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Ancestral role of caudal genes in axis elongation and segmentation.

caudal (cad/Cdx) genes are essential for the formation of posterior structures in Drosophila, Caenorhabditis elegans, and vertebrates. In contrast to Drosophila, the majority of arthropods generate their segments sequentially from a posteriorly located growth zone, a process known as short-germ development. caudal homologues are expressed in the growth zone of diverse short-germ arthropods, but until now their functional role in these animals had not been studied. Here, we use RNA interference to examine the function of caudal genes in two short-germ arthropods, the crustacean Artemia franciscana and the beetle Tribolium castaneum. We show that, in both species, caudal is required for the formation of most body segments. In animals with reduced levels of caudal expression, axis elongation stops, resulting in severe truncations that remove most trunk segments. We also show that caudal function is required for the early phases of segmentation and Hox gene expression. The observed phenotypes suggest that in arthropods caudal had an ancestral role in axis elongation and segmentation, and was required for the formation of most body segments. Similarities to the function of vertebrate Cdx genes in the presomitic mesoderm, from which somites are generated, indicate that this role may also predate the origin of the Bilateria.

Animals↗

Jun NH2-terminal kinase (JNK) prevents nuclear beta-catenin accumulation and regulates axis formation in Xenopus embryos.

Jun NH(2)-terminal kinases (JNKs) regulate convergent extension movements in Xenopus embryos through the noncanonical Wnt/planar cell polarity pathway. In addition, there is a high level of maternal JNK activity spanning from oocyte maturation until the onset of gastrulation that has no defined functions. Here, we show that maternal JNK activation requires Dishevelled and JNK is enriched in the nucleus of Xenopus embryos. Although JNK activity is not required for the glycogen synthase kinase-3-mediated degradation of beta-catenin, inhibition of the maternal JNK signaling by morpholino-antisense oligos causes hyperdorsalization of Xenopus embryos and ectopic expression of the Wnt/beta-catenin target genes. These effects are associated with an increased level of nuclear and nonmembrane-bound beta-catenin. Moreover, ventral injection of the constitutive-active Jnk mRNA blocks beta-catenin-induced axis duplication, and dorsal injection of active Jnk mRNA into Xenopus embryos decreases the dorsal marker gene expression. In mammalian cells, activation of JNK signaling reduces Wnt3A-induced and beta-catenin-mediated gene expression. Furthermore, activation of JNK signaling rapidly induces the nuclear export of beta-catenin. Taken together, these results suggest that JNK antagonizes the canonical Wnt pathway by regulating the nucleocytoplasmic transport of beta-catenin rather than its cytoplasmic stability. Thus, the high level of sustained maternal JNK activity in early Xenopus embryos may provide a timing mechanism for controlling the dorsal axis formation.

Adaptor Proteins, Signal Transducing↗

Neck injuries among the elderly in Sweden.

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patients.

Accidental Falls↗

Harris or axis ring: an aid in diagnosing low (type 3) odontoid fractures.

OBJECTIVE: To present our experience of diagnosing fractures of the odontoid process on lateral radiographs of the cervical spine that show the Harris (axis) ring. DESIGN: Retrospective study. SETTING: Teaching hospital, Belgium. SUBJECTS: 12 patients with multiple injuries, including cervical spine, 8 of them unconscious or uncooperative. INTERVENTIONS: Cross table lateral view of the cervical spine. MAIN OUTCOME MEASURE: Identification of otherwise hidden type 3 axial fractures. RESULTS: Diagnosis of low odontoid fractures in all cases. CONCLUSION: The Harris ring is disrupted in low odontoid fractures and intact in fractures of the odontoid process. Awareness of this sign will allow diagnosis of otherwise hidden axial fractures.

Adolescent↗

An investigation of cervicovertebral morphology in different sagittal skeletal growth patterns.

