C5-C6 Level Research Articles

Two siblings with monogenic lupus due to C1qC deficiency and case based review.

Monogenic lupus is an extremely rare clinical condition in children. Defects in the complement pathway are the most common causes of monogenic lupus. C1qC deficiency is one of the defects in this pathway and is even rarer. Herein, we present two cases of monogenic lupus diagnosed with C1qC deficiency in siblings. In addition, a literature search was conducted for articles on monogenic lupus due to C1qC deficiency. We found 14 articles. Our literature search identified 17 paediatric patients with monogenic lupus associated with C1qC deficiency. 10 (58%) of the reported patients were female. The median age at diagnosis of patients in the literature was 3years. Mucocutaneous involvement was remarkable in all cases of C1qC deficiency. Joint involvement was reported in about half of the cases. Approximately half of the reported cases has suffered from recurrent infections. 38% of the cases have had CNS involvement and 25% of these had nephritis. While both of our patients had mucocutaneous involvement, one of our patients had recurrent EBV infection. ANA was positive, anti-dsDNA was negative, C3-C4 levels were normal in almost all cases in the reported cases. The anti-Sm and anti-SSA positivities of these cases were also remarkable. These laboratory findings were similar in our patients. The G34R mutation of the C1qC gene is the most common genetic defect identified to date. We found a GRCh38/Hg38 1p36.12 homozygous deletion in the C1qC gene in both of our patients. It is necessary to investigate the causes of monogenic lupus in patients with early-onset lupus, history of consanguineous marriages, and antibody positivity.

Evaluation of myelin content in the spinal cord of patients with multiple sclerosis: A positron emission tomography study.

Multiple sclerosis (MS) is divided into Relapsing-Remitting (RRMS) and Progressive (PMS) phenotypes, both associated with spinal cord (SC) damage. MS-related disability and SC atrophy are not yet fully understood and can differ across phenotypes. A combined approach using Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) could provide a broader understanding of myelin changes in the cervical SC (CSC) in different MS phenotypes and the associations with disability. To evaluate CSC myelin content using a PET-MRI with [11C]PIB and its association with disability in PMS and RRMS compared to healthy volunteers (HV). [11C]PIB PET images and T1-MRI of 49 patients with MS and 19 HV were evaluated at C1-C2, C3, and C4 vertebrae levels. [11C]PIB uptake and volume were compared between groups. [11C]PIB uptake was significantly lower at C1-C4, C1-C2, and C3 segments when comparing PMS to RRMS and HV. [11C]PIB uptake inversely correlated with overall disability in all CSC segments in all patients with MS, and in the RRMS phenotype separately. Our findings suggest an association between [11C]PIB CSC uptake and overall disability score measured by EDSS. MRI and PET can be used as complementary methods for studying MS.

Assessment of subcutaneous fat tissue thickness as a biomarker for cervical intervertebral disc degeneration

Cervical intervertebral disc degeneration (IVDD) is a chronic musculoskeletal disorder contributing to neck pain, often associated with mechanical instability of the disc. Obesity and increased subcutaneous fat tissue thickness (SFTT) have been identified as key risk factors for the development of IVDD. This study retrospectively analyzed 245 Turkish female patients aged 40–50 years, who presented with neck pain and underwent cervical MRI between 2022 and 2024. Patients with malignancy, prior spinal surgery, congenital anomalies, or artifacts on MRI were excluded. The severity of IVDD at the C6-C7 level was graded using the Pfirrmann system, and SFTT measurements were performed on axial T2-weighted images at the C3, C5, and C7 levels. Statistical analyses included the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation. IVDD was absent in 29.39 % of participants, while the remaining showed varying grades of degeneration, with Grade 2 being the most common (24.08 %). Patients with disc degeneration had significantly higher SFTT at all measured levels (p < 0.001). ROC analysis identified an optimal cutoff value for SFTT at the C7 level as 22.57 mm, with 79.19 % sensitivity and 63.89 % specificity. These results indicate a positive correlation between increased SFTT and both the presence and severity of IVDD, suggesting that SFTT, particularly at the C7 level, may serve as a non-invasive biomarker for IVDD. Further multicenter research is recommended to confirm these findings.Abbreviations: AUC, Area Under the Curve; BMI, Body Mass Index; C, Cervical; IL, Interleukin; IVDD, Intervertebral Disc Degeneration; MRI, Magnetic Resonance Imaging; ROC, Receiver Operating Characteristic; SFTT, Subcutaneous Fat Tissue Thickness; T2WI, T2-Weighted Image; TNF, Tumor Necrosis Factor.

