Objective To explore the arterial origin and the artery distribution to the brachial plexus and its clinical significance. Methods 1)To observe the zonal pattern of arteries supplying brachial plexus in three fresh cadavers by means of modified lead-oxide and gelatin infusion and radiologic development. 2)To observe the arterial origin and distribution under microscope in 10 cadavers embalmed which were injected with red latex from the common carotid artery. Results The brachial plexus was supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other, according to their distribution feature, the supplied neural structures were divided into three zones. The first zone including the nerve roots from intervertebral foramina to the trunks and this region of the brachial plexus were supplied by the vertebral artery and the deep cervical artery. The second zone including the divisions and the main region of the cords of the brachial plexus were supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The dorsal scapular artery was usually thick and contributed to blood supply of a large region. There were 2.7 (1-5) direct branches of the subcalvian artery on the average which have relatively smaller diameter. The third zone including the distal portion of the cords and the terminal branches of the brachial plexus were supplied by direct branches of the axillary artery. The mean number of these branches was 3.4 (1-6). Conclusion The brachial plexus has plenty of vascular supply which can be divided into three zones. Every vasa nervorum tends to divide into a distal branch and a proximal branch shortly after they enter the brachial plexus. The branches from vasa nervorum communicates without changing their diameter which is called "real connection", and the blood supplied from the three zones can compensate each other, which provide a rich longitudinal blood supply to the brachial plexus. This study provides an anatomical basis for vascularized brachial plexus replacement.

[Objective]To investigate the effect of injectable xuebijing on macrophage ofimervertebral disc hernial tissue.[Method]The pigs were used as animal models after surgery in the intervertebral disc.Macrophage in herniated disc tissue were observed with the immunohistochemical method after it was treated by injectable xuebijing.[Result]Macrophage were found in 11 of 16 herniated disc tissue in the model group,were found in 7 of 16 herniated disc tissue in the low dose xuebijing group,and were found in 6 of 16 herniated disc tissue in the high dose xuebijing group,compared to the model group,all P

Objective To conclude the practical nursing experiences of the infantile actue necrotizing fasciitis treated with vacuum sealing drainage(VSD) and continuous irrigation.Methods 21 cases of the infantile actue necrotizing fasciitis treated with with VSD and continuous irrigation were reviewed from January 2009 to December 2014.The nursing experiences of observation for the state of the illness,the safety management of VSD,the management of medication,mental nursing and health education were summarized.Results 21 infants all recovered and were discharged.Postoperative follow up 6 months later were conducted.No obvious disabilities of the extremities were found.Among them,8 cases were treated with VSD and continuous irrigation for 2 weeks and then had routine wound dressing changing for 10 days,the wound almost healed when discharged.13 cases were treated with VSD and continuous irrigation for one week and then had routine dressing changing for 12 to 13 days.The wound healed when discharged.No skin necrotizing,no scar of the incision and no other complications were detected.Conclusions Using VSD and continuous irrigation to treat the actue necrotizing fasciitis in infants are of great significance for the nurses to reduce the postoperative complication and promote rehabilitation doing as follows:turning over with the postoperative nursing of VSD in a standard manner,observation and management of the incision area,maintenance of the irrigation and VSD;observation and assessment of the infant's condition,management of the medication,mental nursing and health education.

Objective:To evaluate the efficacy and safety profile of ixazomib/lenalidomide/dexamethasone (IRd) in Chinese patients with relapsed/refractory multiple myeloma (MM) .Methods:This study comprising 14 medical centers in China included patients with relapsed/refractory MM who received at least. Ixazomib at an initial oral dose of 4 mg was administered. Seven patients had dose adjustment to 3 mg at the time of first dose. The lenalidomide doses were adjusted according to creatinine clearance rate. The efficacy and safety were evaluated every cycle.Results:In the study cohort of 74 patients, the median age was 65 years and 11 (14.9% ) patients received over three lines of therapy. Overall response rate (ORR) was 54.1% (40/74) , and 7 (9.5% ) , 14 (18.9% ) , and 19 (25.7% ) patients achieved stringent complete response or complete response, very good partial response, and partial response, respectively. The median progression-free survival and overall survival were 9.9 and 20 months, respectively. The median time to response was 1 month. The efficacy and survival outcome were similar to those reported in the Tourmaline-MM1 China Continuous Study. The ORR of patients refractory to bortezomib, lenalidomide, and bortezomib plus lenalidomide were 52.0% (13/25) , 57.1% (4/7) , and 33.3% (6/18) , respectively. The rate of grade 3-4 adverse events was 36.5% (27/74) . Common hematological toxicities were anemia, thrombocytopenia, lymphopenia, and neutropenia. Common non-hematological toxicities were fatigue, gastrointestinal symptoms, and infections. Two cases of grade 3 peripheral neuropathy were reported. The patients eligible for the Tourmaline-MM1 China Continuous Study had a higher ORR than the ineligible patients [77.8% (14/18) vs 46.4% (26/56) , P=0.020]. There was no difference in the rate of grade 3-4 adverse events [33.3% (6/18) vs 37.5% (21/56) , P=0.749]. Conclusion:The IRd regimen had good efficacy and acceptable toxicity in Chinese patients with relapsed/refractory MM.

OBJECTIVETo evaluate the colorectal cancer (CRC) prevention effect of metformin in comparison with that of other T2DM medications from a Markov model perspective.

METHODSLiterature concerning CRC morbidity of T2DM patients with metformin or other diabetes medications treatment was reviewed in PubMed and Cochrane Library database from September 2010 to December 2016.

INCLUSION CRITERIA(1)enrolled population was adult patients with T2DM but without CRC; (2) any of the parameters applied in our model was reported; (3) randomized clinical trials (RCTs), quasi-randomized trials, prospective or retrospective cohort studies. With CRC morbidity as endpoint, parameters were extracted to construct Markov model to assess CRC morbidity and cumulative tumor-free survival in each group over 11 years' follow-up period. Finally, Monte Carlo analysis was performed to evaluate the influence of parameter instability on the model.

RESULTSSeven literatures were recruited and 10 000 patients were virtually allocated for each arm. In contrast with non-metformin group, T2DM patients treated with metformin had a lower rate of CRC(1.670% vs. 2.146%, P=0.016). Moreover, cumulative tumor-free survival of metformin group was, slightly but significantly, better than that of non-metformin group (10.908 years vs. 10.882 years, P=0.000).

CONCLUSIONST2DM patients treated with metformin have a lower morbidity of CRC and a better cumulative tumor-free survival than those of non-metformin group. Large scale RCTs are needed to illustrate the role of metformin in the prevention of CRC.