The purpose of the present study was to examine and compare cervicovertebral morphology in subjects with different sagittal skeletal patterns. The material comprised lateral head films of 90 untreated subjects, 45 girls and 45 boys, aged 13-15 years. The radiographs were obtained in the natural head position using a fluid level method. The subjects were divided into three groups according to ANB angle: ANB angle between 1 and 5 degrees (skeletal Class I), larger than 5 degrees (skeletal Class II), and smaller than 1 degree (skeletal Class III). Each ANB group consisted of 30 subjects, 15 girls and 15 boys. Twenty-nine linear and four area measurements were used to assess cervicovertebral morphology. Differences between the ANB groups and between genders were assessed by means of analysis of variance and the least significant difference test. In addition, cephalometric measurements for all subjects were subjected to discriminant analysis. The results of the analysis of variance showed that there were statistically significant differences in the measurements of the lumen length of C1, inferior depths of C2 and C4, anterior intervertebral spaces of C2 and C3, posterior intervertebral space of C3, and anterior and posterior body heights of C4 among the ANB groups. The total length of C1, inferior depths of C2-C5, anterior intervertebral spaces of C2-C4, posterior intervertebral space of C2, anterior body heights of C4 and C5, and posterior body heights of C3-C5 demonstrated significant gender differences. The results of the discriminant analysis indicated that 54.4 per cent of the original grouped cases were correctly classified in the total sample. The final discriminant model was able to classify correctly 20 of the 30 Class I subjects (66.7 per cent), 17 of the 30 Class II subjects (56.7 per cent), and 12 of the 30 Class III subjects (40.0 per cent).

Adolescent↗

Craniovertebral anomalies.

We have tried to clarify this confusing area by demonstrating the common relationships of these abnormalities. The development of the craniovertebral junction was present in order to understand the formation of the anomalies discussed. The radiologic lines and measurements that have been described are actually to measure the degree of compromise of the functional size of the foramen magnum. This mechanical compromise, either from direct neural compression and/or from a secondary vascular impairment (arterial or venous), leads to the signs and symptoms of cervicomedullary compression.

Adult↗

A clinical tool for measuring functional axial rotation.

BACKGROUND AND PURPOSE: Motion of the neck and back accompany many daily functional activities. Available range of motion is usually measured regionally and within single planes of motion. This report describes a device and measurement technique that can be used to quantify axial motion in a functionally relevant context. Functional axial rotation (FAR) refers to the available motion that persons use to turn toward the posterior, without regard to the plane of motion; FAR-p refers to the physical motion available, and FAR-v refers to the ability to identify objects. SUBJECTS: Nine men and eight women, aged 20 to 74 years, participated. METHODS: Functional axial rotation was determined for each subject. The seated subjects were measured on 2 different days to determine test-retest reliability. Fifteen subjects were measured by two different examiners on the same day to determine interrater reliability. Intraclass correlation coefficients (ICCs) were computed to determine reliability. RESULTS: The FAR-p ranged from 78 to 190 degrees; FAR-v ranged from 135 to 250 degrees. Test-retest reliability of FAR-p and FAR-v was excellent (ICC[1, 1] values of .95 and .90, respectively, to the right and equivalent to the left). Interrater reliability likewise was excellent, with ICC(2, 1) values of .97 to the right and equivalent to the left. CONCLUSIONS AND DISCUSSION: Functional axial rotation provides one means of quantifying a patient's axial motion as it would be used in functional context. The FAR device is easy to construct and portable. Measurement of FAR provides the clinician with reliable information regarding the patient's functional use of available spinal motion, combined with visual ability.

Adult↗

Vertical atlanto-axial subluxation in rheumatoid arthritis.

In a prospective survey of 476 hospital in-patients with rheumatoid arthritis, vertical atlanto-axial subluxation (AAL) was found in 13 patients (3.7 per cent). All were women with severe rheumatoid arthritis. Neurological signs were found in ten patients, and in seven they appeared to be due to vertical AAL. The signs caused by vertical AAL were diminished pain and temperature sensation in the upper divisions of the trigeminal nerve, sensory loss in the areas supplied by C2, nystagmus and pyramidal lesions. Disabling involvement due to vertical AAL was not found although it may occur and the lesion may be fatal. The lower cervical spine was involved in all patients and severe lesions were seen in nine. The most severe neurological lesions appeared to be due to subaxial subluxation. Corticosteroid therapy may have been a contributing factor in four patients.

Adult↗

Dysphagia due to vertical subluxation of the axis in rheumatoid arthritis.

Two patients with rheumatoid arthritis developed swallowing difficulties. These were mild in one case but severe in the other. Associated pyramidal tract signs and striking upward translocation of the dens made it seem probable that dysphagia was attributable to medullary compression despite the absence of other bulbar features. A history of dysphagia may therefore have serious implications for patients with rheumatoid disease.

Arthritis, Rheumatoid↗