Spinal epidural abscess

Introduction. A spinal epidural abscess (SEA) is a rare but serious infectious disease characterized by the accumulation of pus in the spinal epidural space. This condition can lead to compression of the spinal cord and nerve roots, which, if diagnosis is delayed or mistaken, may result in persistent neurological deficits or even death. In recent decades, the incidence of SEA has been increasing, linked to an aging population, the spread of invasive medical procedures, and the rise of risk factors such as diabetes, obesity, and intravenous drug use. Diagnosing SEA is challenging due to its nonspecific symptoms; however, clinical awareness, along with early use of magnetic resonance imaging (MRI), enables timely detection and treatment. Clinical case description. A 55-year-old patient presented with complaints of weakness in all limbs and neck pain. The patient’s history began approximately four months earlier with a sore throat, followed by progressive limb weakness. MRI and CT imaging revealed an SEA at the C4-C5 level, causing spinal cord compression. The patient underwent C4 and C5 corpectomy, abscess removal and drainage, and stabilization with a cervical plate and autograft. In the postoperative period, the patient showed significant improvement; by discharge, the neurological deficit had substantially regressed. Conclusion. This review highlights the need to increase SEA awareness among healthcare professionals to facilitate early diagnosis and treatment initiation, particularly in high-risk patients. Despite advancements in treatment, mortality and neurological complications remain significant, underscoring the need for further research to optimize treatment strategies and improve outcomes for patients with SEA.

Painful Legs and Moving Toes Syndrome: Case Report and Review.

Painful legs and moving toes (PLMT) syndrome is a rare movement disorder characterized by defuse lower limb neuropathic pain and spontaneous abnormal, involuntary toe movements. The objective was to present a rare case of PLMT syndrome with a triggering area in an adult patient due to multilevel discogenic pathology, to make a thorough review of this disorder and to provide a practical approach to its management. A 59-years-old male was admitted to the neurology ward with symptoms of defuse pain in the lower-back and the right leg accompanied by involuntary movements for the right toes intensified by tactile stimulation in the right upper thigh. Magnetic resonance imaging (MRI) revealed a multilevel discogenic pathology of the lumbar and cervical spine, with myelopathy at C5-C7 level. A medication with Pregabalin 300 mg/daily significantly improved both the abnormal toe movements and the leg pain. The clinical effect was constant during the 90-day follow-up without any adverse effects. Painful legs and moving toes (PLMT) is a condition that greatly affects the quality of life of patients, but which still remains less known by clinicians. Spontaneous resolution is rare, and oral medications are the first-line treatment. Pregabalin is a safe and effective treatment option for PLMT that should be considered early for the management of this condition. Other medication interventions, such as botulinum toxin injections, spinal blockade, or non-pharmacological treatment options like spinal cord stimulation, and surgical decompressions, are also recommended when the conservative treatment is ineffective in well-selected patients.

A Strong Association Between Modic Changes Type 2 and Endplate Defects at Nonfused Segments After Anterior Cervical Decompression and Fusion

To determine the association between Modic changes (MC) with other MRI parameters and clinical symptoms of cervical degenerative disc disease (DDD). A retrospective analysis of data on patients with cervical DDD who underwent single-level anterior cervical discectomy and fusion. Preoperative demographic data (age, sex, surgical data) were collected, cervical MRI parameters (disc degeneration grade, MC and endplate defects, each determined at each cervical level) and clinical data (Numerical pain rating scale (NPRS) neck and arm, the Neck Disability Index (NDI)) were compared to preoperative data. The study included 121 patients at Visit 1 and 83 patients at Visit 2. The median follow-up duration was 26.5 [18.9; 33.1] months. Patients with MC had more intense NPRS-based neck pain before surgery compared to patients without MC (p=0.001). There were significant changes in MC rate at the C5-C6 levels due to a significant number of new MCs type 1 and MCs type 2 (p=0.002 and p<0.001, respectively). MC type 2 was associated with disc degeneration, endplate defects defects, patients' age and clinical scales (NDI, NPRS) (p<0.05). The endplate defects defect score threshold for predicting MC type 2 at the С3-С7 cervical levels was 5. The factor predicting MC type 2 at the C3-C7 cervical levels is submaximal damage to the endplate. The MC rate is increased due to MC type 1 and MC type 2. MC types at the cervical levels may not represent consecutive stages of the same process.

