[Objective]To discuss the result of using latissimus dorsi musculocutaneous flap which function was recovered by repairing the thoracodorsal nerve with nerve transfering for reconstruction of flexor of elbow or digits in brachial plexus injury patients.[Method]From march 2000 to June 2003,eight patients with brachial plexus total roots avulsion were treated by mlutiple donor nerves transfer.The function of latissimus dorsi muscle recorved well but not the biceps muscle in five patients.The function of flex digits did not recover while the latissimus dorsi muscule recorverd well in three patients.All of them had the aid of latissimus dorsi musculocutaneous flap to reconstruct the flexor of elbow or digits.[Result]The patients were followed up for one year to half past three years,all of musculocutaneous flap were survived,the muscle strenght graded 3 to 4 and the active motion of the elbow was over 100 degrees in flexion and 10 degrees to 25 degrees in extension.All the digits can grasp,the fist closure was about 2 cm and the muscle strenght was grade 3 of the involved digits.[Conclusion]It is a good method to reconstruct the flexor of elbow or digits by the recovered latissimus dorsi musculocutaneous flap in brachial plexus total roots avulsion patients.When treating brachial plexus total roots avulsion patients,it is necessary to repair the thoracodorsal nerve.

[Objective]To investigate the morphological characteristic of the scalenus minimus. [Methods]Totally 32(64 sides) embalmed adult cadavers were dissected and studied,the morphology of scalenus minimus and its relationship to brachial plexus was observed.Ten scalenus minimus were stained by HE to study membrane of the muscles.Twenty-seven(54 sides) embalmed adult cadavers were dissected carefully to investigate its nerve and blood supply.[Results]Scalenus minimus was found in 84.4% of cadavers(54/64).Its insertion was mainly composed of tendinous tissue,which was spaned by the lower trunk of brachial plexus.Scalenus minimus supply nerve branches was from ventral rami of the cervical seven root,and vascular supply was from:(1) branches of deep cervical artery,(2) branches of subclavia artery.[Conclusion]Scalenus minimus muscle,an independent but inconstant muscle,is existed in most people and sometimes responsible for compression of brachial plexus.It is suggested that scalenus minimus muscle should be resected carefully as well as scalenus anticus and medius during surgical treatment of thoracic outlet syndrome.

Objective:To generate monoclonal antibodies against ciprofloxacin (CIP) and to analyze its immunological traits for establishing a determination method for ciprofloxacin residues in food tissues.Methods:BALB/c mice were immunized by the conjugation of CIP-BSA successfully.The splenic cells of BALB/c mice and the oncocyte were fused and screened in HAT culture medium.Cell strains of 1C9,3F6,6H2,6A7,6G11 and 8F5 were cloned,which could secret the monoclonal antibody (Mab) for ciprofloxacin.Results:By ELISA method,the haplotype of Mabs were identified.The antibody secreted by 1C9,3F6 and 6A7 were classified to the IgG2a.Those of 6H2 and 8F5 were classified to the IgG1 while 6G11 to IgG3.The results of SDS-PAGE showed that the Mab protein was made up of the weight chain and the light chain whose molecular weight were 50 kD and 25 kD,respectively.All of those Mabs had fine specificity and sensibility.The indirect ELISA titer of 1C9 was 1:6.4?102 in supernatant and 1:5.6?105 in ascites.The affinity of 1C9 was 2.85?109 L/mol and the value of IC50 reached to 245.86 ng/ml.The protein secreted by 1C9 was screened for establishing the ELISA method and the detective limitation reached to 45.25 ng/ml.There were no cross reactions to Ofloxacin,Difloxacin,Sarafloxacin,Malachite green,Chloramphenicol and Furacilin while the rate of cross reaction to Enrofloxacin could reach to 84.6%.Conclusion:The Mabs are sensitive and specific,which are suitable to be applied in establishing immunoassay of CIP residues.

