寰枢关节后路动态固定的生物力学研究

目的探讨动态固定(转动钉、滑动钉)对寰枢关节稳定性的影响。方法用6具新鲜成人枕骨(Oc)～颈椎(C4)节段进行测试,分别模拟完整状态、损伤状态、坚强固定、转动钉固定、滑动钉固定。采用重复测量的实验设计,在完整、损伤和不同固定状态下,通过脊柱试验机对标本分别施加1.5 N·m前屈/后伸、左/右侧弯和左/右轴向旋转纯力偶矩。三维运动系统测量寰枢椎运动,分析比较固定节段角度的运动范围(range of motion,ROM)和中性区(neutral zone,NZ)。结果损伤状态下,寰枢关节ROM在前屈、后伸、侧弯和旋转方向上均显著增加,产生了寰枢关节不稳。在前屈、后伸、侧弯和旋转方向上,坚强固定和动态固定后ROM均显著减小。与坚强固定比较,动态固定仅在侧弯方向上ROM较大。动态固定显著减小了在屈伸、侧弯和旋转方向上的NZ,且与坚强固定之间的差异无显著性。结论寰枢关节动态固定后,在前屈、后伸和旋转方向上的稳定性与坚强固定相当,但在侧弯方向上较弱。动态固定能够维持寰枢关节的相对稳定。     

枕颈区后路柔性动态固定的生物力学研究

目的 探讨柔性和动态固定方式对枕颈区稳定性的影响。 方法 采用6具新鲜成人枕颈区Oc~C4节段进行测试,模拟以下状态：（1）完整状态;（2）损伤状态：齿状突II型骨折加寰枕关节囊损伤;（3）坚强固定：C1、C2用普通椎弓根螺钉固定,C3侧块螺钉,直径3.5 mm钛棒连接;(4)柔性固定：直径2.0 mm钛棒连接;(5)C1用2枚转动钉固定;(6)C1、C2用4枚转动钉固定;（7）C1、C2、C3用6枚转动钉固定。通过脊柱试验机对标本施加1.5 Nm的纯力偶矩,三维运动测量系统分析枕颈区Oc~C3角度运动范围和中性区。 结果 直径2.0 mm的棒固定后的运动范围,在各个方向上均大于坚强固定,有显著性差异（P<0.05）。与坚强固定比较,在 C1、C2采用2~4枚转动钉固定,在各方向上运动范围相当（P>0.05）。 C1、C2、C3使用6枚转动钉固定仅在旋转方向上明显增加了Oc~C3运动范围,差别有统计学意义（P=0.031）。不同固定方式在屈伸、侧弯和旋转方向上均显著减小了固定节段的中性区（P<0.05）。 结论 枕颈区Oc~C3节段,采用直径2.0 mm的细棒固定,各方向的稳定性均弱于坚强固定。在C1、C2采用2~4枚转动钉固定,与坚强固定的稳定性相当。在C1、C2、C3采用6枚转动钉固定,仅在旋转方向上弱于坚强固定。     