Combined effect of artificial cervical disc replacement and facet tropism on the index-level facet joints: a finite element study

BackgroundArtificial Cervical Disc Replacement (ACDR) is an effective treatment for cervical degenerative disc diseases. However, clinical information regarding the facet joint alterations after ACDR was limited. Facet tropism is common in the sub-axial cervical spine. Our previous research indicated that facet tropism could lead to increased pressure on the cervical facet joints. This study aimed to assess the impact of facet tropism on the facet contact force and facet capsule stress after ACDR.MethodsA C2–T1 cervical finite element model was constructed from computed tomography (CT) scans of a 28-year-old male volunteer. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by altering the facet orientation at the C5-C6 level. The C5/C6 ACDR was simulated in the intact, moderate asymmetrical and severe asymmetrical models. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the T1 vertebra fixed. The range of motions (ROMs) under all moments, facet contact forces (FCFs) and facet capsule strains were tested.ResultsIn the asymmetrical model, the right FCFs considerably increased under flexion, extension, right bending, left rotation, especially under right bending the right sided FCF of the severe asymmetrical model was about 5.44 times of the neutral position, and 3.14 times of the symmetrical model. and concentrated on the cephalad part of the facets. The facet capsule stresses on both sides remarkably increased under extension, lateral bending and right rotation. In the moderate and severe asymmetrical models, the capsule strain was greater on both sides of each position than in the symmetric model.ConclusionsThe face tropism increased facet contact force and facet capsule strain after ACDR, especially under extension, lateral bending, and rotation, and also could result in abnormal stress distribution on the facet joint surface and facet joint capsule. The results suggest that face tropism might be a risk factor for post-operative facet joint degeneration progression after ACDR. Facet tropism may be noteworthy when ACDR is considered as a surgical option.

Neck triangle nerve enlargement in hereditary transthyretin amyloidosis correlates with changes in the autonomic, cardiac, and gastrointestinal systems.

Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear. We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5-C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis. We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6±5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the Z scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the Z scores of the cervical spinal nerves but not with the Z score of the vagus nerve. In gastrointestinal evaluation, the cross-sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy. Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv.

Effects of Combined Respiratory Physiotherapy with High-Flow Nasal Cannula and Venturi Mask in Spinal Cord Injury: A Single-Subject Research Study and Literature Review.

The level of spinal cord injury affects the severity of respiratory impairment and the alteration of respiratory pattern and gas exchanges. Lesions at the C3-C5 level (phrenic nerve nucleus) cause disruption of descending input with paralysis of the main inspiratory muscle, often requiring tracheostomy and prolonged mechanical ventilation. Oxygen therapy is essential to switch from ventilatory support to removal of the endotracheal tube to correct residual difficulties in oxygenation management. A 58-year-old man had tracheostomy and tetraparesis as complication of tonsillectomy and adenoidectomy treatment for a history of obstructive sleep apnea. A respiratory rehabilitation program with protocol of oxygen therapy with high flow cannula alternated with a low-flow system by Venturi mask during daytime hours only was started. The patient was constantly monitored with capillary partial oxygen saturation to obtain adequate oxygenation (≥ 94%) and registered every 15 minutes in the clinical chart. There was gradual improvement of respiratory function. Oxygen by Venturi mask was gradually reduced due to improvement of partial pressure oxygen values. Over the course of days, the optimal results of respiratory parameters led to a gradual weaning from the Venturi mask until the complete discontinuation of the low-flow system during daytime and decreased of the high-flow fraction of inspired oxygen to the maximal tolerated level during nighttime. Implementing a combined protocol of nighttime oxygen with high flow cannula and daytime Venturi mask improves intensive motor training of patients by promoting the acquisition of ability to perform chair/bed transitions and to be able to achieve standing and begin gait training. More research is needed whether or noted to determine the role of this promising approach in patients with severe SCI and in other critically ill patients. This is a presentation of a new respiratory training protocol of combined oxygen therapy by high flow cannula and Venturi mask in a patient with cervical spinal cord injury and respiratory failure.Due to this new respiratory training, from the weaning of ventilation devices the patient had greater independence and improved quality of life, with more intensive motor training in the gym, improvement of the motor program and the patient tolerance to training.Oxygen therapy with high flow cannula and Venturi mask could be valid and reliable combined respiratory training to improve the respiratory pattern in severely hypoxemic and hypercapnic patients, without adverse events.