Purpose　To study the relationship between sympathetic nerve and the branches of primary sensory neurons in dominating cervical zygapophyseal joints with the HRP retrograde tracing methods.To explore the mechanism of the external intervertebral foramen's cryical nerve compression syndrome with neck-shoulder pain and the symptom of head and face regions.　Methods　8 Wistar rats were used with the right side as experimental side and the left side as control side.5 μl of 30% HRP solution was injected into the C5/C6 cervical zygapophyseal joint capsule of the right side by microinjection syringe and 5 μl of 0.9% normal saline was injected into the left side as control.The animals survived for 48 hours and were killed by perfusing through ascending aorta.The C1-T1 DRG,cervical sympathetic ganglia and trigeminal ganglia on both sides were sectioned by frozen section method,and treated with TMB method.The HRP labeled cells in sections were observed under optical microscope.The classification and count of HRP labeled cells in DRG and cervical sympathetic ganglia on experimental sides were analysed by image pattern analysis system.　Results　There were HRP labeled cells in middle cervical ganglia,inferior cervical ganglia (stellate ganglia) and C5-C7 DRG on experimental sides after HRP injection.Most of the labeled cells were small or middle size.The sum of mean area and the mean optical density of HRP labeled cells were larger in the middle cervical ganglia and C6 DRG than that in inferior cervical ganglia(stellate ganglia) and C5 or C7 DRG separately (P<0.01).There wasn't any HRP labeled cell in C1-T1 DRG of control side and in trigeminal ganglia.　Conclusions　The cervical zygapophyseal joint mainly dominated by the sensory branches of the three cervical nerves next to it and by the branches of the sympathetic nerves.It may be related to the causing of neck-shoulder pain and the symptoms of head and face regions of patients with the external intervertebral foramen's cervical nerve compression

Purpose　To explore the effects of cervical sympathetic nerve on the axoplasmic transport of the trigeminal nerve.　Methods　48 Wistar rats were used with the right side as experimental side and the left side as control side.5 μl of 30% horseradish peroxidare(HRP) solution was injected into the symmetrical areas on both sides of the infraorbital regions.Then 0.4 ml of suspension made up of 0.2 ml 0.5% bupivacaine and 0.2 ml hydroprednisone-A was injected into C5 transverse process on the right side,and 0.4 ml of 0.9% normal saline on the control side.The animals survived for 4,6,8,10,12,14h,and were killed after perfusing through the ascending aorta.The superior cervical sympathetic ganglia and the trigeminal ganglia on both sides frozen sectioned,and treated with TMB method.The HRP labeled cells in the sections were observed under light microscope.The positive labeled cells were classified and counted.The sum of mean area and the mean optical density of HRP labeled cells in superior cervical sympathetic ganglia and the trigeminal ganglia on both sides were analysed by image pattern analysis system.　Results　The labeled cells were found in the trigeminal ganglia of the experimental sides after 6 h,the control side,8 h.The velocity of HRP axoplasmic transport of the experimental side was (5.50±0.95)mm/h,the control side (3.99±0.81)mm/h(P<0.01).The sum of mean area and the product of the sum of mean area and the mean optical density of HRP labeled cells in the trigeminal ganglia of the experimental side were larger than those of the control side (P<0.01).The labeled cells were found in the superior cervical sympathetic ganglia on both sides after 8 h.The sum of mean area and the mean optical density of HRP labeled cells in the superior cervical sympathetic ganglia on the control sides were larger than those of the experimental sides (P<0.01).　Conclusions　Cervical sympathetic nerve can affect the velocity of the axoplasmic transport of the trigeminal nerve.The cervical local block slows accelerates the axoplasmic transport of the cervical sympathetic nerve and the axoplasmic transport of the trigeminal nerve.

