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Intradural extramedullary metastasis of oncocytic carcinoma of the parotid gland: A first case report and review of the literature. 腮腺嗜酸细胞癌的硬膜外髓外转移:第一例报告并文献复习。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-05 DOI: 10.1038/s41394-023-00605-2
Gwenaelle Schackis, Tuan Le Van, Ahmed El Cadhi, Marc Lenfant, François Borsotti, Philibert Alixant

We present an extremely infrequent case of intradural metastasis of a parotid tumour, responsible for motor deficit in legs. To our knowledge, this is the first reported case of an intradural metastasis of a malignant and rare parotid tumour, oncocytic carcinoma. It accounts for less than 1% of salivary gland tumours. Its management is not codified and its prognosis seems to be poor. Local recurrences are common, as are regional metastases. Distant metastases are present in less than 30% of cases and are poorly described, mainly involving the lung. Thanks to the surgical treatment, our patient has partially recovered his motor and sensory functions.

我们报告了一个极为罕见的腮腺肿瘤硬膜内转移病例,该病例是腿部运动功能障碍的原因。据我们所知,这是第一例罕见的腮腺恶性肿瘤,即嗜酸细胞癌的硬膜内转移病例。它只占唾液腺肿瘤的不到1%。它的管理没有成文,而且它的预后似乎很差。局部复发很常见,区域转移也很常见。不到30%的病例存在远处转移,而且描述不多,主要涉及肺部。由于手术治疗,我们的病人已经部分恢复了运动和感觉功能。
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引用次数: 0
Epidemiology and healthcare utilization of First Nations peoples living with spinal cord injury in Alberta: an observational study to explore health inequities. 阿尔伯塔省第一民族脊髓损伤患者的流行病学和医疗保健利用:一项探索卫生不平等的观察性研究。
IF 1.2 Q4 Medicine Pub Date : 2023-09-08 DOI: 10.1038/s41394-023-00603-4
Brett F Wegenast, Tara A Whitten, Jeffrey A Bakal, Lea Bill, Adalberto Loyola-Sanchez

Study design: Retrospective observational cohort study.

Objectives: Estimate spinal cord injury (SCI) prevalence in First Nations and non-First Nations populations and compare healthcare utilization as an indirect marker of health inequities.

Setting: Alberta, Canada.

Methods: We created a prevalent adult SCI cohort by identifying cases between April 1, 2002 and December 31, 2017 who were followed for common SCI complications and location of healthcare access from January 1, 2018 to December 31, 2019 using administrative data sources housed within Alberta Health Services (AHS). First Nations and non-First Nations SCI cohorts were divided into SCI etiology: traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Statistical analyses compared prevalence, demographics, healthcare utilization, and SCI complication rates. A secondary analysis was performed using case matching for demographics, injury type, injury level, and comorbidities.

Results: TSCI prevalence: 248 and 117 per 100,000 in First Nations and non-First Nations cohorts, respectively. NTSCI prevalence: 74 and 50 per 100,000 in First Nations and non-First Nations cohorts, respectively. Visit rates were higher in the TSCI First Nations cohort for visits to General Practitioner (GP), Emergency Department (ED), inpatient visits, and inpatient days with higher complication rates due to pulmonary, genitourinary, skin, and 'other' causes after case matching. Visits rates were higher in the NTSCI First Nations cohort for GP and specialists without differences in complication types after case matching.

Conclusions: Significant differences exist between First Nations and non-First Nations cohorts living with SCI in Alberta, suggesting healthcare inequities against First Nations Peoples in this province.

