Clinical Significance of Articulating Facet Displacement of Lateral Atlantoaxial Joint on 3D CT in Diagnosing Atlantoaxial Subluxation

To improve the recognition of articulating facet displacement of lateral atlantoaxial joint (AFDLAJ), and to evaluate the significance of AFDLAJ in diagnosing atlantoaxial subluxation. Methods: The three-dimensional computed tomography (3D CT) imaging findings of 54 patients with atlantoaxial subluxation were retrospectively analyzed, and the imaging features of AFDLAJ were discussed. All the patients were examined in neutral position, and 25 in an additional rotary position. 3D images of the atlantoaxial joints were obtained by surface shade display and volume rendering. The diagnostic results of 3D CT, routine CT and X-ray were compared. Results: All the 54 patients with atlantoaxial subluxation were correctly diagnosed by 3D CT with no suspicious or missed diagnoses, including 38 cases of rotatory subluxation, 11 of anterior subluxation and five of posterior subluxation. AFDLAJ was found in all the 54 patients in neutral position, with the extent of subluxation between 2.0 mm and 9.0 mm. Among the 25 cases in rotary position, rotational fixation was found in 10 cases and rotational asymmetry in 15. The diagnostic accuracy of 3D CT was higher than that of X-ray or routine CT. Conclusion: Once AFDLAJ appears in neutral position and rotational fixation or asymmetry in rotary position, atlantoaxial subluxation can be ascertained, as well as the type and extent of subluxation, and fake subluxation due to the head's rotation or normal lateralized odontoid can be excluded. AFDLAJ is a vital direct sign in diagnosing atlantoaxial subluxation

Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction

The objective of this article is to display the vertebral artery and bone structure at the craniocervical junction (CJVA and C0-1-2) with three-dimensional CT angiography (3DCTA) and identify their anatomic features and variations. Eighty-eight subjects without pathology of vertebral artery (VA) and C0-1-2 were selected from head–neck CTA examination. 3D images were formed with volume rendering (VR) and multiplanar reconstruction (MPR). On the 3D images, CJVA and C0-1-2 were measured, and their variations were observed. CJVA goes along C0-1-2 with five curves, of which three curves are visibly away from C0-1-2, one is 0.0–8.3 mm away at the second curve with 0.0–11.2 mm in width, another is 0.0–9.2 mm away at the fourth with 2.8–14.8 mm and the other is 0.0–6.2 mm away at the fifth. Statistical comparisons show that there is no significant difference in the measurements between left and right, and that the curves become smaller and farther away from C0-1-2 with the increase of age. CJVA is not equal in size, with the biggest in the fourth curve and the smallest in the fifth. Statistical comparison shows the left CJVA is larger than the right in the fifth curve. Variations were found on CJVA in 16 cases and on C1 in 12 cases. The anatomy and variations of CJVA and C0-1-2 are complicated. It is of vital significance to identify their anatomic features in clinical practice

Clinical significance of articulating facet displacement of lateral atlantoaxial joint 3D CT in diagnosing atlantoaxial subluxaion

Background/Purpose: To improve the recognition of articulating facet displacement of lateral atlantoaxial joint (AFDLAJ), and to evaluate the significance of AFDLAJ in diagnosing atlantoaxial subluxation. Methods: The three-dimensional computed tomography (3D CT) imaging findings of 54 patients with atlantoaxial subluxation were retrospectively analyzed, and the imaging features of AFDLAJ were discussed. All the patients were examined in neutral position, and 25 in an additional rotary position. 3D images of the atlantoaxial joints were obtained by surface shade display and volume rendering. The diagnostic results of 3D CT, routine CT and X-ray were compared. Results: All the 54 patients with atlantoaxial subluxation were correctly diagnosed by 3D CT with no suspicious or missed diagnoses, including 38 cases of rotatory subluxation, 11 of anterior subluxation and five of posterior subluxation. AFDLAJ was found in all the 54 patients in neutral position, with the extent of subluxation between 2.0 mm and 9.0 mm. Among the 25 cases in rotary position, rotational fixation was found in 10 cases and rotational asymmetry in 15. The diagnostic accuracy of 3D CT was higher than that of X-ray or routine CT. Conclusion: Once AFDLAJ appears in neutral position and rotational fixation or asymmetry in rotary position, atlantoaxial subluxation can be ascertained, as well as the type and extent of subluxation, and fake subluxation due to the head's rotation or normal lateralized odontoid can be excluded. AFDLAJ is a vital direct sign in diagnosing atlantoaxial subluxation

Protein-Directed Synthesis of Bifunctional Adsorbent-Catalytic Hemin-Graphene Nanosheets for Highly Efficient Removal of Dye Pollutants via Synergistic Adsorption and Degradation