OBJECTIVE: To explore the influence of granules for nourishing kidney and strengthening brain (GNKSB) on main symptoms of kidney-yin deficiency and blood stasis syndrome and the hemorrheological characteristics of brain atrophy patients. METHODS: Ninety patients of brain atrophy with kidney-yin deficiency and blood stasis syndrome were randomly divided into two groups. Sixty cases in treatment group were treated with GNKSB, and the 30 cases in control group were treated with piracetam for 8 weeks. RESULTS: The effective rate of treatment group was 73.3%, with significant difference as compared with 46.6% of the control group (P<0.01). The scores of symptom-assessment of the two groups were also significantly different (P<0.01). The mini-mental state examination of treatment group was obviously improved, and was significantly different as compared with the control group (P<0.01). The scores of Hasegawa's dementia scale and activities of daily living were increased, but without significant difference as compared with the control group. The platelet aggregation rate was improved, with significant difference as compared with the control group (P<0.05). The whole blood viscosity was also improved obviously, but without significant difference as compared with the control group. CONCLUSION: GNKSB is effective for kidney-yin deficiency and blood stasis syndrome of brain atrophy patients and can improve their mental state and the hemorrheological indexes.

OBJECTIVESTo investigate anatomical mechanism of the ulnar wrist pain caused by the compression of the dorsal branch of the ulnar nerve, and discuss the diagnosis and treatment of the compression.

METHODS40 sides of the upper extremities of adult cadavers were studied anatomically. The dorsal branch of the ulnar nerve and its relationship to the surroundings was dissected and observed grossly and microscopically. 13 cases of the compression of the dorsal branch of the ulnar nerve were treated and followed up.

RESULTSThe dorsal branch of the ulnar nerve was penetrated from the deep of the flexor carpi ulnaris muscle 5.6 approximately 6.8 cm proximally from the styloid process of the ulna, then ran along the ulna and divided into 2 approximately 3 big branches at the medial side of the head of the ulna. The transverse branch was apt to injury during wrist movement as it crossed or rounded the head of the ulna where it was close to the peristeam. Seven of 13 cases of the compression of the dorsal branch of the ulnar nerve were treated by local block, and 6 by surgical neurolysis. Nine cases of this group got showed good effect without recurrence after 4 months to 1 year follow-up.

CONCLUSIONThe anatomical basis of the compression of the dorsal branch of the ulnar nerve is repetitive traction to this nerve during wrist movement, and the compression of the transverse branch is the main cause of ulnar wrist pain. The compression of the dorsal branch of the ulnar nerve should be considered to the patients with ulnar wrist pain and abnormal sensation along the dorsal ulnar side of hand.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Ulnar Nerve ; anatomy & histology ; Ulnar Nerve Compression Syndromes ; diagnosis ; physiopathology ; therapy ; Wrist ; anatomy & histology

[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.

Objective:To assess the effectiveness and feasibility of carrier detection for Spinal muscular atrophy (SMA) by using digital PCR assay.Methods:Peripheral blood samples were collected from 214 pregnant women who were routinely screened for SMA carriers, of which 204 were randomly selected samples and 10 were samples with known copy numbers of SMN1 exons 7 and 8. Samples with known copy numbers of SMN1 exons 7 and 8 were randomly mixed into the experiment to validate the performance of the digital PCR assay. The copy numbers of SMN1 exons 7 and 8 and SMN2 exons 7 and 8 in peripheral blood samples were detected by digital PCR assay. The results of SMN1 exons 7 and 8 were compared with those of the quantitative PCR method to assess the reliability and clinical performance of the digital PCR assay. Results:Among the 204 random samples, digital PCR has detected five samples with simultaneous heterozygous deletion of SMN1 exons 7 and 8, three samples with heterozygous deletion of SMN1 exon 8 only, and 196 samples with no deletion of SMN1 exons 7 and 8. Ten samples with known SMN1 exons 7 and 8 copy numbers were detected with the expected values. The digital PCR test results were fully consistent with that of the quantitative PCR. Conclusion:The results of digital PCR for the detection of copy number variation of SMN1 exons 7 and 8 were consistent with qPCR. Digital PCR assay was able to clearly distinguish the copy number of the target genes, therefore can be used for SMA carrier screening. Moreover, it can also detect copy number of SMN2 exons 7 and 8, which can provide more information for genetic counseling.

Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.