研究设计:回顾性观察队列研究。目的:估计第一民族和非第一民族人群中脊髓损伤(SCI)的患病率,并比较医疗保健利用作为卫生不平等的间接标志。背景:加拿大阿尔伯塔省。方法:利用艾伯塔省卫生服务中心(AHS)的管理数据源,通过确定2002年4月1日至2017年12月31日期间的病例,创建了一个流行的成人SCI队列,这些病例于2018年1月1日至2019年12月31日期间进行了常见的SCI并发症和医疗保健就诊地点的随访。第一民族和非第一民族脊髓损伤队列分为脊髓损伤病因:创伤性脊髓损伤(TSCI)和非创伤性脊髓损伤(NTSCI)。统计分析比较了患病率、人口统计学、医疗保健利用和脊髓损伤并发症发生率。采用人口统计学、损伤类型、损伤程度和合并症的病例匹配进行二次分析。结果:TSCI患病率:第一民族和非第一民族人群中分别为每10万人248例和117例。NTSCI患病率:在第一民族和非第一民族人群中,分别为每10万人74人和50人。在TSCI第一民族队列中,就诊于全科医生(GP)、急诊科(ED)、住院就诊和住院天数的就诊率较高,在病例匹配后,由于肺部、泌尿生殖系统、皮肤和“其他”原因导致的并发症发生率较高。就诊率较高的NTSCI第一民族队列的全科医生和专家在病例匹配后没有并发症类型的差异。结论:阿尔伯塔省第一民族和非第一民族的脊髓损伤患者之间存在显著差异,表明该省存在针对第一民族的医疗保健不公平。
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引用次数: 0
Correction to: Development of a comprehensive assessment tool to measure the quality of care for individuals with traumatic spinal cord injuries. 更正:开发一种综合评估工具,以衡量创伤性脊髓损伤患者的护理质量。
IF 1.2 Q4 Medicine Pub Date : 2023-09-06 DOI: 10.1038/s41394-023-00578-2
Zahra Ghodsi, Seyed Behnam Jazayeri, Ahmad Pourrashidi, Mohsen Sadeghi-Naeini, Zahra Azadmanjir, Vali Baigi, Seyed Farzad Maroufi, Amir Azarhomayoun, Morteza Faghih-Jouybari, Abbas Amirjamshidi, Khatereh Naghdi, Roya Habibi Arejan, Maryam Shabani, Arvin Sepahdoost, Hojat Dehghanbanadaki, Reza Habibi, Mahdi Mohammadzadeh, Maryam Bahreini, Gerard Michael O'Reilly, Alexander R Vaccaro, James S Harrop, Benjamin M Davies, Lu Yi, Seyed Mohammad Ghodsi, Vafa Rahimi-Movaghar
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引用次数: 0
Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails. 减轻非卧床病人的颈胸椎病:当牵引失败时。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-05 DOI: 10.1038/s41394-023-00604-3
Brendan F Judy, Jovanna A Tracz, Jordina Rincon-Torroella, A Karim Ahmed, Timothy F Witham

Introduction: Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails.

Case presentation: A 21-year-old man with no significant past medical history presented after a high-speed motor vehicle collision with cervicothoracic pain and mild hand grip weakness in addition to numbness of the fourth and fifth digits bilaterally (American Spinal Injury Association Impairment Scale Grade D). Computed tomography imaging revealed spondyloptosis of C7 over T1, a fracture of the C2 vertebral body, and a burst fracture of C3. To relieve spinal cord compression and restore sagittal realignment, closed reduction was attempted, however this resulted in perching of the bilateral C7-T1 facets, leading to an open posterior approach. The patient underwent C7 laminectomy, bilateral C7-T1 facetectomy, and manual reduction using a Mayfield skull clamp followed by C2-T3 fixation. Postoperatively, pain was diminished, sensory disturbances were resolved and the patient was otherwise neurologically stable.

Discussion: There is a role for closed traction for reduction of cervical spondyloptosis, however, its role is debated especially when the patient is predominately neurologically intact. In this setting, the spine surgeon may be required to change traction and operative strategies in order to minimize potentially harmful manipulation while restoring sagittal realignment and stabilizing the spine for preservation of neurological function.

简介:颈椎骨质增生是高能量创伤的一种罕见并发症,通常会导致患者严重的发病率和死亡率。作者介绍了一例 C7 超过 T1 的脊柱椎体畸形病例,其根性症状极轻,在其他方面完全保留了脊髓。该病例强调了颈椎椎弓根突出症所面临的手术挑战以及牵引失败时所使用的技术:一名 21 岁的男子,既往无重大病史,在一次高速行驶的机动车碰撞后出现颈胸疼痛和轻度手部握力减弱,双侧第四和第五位数字麻木(美国脊柱损伤协会损伤量表 D 级)。计算机断层扫描成像显示,T1上方的C7椎体软化,C2椎体骨折,C3椎体爆裂性骨折。为了缓解脊髓压迫并恢复矢状位对齐,患者尝试了闭合复位,但这导致双侧C7-T1面的栖息,从而导致了开放性后路手术。患者接受了 C7 椎板切除术、双侧 C7-T1 椎面切除术,并使用梅菲尔德颅骨钳进行了人工复位,随后进行了 C2-T3 固定。术后,患者疼痛减轻,感觉障碍消失,其他神经功能稳定:讨论:闭合牵引在减轻颈椎病方面有一定作用,但其作用还存在争议,尤其是在患者神经功能基本完好的情况下。在这种情况下,脊柱外科医生可能需要改变牵引和手术策略,以尽量减少潜在的有害操作,同时恢复矢状位对齐和稳定脊柱以保护神经功能。
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引用次数: 0
Correction: Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report. 纠正:自体生物反馈训练可改善颈椎运动性完全性脊髓损伤患者的自主神经反应——病例报告。
IF 1.2 Q4 Medicine Pub Date : 2023-08-24 DOI: 10.1038/s41394-023-00602-5
Rachel D Torres, Hani Rashed, Prateek Mathur, Camilo Castillo, Thomas Abell, Daniela G L Terson de Paleville
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引用次数: 0
Correction: Transient alteration of consciousness in spinal cord injury secondary to Baclofen use: a case report. 纠正:巴氯芬继发于脊髓损伤的短暂性意识改变:1例报告。
IF 1.2 Q4 Medicine Pub Date : 2023-08-18 DOI: 10.1038/s41394-023-00601-6
Thomas John Pisano, Jessica Ace, Beverly Hon
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引用次数: 0
Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports. 感染性特应性湿疹并发金黄色葡萄球菌化脓性脊髓感染导致脊髓损伤:两例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-14 DOI: 10.1038/s41394-023-00599-x
K MacKay, E J McCaughey, N Fullerton, M Purcell

