A family of Structural Maintenance of Chromosome (SMC) complexes is essential for key cellular processes ensuring proper cohesion, condensation and replication. They share a common SMC-kleisin ...architecture allowing them to embrace DNA. In SMC5/6, the NSE1 and NSE3 KITE and NSE4 kleisin subunits form a stable subcomplex that binds DNA and regulates essential processes. In addition, NSE5 and NSE6 subunits associate with the core SMC5/6 complex and recruit it to DNA repair sites.
The architecture of the SMC5/6 complex is crucial for its proper functioning, and mutations within the human SMC5/6 subunits result in severe syndromes. Therefore, we aimed to analyze interactions within the human SMC5/6 complex and determine its detailed architecture. Firstly, we analyzed different parts of SMC5/6 by crosslinking and MS/MS analysis. Our data suggested domain arrangements of hNSE1–hNSE3 and orientation of hNSE4 within the hNSE1–hNSE3–hNSE4 subcomplex. The crosslinking and electron microscopic analysis of the SMC5/6 core complex showed its rod-like architecture with juxtaposed hSMC5–hSMC6 arms. Additionally, we observed fully or partially opened hSMC5–hSMC6 shapes with the hNSE1–hNSE3–hNSE4 trimer localized in the SMC head domains. To complete mapping of the human SMC5/6 complex architecture, we analyzed positions of hNSE5-hNSE6 at the hSMC5–hSMC6 arms. We showed that hNSE6 binding to hNSE5 and the coiled-coil arm of hSMC6 is mediated by a conserved FAM178 domain, which we therefore renamed CANIN (Coiled-coil SMC6 And NSE5 INteracting) domain. Interestingly, hNSE6 bound both hSMC5 and hSMC6 arms, suggesting that hNSE6 may lock the arms and regulate the dynamics of the human SMC5/6 complex.
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•hSMC5 and hSMC6 arms can adopt rod-like shapes with juxtaposed coiled-coil segments.•hNSE6 binds both hSMC5 and hSMC6 arms and may lock them together.•hNSE6 binding to hSMC6 arm and hNSE5 is mediated by the conserved CANIN domain.•Domain arrangement within the hNSE1–hNSE3–hNSE4 subcomplex was determined.
The study examined the relationship between sense of responsibility for health, health suggestibility, and dispositional optimism in diabetic patients (
n
= 110) with (
n
= 56) and without (
n
= ...54) complications/accompanying diseases. The two groups of patients did not differ significantly in their sense of responsibility for heath, but health suggestibility was significantly higher and optimism was significantly lower in patients with complications. Health suggestibility and optimism had positive significant correlations with sense of responsibility for health in patients without complications, but in patients with complications, these correlations were not significant. However, the correlations between the two groups did not differ significantly suggesting lack of significant moderation effects due to complications. While it is understandable that suggestibility scores are higher and optimism lower in patients with complications, it is not easy to explain as to why the correlations were significant in patients without complications, but not in patients with complications. Further studies are warranted to draw any clinical implications of these results.
Highlights • This is an extension study of a previous publication. • Women were randomization to receive rocuronium or suxamethonium for caesarean section. • There were more 1-min Apgar scores <7 ...with rocuronium. • There were no differences in 5-min or 10-min Apgar scores. • There were no difference in umbilical arterial blood gases.
There is increasing evidence of gender differences in the pharmacokinetics and pharmacodynamics of aminosteroid neuromuscular blocking agents. Compared to males, females are more susceptible, ...requiring approximately 30% less rocuronium to achieve the same degree of neuromuscular block. However, little information is available whether this difference is applicable to modern benzylisoquinolines (cisatracurium).
In all, 848 patients (423 males, 425 females) undergoing general surgery under total intravenous anaesthesia with muscle relaxation, tracheal intubation and mechanical ventilation were studied. Patients were randomized to receive a single bolus dose of cisatracurium (0.1 mg kg-1, 221 males and 199 females) or rocuronium (0.6 mg kg-1, 202 males and 226 females). The onset time for 95% depression of T1, clinical duration until 25% recovery and recovery index (T1 from 25% to 75%) were determined with an NMT electromyographic module of the Datex-Ohmeda S/5 Anaesthesia Monitor. The data for male and female groups were compared with appropriate statistical tests (unpaired t-test, Mann-Whitney rank sum test and Fisher's exact test).