Percutaneous and open anterolateral cordotomy for intractable cancer pain: a technical note

IntroductionAnterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique. Material and methodsPatient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video. ResultsMain indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 s during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4−5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain. ConclusionAL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon’s armamentarium.

Duropathy as a rare motor neuron disease mimic: from bibrachial amyotrophy to infratentorial superficial siderosis

BackgroundBibrachial amyotrophy associated with an extradural CSF collection and infratentorial superficial siderosis (SS) are rare conditions that may occasionally mimic ALS. Both disorders are assumed to be due to dural tears.Case presentationA 53-year-old man presented with a 7-year history of slowly progressive asymmetric bibrachial amyotrophy. Initially, a diagnosis of atypical motor neuron disease (MND) was made. At re-evaluation 11 years later, upper limb wasting and weakness had further progressed and were accompanied by sensorineural hearing loss. MRI of the brain and spine demonstrated extensive supra- and infratentorial SS (including the surface of the whole spinal cord) as well as a ventral longitudinal intraspinal fluid collection (VLISFC) extending along almost the entire thoracic spine. Osteodegenerative changes were observed at C5-C7 level, with osteophytes protruding posteriorly. The bony spurs at C6-C7 level were hypothesized to have lesioned the dura, causing a CSF leak and thus a VLISFC. Review of the MRI acquired at first evaluation showed that the VLISFC was already present at that time (actually beginning at C7 level), whereas the SS was not. 19 years after the onset of upper limb weakness, the patient additionally developed parkinsonism. Response to levodopa, brain scintigraphy with 123I-ioflupane and brain MRI with nigrosome 1 evaluation were consistent with idiopathic Parkinson’s disease (PD). On the latest follow-up 21 years after symptom onset, the VLISFC was unchanged, as were upper arm weakness and wasting.ConclusionsBased on the long-term follow-up, we could establish that, while the evidence of the VLISFC was concomitant with the clinical presentation of upper limb amyotrophy and weakness, the radiological signs of SS appeared later. This suggests that SS was not per se the cause of the ALS-like clinical picture, but rather a long-term sequela of a dural leak. The latter was instead the causative lesion, giving rise to a VLISFC which compressed the cervical motor roots. Dural tears can actually cause several symptoms, and further studies are needed to elucidate the pathophysiological correlates of “duropathies”. Finally, as iron metabolism has been implicated in PD, the co-occurrence of PD with SS deserves further investigation.

Acylcarnitines metabolism in depression: association with diagnostic status, depression severity and symptom profile in the NESDA cohort.

Acylcarnitines (ACs) are involved in bioenergetics processes that may play a role in the pathophysiology of depression. Previous genomic evidence identified four ACs potentially linked to depression risk. We carried forward these ACs and tested the association of their circulating levels with Major Depressive Disorder (MDD) diagnosis, overall depression severity and specific symptom profiles. The sample from the Netherlands Study of Depression and Anxiety included participants with current (n = 1035) or remitted (n = 739) MDD and healthy controls (n = 800). Plasma levels of four ACs (short-chain: acetylcarnitine C2 and propionylcarnitine C3; medium-chain: octanoylcarnitine C8 and decanoylcarnitine C10) were measured. Overall depression severity as well as atypical/energy-related (AES), anhedonic and melancholic symptom profiles were derived from the Inventory of Depressive Symptomatology. As compared to healthy controls, subjects with current or remitted MDD presented similarly lower mean C2 levels (Cohen's d = 0.2, p ≤ 1e-4). Higher overall depression severity was significantly associated with higher C3 levels (ß=0.06, SE = 0.02, p = 1.21e-3). No associations were found for C8 and C10. Focusing on symptom profiles, only higher AES scores were linked to lower C2 (ß=-0.05, SE = 0.02, p = 1.85e-2) and higher C3 (ß=0.08, SE = 0.02, p = 3.41e-5) levels. Results were confirmed in analyses pooling data with an additional internal replication sample from the same subjects measured at 6-year follow-up (totaling 4141 observations). Small alterations in levels of short-chain acylcarnitine levels were related to the presence and severity of depression, especially for symptoms reflecting altered energy homeostasis. Cellular metabolic dysfunctions may represent a key pathway in depression pathophysiology potentially accessible through AC metabolism.