Introduction: Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin's natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.

Case presentation: We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.

Discussion: We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.

导言:化脓性脊柱感染(PSI)是脊髓损伤(SCI)的罕见病因。最常见的感染部位是腰椎,其次是胸椎,最不常见的是颈椎,最常见的致病菌是金黄色葡萄球菌。特应性湿疹是一种皮肤病,可导致皮肤的天然屏障功能被破坏,从而导致细菌定植和感染。从远处感染源(包括皮肤和软组织)进行血液学细菌播种是 PSI 的公认病因:我们介绍了两名因特异性湿疹继发 PSI 而导致 SCI 的患者。两名患者的致病菌均为对甲氧西林敏感的金黄色葡萄球菌(MSSA)。这两名患者需要长期静脉注射抗生素,然后再口服抗生素。两名患者的神经系统结果各不相同。其中一名患者为不完全四肢瘫痪(C3 AIS C),出院时需要从床上抬到电动椅上,留置尿道导尿管,并需要肠道护理。另一名患者为不完全截瘫(L3 AIS D),出院时能独立进行日常生活活动,并能使用双肘拐杖移动:我们认为,这里介绍的两个病例是已发表文献中唯一一个二次感染特应性湿疹导致 PSI 并导致 SCI 的病例。由于 SCI 是一种严重且可能影响生命的并发症,因此治疗特应性湿疹患者的医务人员应了解这一风险。
{"title":"Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports.","authors":"K MacKay, E J McCaughey, N Fullerton, M Purcell","doi":"10.1038/s41394-023-00599-x","DOIUrl":"10.1038/s41394-023-00599-x","url":null,"abstract":"<p><strong>Introduction: </strong>Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin's natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.</p><p><strong>Case presentation: </strong>We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.</p><p><strong>Discussion: </strong>We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery. 颈椎后路减压融合手术后双侧膈神经麻痹:术后罕见病例。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-12 DOI: 10.1038/s41394-023-00595-1
Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop

Introduction: Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.

Case report: A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.

Conclusion: Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.

简介延迟性 C5 无力是颈椎手术中的一个已知病例,但其临床表现各不相同,作用机制也鲜为人知。我们描述了文献中第一例颈椎后路减压融合术后双侧 C5 麻痹导致双侧膈神经功能障碍的病例:一名 76 岁的男性因腰痛前来就诊,被诊断为脊髓病。在最初的神经系统检查中,他在没有人搀扶的情况下无法下地行走,双腿步态不稳。最初的颈椎 MRI 和 CT 扫描显示,颈椎出现晚期多层次退行性病变,伴有严重的脊髓压迫和髓鞘病变。患者接受了 C3-C6 颈椎后路减压融合术(PCDF)。他醒来后进行了基线检查,术中没有神经电生理监测变化,也没有 C5 根 EMG 活动。术后对颈椎进行了核磁共振检查,结果显示减压效果良好。患者神经功能稳定,已出院前往康复机构。患者在术后第 74 天(POD)出现延迟性双侧 C5P。延迟的双侧 C5P 和膈神经损伤被确定为导致该患者呼吸困难的原因。PM&R 顾问建议放置膈肌起搏器。然而,在临床上,他的呼吸功能和运动障碍已逐渐改善:结论:双侧膈肌麻痹是颈椎手术的严重并发症,可能导致呼吸困难和上肢无力。C5P是其根本原因,可能由多种因素引起。早期发现膈肌无力并通过物理疗法和起搏器进行治疗至关重要,这强调了医护人员和外科医生保持警惕的必要性。
{"title":"Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery.","authors":"Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop","doi":"10.1038/s41394-023-00595-1","DOIUrl":"10.1038/s41394-023-00595-1","url":null,"abstract":"<p><strong>Introduction: </strong>Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.</p><p><strong>Case report: </strong>A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.</p><p><strong>Conclusion: </strong>Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis. 脊髓损伤患者两种吸气肌训练方案的比较:二次分析。
IF 1.2 Q4 Medicine Pub Date : 2023-08-12 DOI: 10.1038/s41394-023-00594-2
Anne E Palermo, Jane E Butler, Claire L Boswell-Ruys