In both groups (cisatracurium and rocuronium), males were significantly taller (P < 0.001) and heavier (P < 0.001) than females, but the body mass index was comparable. For rocuronium, the onset time was shorter 91.7 +/- 14.3 s vs. 108.0 +/- 14.6 s (P < 0.001) and the clinical duration was increased in females 43.3 +/- 7.8 min vs. 31.3 +/- 5.5 min (P < 0.001). In the cisatracurium group, both onset times (248.9 +/- 60.7 s for males vs. 253.4 +/- 70.9 s for females) and clinical duration (42.6 +/- 6.9 min for males vs. 43.1 +/- 6.9 min for females) were similar. The recovery index was identical for males and females in both groups.
Females were more sensitive than males to a single bolus dose of rocuronium. Under the study conditions described, the onset time was shorter and the clinical duration was increased in female patients. This suggests that the routine dose of rocuronium should be reduced in females compared to males. On the contrary, we could demonstrate no gender differences in the onset time or clinical duration of cisatracurium.
The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the greater occipital nerve versus a greater occipital nerve block with a mixture of local anaesthetic and steroid ...in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A greater occipital nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.001) and 9 months (p<0.01), respectively. No serious complication was noted. Greater occipital nerve block is a safe, efficient technique in the management of cervicogenic headaches. Despite the lack of high quality scientific evidence (level III or IV) in the literature, we have extensive experience with steroid application and pulsed radiofrequency to the greater occipital nerve and report the beneficial results in our study.
Odontoid process fractures in patients with ankylosing spondylitis (AS) are rare and their finding together with subaxial cervical spine injury is a great exception. Neither the mechanism of such a ...combined cervical spine injury nor its surgical treatment has so far been reported in the relevant literature (MEDLINE). The authors present two such cases, one in a 30- and the other in a 74-year-old man. Both AS patients showed a common mechanism of injury sustained in a car accident, which involved hitting a solid barrier at 60 to 70 kilometres per hour, resulting in hyperextension of the cervical spine. In both patients the fractures were stabilised from the anterior approach: the dens fractures with one or two screws by the Magerl-Böhler method and the subaxial fractures with long-plate and screw fixation. At 2 post-operative years complete bone union of the subaxial spine was recorded in both patients; complete healing of the dens fracture was achieved in one patient while in the other partial fibrous union of the dens fracture occurred.
Background
Pulsed radiofrequency treatment (PRF) applied to the suprascapular nerve may provide pain relief for patients suffering from shoulder pain as described in three case series.
Aims
The ...effect of PRF to the suprascapular nerve was retrospectively analysed on 28 patients with shoulder pain lasting longer than 1 month, with a 6-month follow-up. Group A was treated with PRF and local anaesthetics only while group B was treated with PRF, local anaesthetic and steroid. Pain scores were evaluated before and after the procedure and at 1, 3 and 6 months.
Results
More than 50% of patients in both groups had significant pain relief after 3 months. No major, but only one minor complication occurred.
Conclusions
Our results suggest that the analgesic effects of PRF last more than 3 months in the majority of patients. The addition of steroid to the PRF treatment appears to have no benefit.
To present the authors' philosophy on the surgical treatment of juxtafacet cysts of the lumbosacral (LS) spine, with its primary aim of dynamic lumbar stabilisation with an interspinous implant, ...inserted by a minimally invasive approach, without concurrent exploration of the spinal canal and cyst removal.
During a 20-month period, ten patients aged between 25 and 70 years (average age, 53.2 years) were indicated for surgical treatment of a juxtafacet cyst by percutaneous insertion of an In-Space interspinous spacer without surgical exploration of the spinal canal. The group comprised six men and four women. At a follow-up of 6 weeks to 18 months, each patient underwent MRI examination of the LS spine and the degree of cyst resorption was assessed. The visual analogue scale (VAS) scores, Oswestry Disability Index (ODI) and range of motion (ROM) values, and a sagittal angle (SA) of the segment treated obtained for the whole group at 3 to 18 months after surgery were compared with the pre-operative va - lues. The surgeon evaluated the effect of surgery on radicular and axial pain.