经口寰枢椎前路钢板固定有限元分析及临床意义

目的　对经口寰枢椎钢板前路固定力学参数进行有限元分析,为该节段手术的开展及改进提供参考。 方法　随机选取2014年1月来本院就诊检查的非颅底-寰枢椎疾患病例1例,男性,36岁,体质量64 kg。对颅底-寰枢椎进行0.625 mm薄层扫描,采用Mimics 16.01软件对影像资料进行重建,利用Pro/ENGINEER 4.0软件对经口寰枢椎前路钢板进行重建,将重建后的钢板螺钉三维模型导入Mimics 16.01中按照经典经口寰枢椎前路手术要求进行配准,并对模型进行面、体网格划分和材料赋值,将模型导入ANSYS14.0软件内,垂直方向加载80 N,表面施加15 Nm力矩,模拟前屈、后伸和侧弯3种运动状态,测量螺钉和棒的应力。 结果 寰枢椎三维重建模型共划分39 842个体网格,对模型进行加载后,上位螺钉根部前屈最大应力为（62.34±5.52）MPa （F=73.23,P<0.05）; 下位螺钉根部和顶端侧弯最大应力分别为（78.42±5.5.14）Mpa（F=112.32, P<0.05）;（95.48±7.12）Mpa（F=62.32, P<0.05）,差异均有统计学意义;前屈和后伸状态下上位螺钉根部应力大于下位（t前屈=12.2,t后伸=9.23,t侧弯=-22.98,均P<0.05）,而在侧弯时下位螺钉根部应力大于上位;下位螺钉顶端与根部在相同运动状态下比较,顶端大于根部,差异均有统计学意义（t前屈=23.14,t后伸=22.01,t侧弯=8.13,均P<0.05）。 结论 经口寰枢椎固定系统应力分布较为合理,能承受正常寰枢椎运动承载的应力,但术后患者要减少前屈和侧弯运动,以降低固定系统疲劳断裂的风险。     

寰枢椎不稳后路椎弓根螺钉固定的三维有限元分析

目的:建立寰枢椎后路椎弓根螺钉固定系统三维有限元模型,分析寰枢椎后路椎弓根螺钉固定的稳定性。方法:1例寰枢椎不稳标本行后路椎弓根螺钉系统固定,采用螺旋CT扫描,通过工作站将扫描获得的图像导入计算机中,利用ANSYS8.0软件建立寰枢椎不稳三维有限元模型。给予模型加载不同边界条件,模拟寰枢椎的不同运动,分析寰枢椎不稳采用后路椎弓根螺钉固定的稳定性。结果:寰枢椎不稳采用后路椎弓根螺钉系统固定在不同运动状态下应力主要集中在枢椎椎弓根螺钉的根部。前屈运动时,椎弓根螺钉根部的应力为0.350×109Pa,前屈角度为0.7°;后伸运动时,椎弓根螺钉根部的应力为0.427×109Pa,后伸角度为1.2°;侧弯运动时,椎弓根螺钉根部的应力为0.295×109Pa,侧弯角度为0.3°;旋转运动时,椎弓根螺钉根部的应力0.635×109Pa,旋转角度为0.8°。结论:寰枢椎不稳采用后路椎弓根螺钉系统固定具有良好的术后即时稳定性。     

寰枢椎后路二种内固定技术的三维稳定性评价

目的:对比寰枢椎椎弓根螺钉固定系统与枢椎椎弓根螺钉联合寰椎椎板钩固定系统的生物力学稳定性,为临床应用提供实验依据。方法:新鲜颈椎标本6例,损伤齿突基底部,建立寰枢椎失稳模型,在脊柱三维运动实验机上先测量失稳寰枢椎的三维运动范围,再在失稳模型上对每具标本进行两种内固定:C1椎弓根螺钉 C2椎弓根螺钉的钉棒内固定系统,C1椎板钩 C2椎弓根螺钉的钉棒钩内固定系统,测量二种不同固定方法的寰枢椎三维运动范围,比较两种状态下的寰枢椎稳定状况。结果:C1椎弓根螺钉 C2椎弓根螺钉的钉棒内固定与C1椎板钩 C2椎弓根螺钉的前屈、后伸、左右侧屈无显著性差异,左右旋转C1椎弓根螺钉组优于C1椎板钩组。结论:两种寰枢固定方法:C1椎弓根螺钉 C2椎弓根螺钉固定系统在抗左右旋转方面较C1椎板钩 C2椎弓根螺钉固定系统的稳定性优越,临床上应优先选择C1、C2椎弓根螺钉固定方法,当C1椎弓根过于细小时可选用C1椎板钩 C2椎弓根螺钉的固定技术。     