AIRWAY CHALLENGES IN A ANKYLOSING SPONDYLITIC PATIENT WITHTRAUMATIC CERVICAL SPINE FRACTURE - A CASE REPORT

Background:Ankylosing Spondylitis (AS) is a chronic inflammatory condition that results in the fusion of the spine and decreased flexibility, commonly known as bamboo spine. This condition presents significant challenges to anesthesiologists due to potential difficulties in managing the airway, cardiovascular issues, and compromised respiration. AS patients face an increased risk of fractures and spinal cord injury, especially in the cervical spine, which is prone to instability and higher morbidity and mortality rates. Maneuvers to manage the airway and intubation techniques may exacerbate movement in the cervical spine, potentially leading to further injury. Case Report: A 42-year-old man with a history of AS presented with a cervical spine injury after a road traffic accident. MRI showed fractures at the posterior arch of C1 and C4-C5 levels with nerve root compression. The patient, who was not regularly followed up, was taking medication. Preoperative assessment revealed a potentially difficult airway, and the patient had quadriparesis and reduced sensation. Due to the risk of spinal cord injury, an awake fiberoptic intubation (AFOI) was planned. The AFOI was successfully performed through the nasal route, and the patient underwent a C4-C5 discectomy and stabilization. The postoperative recovery was uneventful, with no new neurological deficits. Discussion: The case emphasizes the need to minimize movement of the cervical spine when managing the airway in AS patients with cervical spine fractures. Using AFOI is more effective than other techniques in this scenario, as it minimizes cervical movement and allows for post-intubation neurologic assessments. Although the glidescope video laryngoscope and intubating laryngeal mask airway are considered as alternatives to direct laryngoscopy, anesthesiologists still prefer AFOI as the primary option. Conclusion: This case report demonstrates the best airway management for an AS patient with a cervical spine fracture, with a focus on the role of the anesthesiologist in preventing further injury and neurologic deterioration. Awake fiberoptic intubation is the safest alternative for AS patients with cervical spine fractures, as long as the anesthesiologist has the requisite skills and knowledge.

Blunt Traumatic Vertebral Artery Injury After Cervical Fracture Dislocation: A Systematic Review of the Literature.

Certain high-energy blunt forces may produce unstable cervical fractures with or without dislocation. In rare cases where the superior facets are dislocated, however showing a significant increase within the last decade, these types of injuries may include vertebral artery entrapment at the involvement level leading to artery dissection or occlusion. This phenomenon is usually seen at the C4-C5 and C5-C6 levels of injury. A systematic review of the literature was performed by examining online databases such as PubMed - NCBI, Web of Science, Cochrane Library, Scopus, and Embase to identify relevant scientific articles. Keywords (MeSH terms) used in the search included cervical spine injuries, cervical spine dislocation, cerebrovascular injury, vertebral artery injury, vertebral artery injury management, and incidence of vertebral artery injury. Initially, 1516 studies were identified as a primary search for screening. After excluding papers that did not fulfill the inclusion criteria, 34 studies were included in this review. Vertebral artery injury consists of a severe complication that could compromise a surgical intervention since the patient's clinical image may be unrevealing at first. Early diagnosis and correct timing constitute the golden standard for adequate treatment. This systematic review aims to summarize the current evidence for the diagnosis, management, and treatment of blunt traumatic vertebral artery injuries.

How Static and Cyclic Loading Affect the Mechanical Properties of the Porcine Annulus Fibrosus.

