ is obligatory for fat mass generation and is thought to determine the amount of TAG stored per fat cell. We investigated whether ligand availability for PPAR¿ is rate limiting in fat mass generation and substrate metabolism. Twenty healthy men (20¿29 years) were randomly assigned to receive the PPAR¿ ligand rosiglitazone (RSG) (8 mg/d) (n 10) or a placebo (n 10) during a stay of 7 d in a respiration chamber. Food intake was ad libitum, resulting in positive energy balances of 32·2 MJ (placebo) and 44·7 MJ (RSG). Fat cell size and expression of PPAR¿, adipocyte fatty acid-binding protein (aP2), adipsin, adiponectin and fasting-induced adipose factor (FIAF) were determined in subcutaneous abdominal fat biopsies. The total amount of fat stored and the amount of TAG per fat cell were not different between groups. For the entire group, fat cell size was decreased after overeating (P = 0·02). FIAF mRNA levels were decreased after overeating in the RSG group (P = 0·01), with a trend towards a decrease in the placebo group. Unexpectedly, RSG treatment did not influence the expression levels of PPAR¿ and of the PPAR¿ responsive genes aP2, adiponectin and adipsin. In addition, RSG resulted in a larger increase in plasma TAG during overeating than placebo treatment. These results suggest that in healthy, non-obese males the PPAR¿ ligand RSG influences TAG metabolism, independent of its PPAR¿ transcriptional activity in the subcutaneous adipose tissue
A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy
No full textBackground
Cervical radiculopathy is usually caused by disc herniation or spondylosis. The prognosis is expected to be good in most patients, but there is limited scientific evidence on the indications for nonsurgical and surgical treatments. The aim of the present study is to evaluate and compare the effectiveness of surgical and nonsurgical treatment in two trials – including disc herniation and spondylosis, respectively, and to evaluate factors that contribute to better decision making.
Methods/design
Patients with disabling radicular arm pain and MRI-proven cervical disc herniation or spondylosis will be randomised to receive nonsurgical or surgical treatment. The follow-up period is one year and the sample size is estimated to be 50 for each arm in the two trials, giving a total of 200 patients. The primary outcomes are the Neck Disability Index and arm pain. Secondary outcomes include neck pain; EQ-5D and costs to evaluate cost-effectiveness; prognostic factors; CT and MRI scans, to estimate intervertebral foraminal area and nerve root compression; and the expected minimal improvement for willingness to undergo treatment.
Discussion
The outcomes of this study will contribute to better decision making in the treatment of cervical radiculopathy.
Trial registration
This study has been registered at ClinicalTrials.gov as NCT03674619, on September 17, 2018
Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients High on-treatment platelet reactivity analysis of the TRIPLET trial
No full textHigh on-treatment platelet reactivity (HPR) has been identified as an independent risk factor for ischaemic events. The randomised, double-blind, TRIPLET trial included a pre-defined comparison of H PR in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) following a placebo/600-mg clopidogrel loading dose (LD) immediately before a subsequent prasugrel 60-mg or 30-mg LD. Platelet reactivity was assessed using the VerifyNow (R) P2Y12 assay (P2Y12 Reaction Units, PRU) within 24 hours (h) following the placebo/clopidogrel LD (immediately prior to prasugrel LD), and at 2, 6, 24, 72 h following prasugrel LDs. The impact of CYP2C19 predicted metaboliser phenotype (extensive metabolisers [EM] and reduced metabolisers [RM])) on HPR status was also assessed. HPR (PRU >= 240) following the clopidogrel LD (prior to the prasugrel LD) was 58.5% in the combined clopidogrel LD groups. No significant difference was noted when stratified by time between the clopidogrel and prasugrel LDs (56 hs vs >6 h). At 6 h following the 2nd loading dose in the combined prasugrel LD groups, HPR was 7.1%, with 0% HPR by 72 h. There was no significant effect of CYP2C19 genotype on pharmacodynamic (PD) response following either prasugrel LD treatments at any time point, regardless of whether it was preceded by a clopidogrel 600-mg LD. In conclusion, in this study, patients with ACS intended for PCI showed a high prevalence of HPR after clopidogrel 600-mg LD regardless of metaboliser status. When prasugrel LD was added, HPR decreased substantially by 6 h, and was not seen by 72 h
The Fundamentalist Journal, Volume 7, Number 5
No full textCourt rules against Bible club. By: Mawyer, Martin. 7 no 5 My 1988, p 59-60. Subjects: Law--United States; Public schools and religion
The church and gay rights. By: Ferrara, Peter J.; Broadus, Joseph E.. 7 no 5 My 1988, p 61. Subjects: Freedom, Religious--United States; Homosexuality--Law
God knows the seasons. By: Wharton, Ann. 7 no 5 My 1988, p 28-29. Subjects: Sundseth, Carolyn
Handley C G Moule : beloved bishop. By: DeRemer, Bernard R.. 7 no 5 My 1988, p 31-32. Subjects: Moule, Handley Carr Glyn, Bp, 1841-1920; Church of England--Bishops
Can God win in the valleys. By: Moule, Handley Carr Glynn, Bp. 7 no 5 My 1988, p 33. Subjects: Sermons
Israel at Forty By: Sevener, Harold A.. 7 no 5 My 1988, p 36.
Land of Promise, Land of Strife: Israel at Forty By: Willmington, H L.. 7 no 5 My 1988, p 36-37. Mom\u27s covenant with the Lord. By: Middlebrook, William C.. 7 no 5 My 1988, p 40-41.
Will you love Him anyway. By: Hinshaw, Nadine. 7 no 5 My 1988, p 44-45. Subjects: God--Love
Lead, follow, or get out of the way. By: Sargent, John T.. 7 no 5 My 1988, p 50. Subjects: Christian life
Fuller, David Otis, 1903-1988. 7 no 5 My 1988, p 53. Subjects: Fuller, David Otis, 1903-1988; Death notices
My journey through the fog. By: Schillinger, Grace V.. 7 no 5 My 1988, p 55-56. Subjects: Bereavement
Israel at forty : a compilation of excerpts from the book by Harold L Willmington and Ray Pritz. By: Willmington, Harold L.; Pritz, Ray. 7 no 5 My 1988, p 16-18,34. Subjects: Christians--Israel; Israel--Foreign opinion
Exploring the past : in quest of the future. By: Willmington, Harold L.; Pritz, Ray. 7 no 5 My 1988, p 19-21. Subjects: Bible--Antiquities; Palestine--Antiquities
On home and nation. By: Crosby, Fanny. 7 no 5 My 1988, p 23. Subjects: Family--United States
She hath done what she could By: Gosselin, Blanche. 7 no 5 My 1988, p 26-27,35. Subjects: Crosby, Fanny, 1820-1915; Hymn writer
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