一种新型寰枢椎后路动态固定系统的稳定性研究

目的 　评价新型寰枢椎后路动态固定系统的稳定性。 方法　8具较新鲜的成人枕颈标本（C0~4）,随机分成4组：①完整状态组（A组）、②寰枢椎不稳状态组（B组）、③寰枢椎后路动态固定状态组（C组）和④寰枢椎后路椎弓根螺钉固定状态组（D组）。测量在1.50 Nm的力矩下,寰枢关节前屈/后伸,左/右侧弯和左/右旋转等6种运动方式下的运动范围（ROM）及稳定性指数（Sf值）,进行统计学分析。 结果　C组与A组的各方向ROM比较,差异无统计学意义（P>0.05）;而C组与D组的各方向ROM比较,差异有统计学意义（P<0.001）。C组与B组和D组的屈伸、侧屈和旋转的稳定性指数（Sf值）比较,差异有统计学意义（P<0.05）;C组的屈伸、侧屈和旋转的Sf值最接近完整状态组（A组）,差异无统计学意义（P>0.05）。 结论　寰枢椎后路动态固定在重建寰枢关节稳定性上有独特优势,既可维持寰枢椎的活动性,又可达到坚强固定的稳定性,为寰枢椎后路固定提供一种新的选择。     

新型后路寰枢椎限制性非融合内固定系统的有限元分析

背景:寰枢椎融合是目前治疗寰枢椎脱位的主要修复方式,但是其前提是牺牲寰枢椎活动为代价,特别是旋转功能。限制性非融合内固定是一种既可以维持寰枢椎稳定性,又可保留寰枢椎活动功能的方法,其生物力学特点与传统融合术之间的差异有待进一步研究。目的:通过建立寰枢椎不稳的三维有限元模型并模拟后路寰枢椎限制性非融合内固定系统和后路寰枢椎钉棒内固定系统,验证该新型内固定系统的生物力学特性。方法:选择1名31岁成年健康男性志愿者,采集从枕骨底到第3颈椎(C0-C3)的CT数据,应用Simpleware3.0、Geomagic 8.0、Hypermesh 10.0、Abaqus 6.9、Rhino 4.0软件构建有限元模型。施加1.5 N·m的纯力偶矩,使模型在屈伸、侧弯、旋转方向上运动,将模型的椎间活动度与文献报道的体外生物力学实验数据相比进行验证。建立后路寰枢椎限制性非融合内固定系统模型和后路寰枢椎钉棒内固定系统模型,对比两种模型在前屈、后伸、侧弯、旋转等工况下的椎间活动度,记录下限制性非融合内固定系统模型的SMise应力云图。结果与结论:(1)实验建立了健康人的上颈椎(C0-C3)三维非线性有限元模型,模型包括206 747单元,72 500个节点,其外形逼真,椎间活动度与文献报道的体外生物力学实验结果吻合;(2)限制性非融合内固定系统模型C1-C2节段前屈、后伸工况的活动度与传统钉棒内固定系统模型相似;(3)在左右侧屈工况下,传统钉棒内固定系统模型C1-2间的侧屈活动度明显受限,而限制性非融合内固定系统模型的活动度比寰枢椎脱位模型有所增加,与正常寰枢椎模型基本相同;(4)在左右旋转工况下,传统钉棒内固定系统模型寰枢椎之间的旋转活动度基本消失,而限制性非融合内固定系统模型其活动度虽有所减少,但仍保留大部分旋转活动度;(5)限制性非融合内固定系统模型在螺钉与连接棒、连接杆接触部位出现应力集中;(6)结果表明,后路寰枢椎限制性非融合内固定系统是一种实用、有效的寰枢椎内固定方式,该限制性非融合内固定装置具有限制屈伸活动,并且有效保留寰枢椎轴向旋转和侧弯活动功能的特点。     