This study sought to evaluate the effects of prolonged cyclic loading on the tissue-level mechanical properties of the spinal annulus fibrosus. Functional spinal units (FSUs) were obtained from porcine cervical spines at the C3-C4 and C5-C6 levels. Following a 15-min preload of 300 N of axial compression, the FSUs were split into three groups: the cyclic loading group cycled between 0.35 MPa and 0.95 MPa for 2 h (n = 8); the static loading group was compressed at 0.65 MPa for 2 h (n = 10); and a control group which only underwent the 300 N preload (n = 11). Following loading, samples of the annulus were excised to perform intralamellar tensile testing and interlamellar 180 deg peel tests. Variables analyzed from the intralamellar test were stress and strain at the end of the toe region, stress and strain at initial failure (yield point), Young's modulus, ultimate stress, and strain at ultimate stress. Variables evaluated from the interlamellar tests were lamellar adhesion strength, adhesion strength variability, and stiffness. The analysis showed no significant differences between conditions on any measured variable; however, there was a trend (p = 0.059) that cyclically loaded tissues had increased adhesion strength variability compared to the static and control conditions. The main finding of this study is that long-duration axial loading did not impact the intra- or interlamellar mechanical properties of the porcine annulus. A trend of increased adhesion strength variability in cyclically loaded samples could indicate a potential predisposition of the annulus to delamination.

Role of serum complement C3 and C4 on kidney outcomes in IgA nephropathy

IgA Nephropathy (IgAN) is the most prevalent glomerular disease worldwide. Complement system activation is crucial in its pathogenesis. Few studies correlated serum C3 and C4 with disease activity and prognosis. This retrospective study investigated the prognostic value of serum complement at the time of diagnosis in patients with IgAN. Specifically we evaluated whether adding serum C3 and C4 levels to established predictive models-one based on variables related to chronic kidney disease (CKD) progression and another incorporating variables from the International IgA Prediction Tool (IntIgAPT)-enhances the accuracy of outcome prediction. A composite renal outcome was defined as 50% decline in eGFR or onset of kidney failure. 101 patients were stratified according to baseline C3 levels in three groups (Low, Medium and High). During a median follow-up of 54 months, the Low group exhibited higher incidence of primary outcome (16.3 events vs 2.9 and 1.7 events × 100 pts/year, p = 0.0026). Model-1 (M1), consisting of CKD progression variables, and Model-3 (M3), comprising IntIgANPT variables, were implemented with baseline C3 and C4 to create Model-2 (M2) and Model-4 (M4), respectively. M2 demonstrated better predictive performance over M1, showing higher discrimination (lower AIC and BIC, higher C-index and NR2). Similarly, M4 outperformed M3, showing enhanced outcome prediction when C3 and C4 levels were added. Implementation of serum C3 and C4 can enhance prediction accuracy of already-validated prognostic models in IgAN. Lower C3 and higher C4 levels were associated with poorer prognosis, highlighting a more 'Complement-Pathic' subset of patients.

Biomechanical Motion Changes in Adjacent and Noncontiguous Segments Following Single-Level Anterior Cervical Discectomy and Fusion: A Computed Tomography-Based 3D Motion Capture Study.

Anterior cervical discectomy and fusion (ACDF) is known to elicit adverse biomechanical effects on immediately adjacent segments; however, its impact on the kinematics of the remaining nonadjacent cervical levels has not been understood. This study aimed to explore the biomechanical impact of ACDF on kinematics beyond the immediate fusion site. We hypothesized that compensatory motion following single-level ACDF is not predictably distributed to adjacent segments due to compensation from noncontiguous levels. Six fresh-frozen cervical spines (C2-T1) underwent fluoroscopic screening and sagittal and coronal reformats from computed tomography scans and were utilized to grade segmental degeneration. Each specimen was tested to 30° of flexion and extension intact and following single-level ACDF at the C5-C6 level. The motions of each vertebral body were tracked using 3-dimensional (3D) motion capture into an inverse kinematics model, facilitating correlations between the 3D reconstruction from computed tomography images and the 3D motion capture data. This model was used to calculate each level's flexion/extension range of motion (ROM). Single-level fusion at the C5-C6 level across all specimens resulted in a significant motion reduction of -6.8° (P = 0.002). No significant change in ROM occurred in the immediate adjacent segments C4-C5 (P = 0.07) or C6-C7 (P = 0.15). Hypermobility was observed in 2 specimens (33%) exclusively in adjacent segments. In contrast, the other 4 spines (66%) displayed hypermobility at noncontiguous segments. Hypermobility occurred in 42% (5/12) of the adjacent segments, 28% (5/18) of the noncontiguous segments, and 50% (3/6) of the cervicothoracic segments. Single-level ACDF impacts ROM beyond adjacent segments, extending to noncontiguous levels. Compensatory motion, not limited to adjacent levels, may be influenced by degenerative changes in noncontiguous segments. Surprisingly, hypermobility may not occur in adjacent segments after ACDF. Overall, the multifaceted biomechanical effects of ACDF underscore the need for a comprehensive understanding of cervical spine dynamics beyond immediate adjacency, and it needs to be taken into consideration when planning single-level ACDF.