Complete resorption of the cyst was found in seven patients (70%) and three (30%) showed partial resorption. Complete resolution of radicular symptoms was reported by five patients (50%); five experienced partial relief (50%). Lumbago was relieved completely in three (30%) and partially in seven (70%) patients. The average VAS score was 6.7 points (range, 4-10) pre-operatively and 3.5 (0-8) post-operatively, i.e. it decreased by 3.2 points, which meant an improvement by 48%. The average ODI value was 58.4% (range, 32-80) pre-operatively and 23.9% (0-70) post-operatively, i.e., it decreased by 34.5 percentage points and was an improvement by 59%. The average ROM measures were 5.65 degrees (range, 2°-10°) pre-operatively and 5.55 degrees (0°-19°) post-operatively. The average pre- and post-operative sagittal angles in normal lumbar lordosis were 7.1 degrees (1°-13°) and 6.2 degrees (1°-11°), respectively.
The conventional surgical procedure involves cyst extirpation. However, the procedure only relieves nerve root compression but does not remove the cause of juxtafacet cyst development, which is due to facet joint degeneration and instability. This may results in persistent or recurrent clinical symptoms. On the other hand, a reduction of both mobility and loading of the intervertebral joints achieved by implantation of an interspinous spacer is the mechanism allowing for resorption of the cyst and resolution of symptoms.
1. The original method of treating juxtafacet cysts of the LS spine by an In-Space interspinous spacer, as presented here, was efficient in all patients and resulted in complete, or at least partial, resorption of the cyst. 2. Segmental mobility and spondyloarthritis are the major aetiological factors of juxtafacet cyst development. 3. Dynamic interspinous stabilisation will reduce loading of the intervertebral joints and will thus allow for cyst resorption and clinical symptom resolution. 4. Percutaneous implantation of an "In-Space" interspinous spacer is a minimally invasive method of dynamic stabilisation that means no restrictions in patients' activities and reduces the length of hospital stay.
The effective analyzing power in Mott scattering was computed with a Monte Carlo simulation and compared to experimental results for electron-beam energies between 1.0 and 3.5 MeV. The dependence on ...target thickness and beam energy was analyzed, and possible parametrizations were discussed. The optimal target thickness and scattering angle for the measurement of polarization transfer in Møller scattering were determined.
The aim of the study was to present the effect and advantages of surgical decompression and dynamic transpedicular stabilisation in patients with degenerative spondylolisthesis of the lumbosacral ...spine.
This prospective study involved patients undergoing dynamic transpedicular stabilisation using Isolock or Isobar TTL (Scient X, France) systems. Between June 2003 and June 2009, 65 patients were treated and followed-up. They were aged 35 to 75 years (average, 57.17 years), and there were 32 men and 33 women. Follow-up ranged from 1 to 6 years. Based on indications for surgery they fell into two groups. Group 1 included 52 patients with grade I or II degenerative spondylolisthesis or retrolisthesis. Group 2 (control) consisted of 13 patients with degenerative disc disease or failed back surgery syndrome. The disorder had always been manifested by combined axial and radicular symptoms. Treatment included posterior decompression of nerve structures by laminectomy in conjunction with semi-rigid stabilisation, without fusion. Followup clinical (VAS, ODI), neurological and radiographic examinations were carried out at 6 weeks, 6 months and 1 to 6 years after surgery. The VAS and ODI results of both groups were statistically analysed and compared.
During follow-up the ODI values decreased by 54 % (from 58.4 % to 26.8 %) and VAS values by 62 % (from 7.9 to 3.0) as compared with the pre-operative values, and this was statistically significant. When both groups were compared, the VAS values decreased significantly (by 5.61) in Group 1, as compared with Group 2 (decrease by 3.54).
In the treatment of pseudospondylolisthesis, the semi-rigid stabilisation with spinal decompression, as presented here, is a convenient alternative to simple decompression without fixation or to various forms of instrumented or non-instrumented arthrodesis. A disadvantage associated with arthrodesis is a higher risk of ASD development; dynamic systems do not allow for reduction of spondylolisthesis and involve a change in sagittal spinal balance, and simple decompression carries the risk of slip progression and recurrent problems.
The authors demonstrated that decompression combined with semi-rigid stabilisation had a very good effect on the clinical state of patients with degenerative spondylolisthesis (retrolisthesis) at medium-term follow-up. The procedure was less effective in other indications. Semi-rigid stabilisation with Isobar TTL or Isolock systems prevented the progression of anterolisthesis or retrolisthesis; none of the patients experienced instrumentation failure. Neither symptomatic restenosis nor disc herniation was found in the instrumented segment. Semi-rigid stabilisation can, if necessary, be converted to fusion or disc replacement.