寰椎枕骨化对枕颈部生物力学影响的实验研究

目的 :建立人类寰椎枕骨化模型 ,进行生物力学测试 ,阐明寰椎枕骨化畸形对枕颈部生物力学的影响。方法 :采用新鲜人体枕颈部标本制作人类寰椎枕骨化实验模型 ,分别对标本和模型进行生物力学测试 ,确定寰枕关节和寰枢关节的运动参数 ,进行统计学分析。结果 :与标本比较 ,模型的枕寰关节各轴向的运动几近消失 (P <0 .0 0 1 ) ,最大的运动参数是后伸运动范围 ,仅 0 .2 1°。寰枢关节屈曲运动的弹性区和运动范围分别从正常的 1 1 .71°和 1 5 .55°增加至 1 6 .63°和 2 1 .0 4°,相差显著 (P <0 .0 5) ,旋转运动的中性区和运动范围分别从正常的 36 .88°和 48.2 4°增加至 41 .70°和 52 .2 4° ,相差显著 (P <0 .0 5) ,屈曲运动的中性区、旋转运动的弹性区及后伸和侧曲运动各运动参数均相差不显著 (P >0 .0 5)。结论 :1 .寰椎枕骨化畸形造成寰枕关节运动丧失 ,寰枢关节的负荷和旋转不稳定趋势增加 ,容易导致寰椎横韧带退变、松弛和寰枢关节不稳。 2 .建议对寰椎枕骨化畸形的患者密切观察 ,证实寰枢关节临床不稳 ,尽早手术融合     

Vertex万向螺钉系统在寰枢椎后路固定中的应用

研究Vertex万向螺钉系统在寰枢椎后路固定中的作用及价值。使用Vertex万向螺钉治疗寰枢椎不稳定,寰椎进钉点在寰椎后弓上,寰椎中线外侧,距正中矢状线18～20mm,距寰椎后弓下缘2.0mm,进钉时向内倾斜10°,向头侧倾斜5°;枢椎椎弓根螺钉进钉应在直视下平行枢椎峡部内侧缘及上面的平面进入。寰枢螺钉之间使用钛棒连接固定。结果表明置钉顺利,无并发症,所有病例获随访,平均9个月,寰枢椎复位固定良好。JOA评分法术前平均9.6分,术后平均15.9分。研究结果表明Vertex万向螺钉系统治疗寰枢椎不稳定效果良好,是寰枢椎后路固定可供选择的术式之一,并适用于年幼患者的固定。     

新型钉尾横连在后路寰枢椎固定中的生物力学分析

背景：后路寰-枢椎椎弓根钉棒内固定是治疗寰枢椎脱位的主要方法，横连接在内固定系统抗旋转能力中起着重要作用。新型寰椎钉尾横连可以有效克服传统横连安装不便、影响植骨床和脊髓损伤可能等缺点，但不同安装模式的新型钉尾横连的生物力学性能尚不清楚。目的：测试不同安装模式的新型寰椎钉尾横连在后路寰-枢椎椎弓根钉棒内固定系统中的生物力学特性，为临床选择最佳安装模式提供理论依据。方法：6具新鲜人体枕颈标本作为完整组(A组)，在完整组基础上建立Ⅱ型齿状突骨折的寰枢椎失稳模型(B组)，在失稳组基础上对每具标本先后进行后路寰-枢椎椎弓根钉、棒内固定(C组)，在C组上依次安装不同模式新型寰椎钉尾横连，其中包括上水平横连(两寰椎螺钉钉尾)为D组，下水平横连(两枢椎螺钉钉尾)为E组，斜形横连(左上右下为F组，左下右上为G组)，交叉横连为H组。在三维运动机上将标本模型按顺序进行前屈、后伸、左右侧屈和左右旋转测试，获取各个内固定状态下的寰枢椎活动度。运用重复测量方差分析评价各组模型的生物力学特性。结果与结论：(1)在6种工况下，A、C、D、E、F、G、H组寰枢椎活动度小于B组，差异均有显著性意义(P <0.05)...     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

État de l’art : nouveaux anticoagulants et transfusion

Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.