Study design/setting: Secondary analysis.

Objectives: To compare the change in maximal inspiratory pressure (PImax) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury.

Methods: Data originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PImax, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30-80% weekly PImax, twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A-C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PImax from baseline at the end of week four were analysed.

Results: Over 4 weeks, there was no difference in the change in PImax between groups (Absolute change in PImax (cmH2O): p = 0.456, Percent change in PImax relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH2O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PImax × number of breaths), p = 0.535).

Conclusions: Our findings support both methods of IMT as the change in PImax and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PImax.

研究设计/设置:二次分析。目的:比较两种不同的吸气肌训练(IMT)方案前4周最大吸气压力(PImax)的变化,并探讨哪种方法对脊髓损伤患者更有效。方法:数据来源于两项已发表的研究。参与者完成流动阻力IMT (F-IMT)在80%的每日PImax,每周7天(监督每周),或阈值IMT (T-IMT)在30-80%的每周PImax,每天两次,每周5天(监督每次)。每个试验的7名参与者按照训练依从性、脊髓损伤程度、损伤等级(A-C)和身高进行匹配。分析F-IMT组和T-IMT组在训练强度、呼吸量、吸气功以及第四周结束时基线的PImax变化方面的差异。结果:在4周内,两组间PImax的变化无差异(PImax的绝对变化(cmH2O): p = 0.456, PImax相对于基线的百分比变化:p = 0.128)。F-IMT参与者训练强度更高(中位数:77 cmH2O vs 22 cmH2O, p = 0.001, 80%基线vs 61%基线,p = 0.038),但比T-IMT参与者呼吸次数更少(840对1404次呼吸,p = 0.017)。两组之间的吸气功相似(64,789 vs 65,910 (% PImax ×呼吸次数),p = 0.535)。结论:我们的研究结果支持两种IMT方法,因为两组之间PImax和吸气功的变化相似。然而,每日高强度的间歇监督的F-IMT需要更少的呼吸和更少的参与者和治疗师的时间。未来的研究应检查最佳剂量和所需的监督,以达到增加PImax。
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引用次数: 0
Posterior cervical congenital dermal sinus tract: case report and review of literature. 颈后先天性真皮窦道:1例报告及文献复习。
IF 1.2 Q4 Medicine Pub Date : 2023-08-02 DOI: 10.1038/s41394-023-00575-5
Amir Vokshoor, Harseerat Jajj, Tiffany Grunwald, Steven Kolker, Jack Petros

Background and importance: Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.

Clinical presentation: In this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient's preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1-C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.

Conclusion: A review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.

背景和重要性:先天性真皮窦道(DST)是一种罕见的脊柱异常,其特征是由上皮细胞排列的持续性通道,始于表皮,终止于更深的组织层。1%的先天性DST病例发现于宫颈区域,只有4%的病例在20岁以后被诊断出来。临床表现:本例患者为65岁女性,颈段先天性DST,表现为颈部和部分手臂疼痛,枕下头痛,并有独特的外部特征。采用颈部残疾指数和视觉模拟量表评估患者术前、术后疼痛及生活质量。患者接受手术干预,其中手术切除DST,然后在C1-C2椎板间减压,切除硬膜外成分,活检后进行整形手术修复。病理分析显示鳞状上皮排列的窦道与硬脑膜相互作用。最值得注意的是,发现脑膜上皮增生并伴有沙质钙化,类似脑膜瘤。结论:回顾文献,进一步讨论临床和影像学表现,并记录这种先天性DST的新外观。作为最古老的DST病例之一,它表现出不同寻常的病理特征,在硬膜外水平报道了脑膜上皮增生,与脑膜瘤相容。
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引用次数: 0
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Spinal Cord Series and Cases
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