Herein, for the first time, we report a “green”, one-pot reduction/decoration method for the synthesis of bifunctional adsorbent-catalytic hemin-graphene nanosheets by using a common available protein (bovine serum albumin, BSA) as both a reductant and a stabilizer. Our prepared nanosheets are highly stable and possess intrinsic peroxidase-like catalytic activity due to the decoration of BSA and hemin. Furthermore, benefiting from the combined advantages of graphene and BSA, these nanosheets are able to efficiently adsorb dye pollutants from aqueous solution. More importantly, due to their adsorption and catalytic ability, these adsorbent-catalytic nanosheets can be applied to highly efficient dye removal via synergistic adsorption and degradation. Specifically, our catalysts can easily bring organic dyes to their surface by adsorption, and then activate H₂O₂ to generate hydroxyl radicals, leading to the degradation of the dyes. Such catalytic mechanism of our as-prepared nanosheets was analogous to that of natural enzymes, in which the extremely high catalytic efficiency is largely dependent upon their ability to bring substrates in close proximity to the active sites of enzymes. Our finding may open new potential applications of hemin-graphene hybrid nanosheets in environmental chemistry, biotechnology, and medicine

Zuberitamab, an innovative anti-CD20 monoclonal antibody, for patients with primary immune thrombocytopenia in China: a randomized, double-blind, placebo-controlled, phase 2 studyResearch in context

Summary: Background: Primary immune thrombocytopenia (ITP) is an autoimmune disease, and rituximab (RTX) induces long-term effect as second-line treatments. Zuberitamab is an innovative anti-CD20 monoclonal antibody, which was first developed in China and launched in diffuse large B lymphoma. This study aimed to investigate the safety, efficacy, and anticipated therapeutic dose of zuberitamab in Chinese ITP patients. Methods: This randomised, double-blind, placebo-controlled, phase 2 study was conducted at 26 hospitals in China. Eligible patients were aged 18–70 years, had primary immune thrombocytopenia for more than 6 months, and did not respond or relapsed after previous treatment and had a pre-treatment platelet count of <30 × 109/L. Patients randomly received zuberitamab in a dose escalation (100/300/600 mg) or placebo once-weekly for 4 weeks and followed up to 24 weeks. The primary endpoint is the proportion of patients with a platelet count ≥50 × 109/L at week 8. Secondary endpoints include the proportion of patients with platelet counts ≥50 × 109/L or ≥100 × 109/L at least once within week 12/24, the proportion of patients experiencing platelets increased twice more than baseline as well as ≥30 × 109/L at least once during the treatment. Adverse events, pharmacokinetic, B cell depletion and immunogenicity were also assessed. This study is registered with https://www.chictr.org.cn/as ChiCTR2100050513. Findings: From October 2021 to March 2023, 50 patients were screened for eligibility, of whom 32 patients were enrolled and randomly assigned to placebo (n = 4), zuberitamab 100 mg (n = 10), 300 mg (n = 8) and 600 mg (n = 10) groups. The primary endpoint (PLT ≥50 × 109/L at week 8) was achieved by 40% of patients in the 100 mg group, while none in the other groups. Within 12 weeks, the proportions of patients in each treatment group achieving at least one instance of platelet count ≥50 × 109/L or ≥100 × 109/L or an increase twice more than baseline as well as ≥30 × 109/L were (70%, 38%, 50%), (60%, 13%, 30%), and (80%, 50%, 70%) in zuberitamab 100/300/600 mg groups, respectively. By week 24, the proportions of patients achieving these secondary endpoints remained relatively stable or showed a mild increase of around 10%. The anticipated therapeutic dose of zuberitamab was 100 mg. The plasma concentration of zuberitamab showed an increasing trend with dose (100 mg–600 mg) and linear pharmacokinetic behavior. CD19+ B cells and CD20+ B lymphocytes rapidly declined to 0% within one week and consistently maintained reduced levels throughout the entire treatment phase in three groups. Adverse events occurred in all patients with most of them were mild to moderate, no severe infections occurred. A slight decrease in immunoglobulins was observed in the 600 mg group, but gradually recovered at week 20. Three patients (2 in 100 mg and 1 in 600 mg group) were tested positive for anti-zuberitamab antibodies. We also observed that women, disease duration <12 months, and MAIPA + patients may have higher response rates. Interpretation: This study preliminarily confirmed that 100 mg zuberitamab was safe and effective in treating ITP and was recommended to support further investigation. Funding: National Natural Science Foundation of China and Zhejiang Bioray Biopharmaceutical Co. Ltd