Bilateral Vocal Fold Motion Impairment Associated With Diffuse Idiopathic Skeletal Hyperostosis.

To describe the clinical courses and interventions of symptomatic patients with bilateral vocal fold motion impairment (BVFMI) attributed to diffuse idiopathic skeletal hyperostosis (DISH). Retrospective cohort study. Single Institution Academic Health Center. Retrospective chart review of patients ≥18 years old evaluated and treated for symptomatic BVFMI secondary to DISH between February 2021 and March 2023. A literature review was conducted. A total of 4 cases were identified. All patients were male and had symptomatic BVFMI attributed to cervical spine DISH, as seen on imaging. Symptoms ranged from life-threatening dyspnea to breathy dysphonia in addition to dysphagia. Each patient was offered surgery for DISH. Two patients underwent osteophyte removal at the C5-C6 level with improved vocal fold (VF) mobility, breathing, and voice quality. Two patients elected serial observation as voice, swallow, and airway symptoms were manageable. The literature review showed a male-dominant (100%) presentation with an average of 70 years of age. Hypertension (45%) and diabetes mellitus (36%) were the most common comorbidities. Most patients were treated surgically (55%). Both surgical and conservative interventions may be considered for symptomatic relief and improvement in VF mobility on a patient-to-patient basis. Further study is warranted to investigate the etiology and treatment outcomes in these cases.

Different aspects of immunological profile in patients with Non-Alcoholic Fatty liver disease.

NAFLD is thought to affect approximately one-fourth of the world's population. Therefore, we evaluated the role of serum complement and immunoglobulins in the NAFLD pathogenesis. 200 participants were used in this study, divided into two groups; Group I: 100 NAFLD patients and Group II: 100 healthy volunteers. The diagnosis of NAFLD is based on non-invasive methods, following the EASL guideline 2022. IgG, IgM, IgA, C3, and C4 assays were performed on all participants. When the immunological profiles of patients with NAFLD and healthy controls were compared, it was found that the mean IgA in NAFLD patients was (4.20±5.07), whereas the mean IgA in healthy controls was (2.22±1.05) (P=0.000). Additionally, a significant increase in IgG was found in NAFLD patients (17.08±3.87) compared with healthy controls (11.59±3.34), with a P value of (p<0.001). complement C3 and complement C4 levels significantly increased in nonalcoholic fatty liver disease patients (1.28± 0.61 and 0.40 ± 0.19, respectively), compared to healthy controls (0.90 ±0.27 and 0.30 ±0.12, respectively), with a significant P value (p<0.001 for each). Elevated IgA, IgG, C3 and C4 exist in patients with NAFLD and could be associated with fatty liver development and progression of hepatic fibrosis in patients with NAFLD.

Trauma of the spine: Epidemiological aspects and tomodensitometric in Niamey

Introduction: The trauma of spine is a frequent pathology. It is a pathology of young male adults. Medical imaging in particular CT scan is essential in the precise assessment of traumatic bone lesions of the spine. Aim: Study the epidemiological and computed tomography aspects of spine trauma in radiology and medical imaging services at the Niamey National Hospital and the Niamey Reference General Hospital. Materials and methods: This is a retrospective and prospective study about 73 cases collected at Niamey National Hospital and Niamey Reference General Hospital from January 1, 2016 to October 31, 2019. Results: In this study, male sex was largely predominant. The age group 20-30 was the most represented. The cervical and back spinal floors were the most explored. The fracture was the most found lesion. The compact fracture is the most recorded fracture in the vertebral body. The cervical spine was the seat of the majority of fractures. The anterior luxation was notified, and like the fracture, it was mainly located at the level of the cervical spine more precisely at the level of C5-C6. The post-traumatic disc hernia was mainly cervical and the location was majority C5-C6. Note the spinal channel was mostly normal. Conclusion: The trauma of the spine is a frequent pathology which most often affects young male adults. Computed tomography allows a balance of traumatic bone lesions of the spine.