Objective To reconstruct the three-dimensional structure of human brachial plexus including its outer contour and delicate pathways of nerve fascicles inside, and to explore an useful and practical method for three-dimensional reconstruction of brachial plexus. Methods Taking woman hair as the localizing marks, two left-side brachial plexus from healthy adult cadaver were serially horizontally sliced with each section 0.2 mm in thickness(from the outlet of nerve root canal to the origin of median nerve, about 20 cm in length on an average), each slice was stained by AchE histochemical method. Each section of the two-dimensional image was taken by high-resolution digital camera, and the three-dimensional microstructure of brachial plexus was reconstructed and computer-assisted. Results The three-dimensional structure of brachial plexus reappeared successfully, including its outer contour and its delicate pathways of nerve bundles inside, the topographic anatomy of every nerve fascicle and its relationship in arbitrary sections as well as the patterns of branching, intersection and recombination of nerve bundles in the whole length. It could also display the outer contour of brachial plexus and the delicate pathways of nerve bundles inside either separately or totally. The reconstructed microstructure of the brachial plexus was smooth, natural and realistic, it could be rotated, zoomed and divided in any direction. The fascicular number of C7 root was more than C6 or C8, while C5 and T1 were the least. Conclusion The three-dimensional structure of brachial plexus inside is very complicated. The nerve bundles crisscross and recombine with each another. It combines a fine and delicate nerve network. Using the advanced localizing method, a good result is obtained. This is a practical method for three-dimensional reconstruction of the microstructure of brachial plexus.

Objective To investigate the efficacy of Kurokawa s open door expansive laminoplasty for the treatment of cervical spinal stenotic myelopathy. Methods Sixty seven patients admitted to Zhongshan hospital with cervical spinal stenotic myelopathy undergone Kurokawa s procedure in the last 6 years were included in this study. All of the patients were followed up after operation. The follow up period ranged from 10 months to more than 6 years. The average age at operation was 55.2 years. Japanese Orthopedic Association (JOA)score were used to measure the severity of cervical spinal stenotic myelopathy and recovery rates. Results JOA scores increased from 7.1 to 12.5, 12.9 and 12.8 at the first, third, and fifth postoperative year respectively(P

Objective To evaluate valvular functionality after transcatheter pulmonary valve replacement in sheep using a novel polymeric prosthetic pulmonary valve.Methods In this study,we designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent,and the valve leaflet was made of 0.1 mm expanded polytetrafluoroethylene (ePTFE).We chose bovine pericardium valve as control.Pulmonary valve stents were implanted in situ by right ventricular apical approach in 8 healthy sheep(6 for polymeric valve and 2 for bovine pericardium valve) weighing an average of(22.8 ± 2.2) kg.Angiography was performed after implantation to assess immediate valvular function.Color Doppler echocardiography and 64-row computed tomography were used to assess valvular function 4 weeks after implantation.Results Implantation was successful in 8 sheep.Angiography at implantation showed one polymeric valve was located below the ideal position and most of the stent was in the outflow tract of right ventricle.While,all the other prosthetic valves demonstrated orthotopic position and exhibited normal open and close functionality.Echocardiography 4 weeks after implantation showed all the prosthetic valves exhibited normal functionality and no significant insufficiency.The peak-peak transvalvular pressure gradient of the polymeric valves was (18.8 ± 6.0) mmHg,while that of two bovine pericardium valves were 9 mmHg and 20 mmHg.CT 4 weeks after implantation demonstrated orthotopic position of the stents except the above-mentioned one and all the stents had no deformation.Conclusion The success rate of transcatheter pulmonary valve replacement by right ventricular apical approach is satisfactory.The early valvular functionality of the novel ePTFE pulmonary valve after transcatheter pulmonary valve replacement in sheep is good.

BACKGROUND:Our preliminary study found that the monocusp valves made of ultramicropore expanded
polytetrafluoroethylene (ePTFE) revealed no significant thrombus, calcification, or degradation 20 weeks after implanted into the descending aorta and the left pulmonary artery in sheep, which verified the good property of ePTFE. However, the surface of ePTFE in the left pulmonary artery was covered with obvious neointima.
OBJECTIVE: To assess the biocompatibility of phosphorylcholine-coated ePTFE.
METHODS:ePTFE surface was modified by phosphorylcholine derivative. Then the changes of surface shape, tensile stress at yield and elasticity modulus, water contact angle, and protein absorption capacity of ePTFE after surface modification were observed. (1) Hemolytic test: the leaching solution of phosphorylcholine-coated ePTFE, leaching solution of uncoated ePTFE, normal saline, and distiled water were added to the diluted human blood, respectively. (2) Platelet count test: the phosphorylcholine-coated ePTFE, uncoated ePTFE, high density
polyethylene, and Zymosan A were added to the whole blood samples from healthy volunteers, respectively.
(3) Platelet activation test: the phosphorylcholine-coated ePTFE, uncoated ePTFE, γ-Globulins, and Zymosan A
were added to the whole blood samples from healthy volunteers, respectively.
RESULTS AND CONCLUSION: The mean micropore diameter of ePTFE was significantly decreased after
phosphorylcholine coating (P < 0.001). The hydrophilicity and the ability of suppressing protein adsorption were
significantly strengthened after phosphorylcholine coating (P < 0.001). Phosphorylcholine coating did not influence
ePTFE in biomechanical properties and hemolytic test. The platelet count test and platelet activation test demonstrated that phosphorylcholine coating significantly improved anti-thrombus function of ePTFE. So, phosphorylcholine coating can enhance anti-thrombus function, suppress protein adsorption, and improve biocompatibility of ePTFE.

Objective: To explore the effect of exercise preconditioning (EP) on pathological cardiac hypertrophy and heart failure (HF) in pressure over-loaded experimental rats.
Methods:A total of 60 SD rats at the age of 6 weeks were randomly divided into 3 groups, n=20 in each group. Sham-operation group, Transverse aortic constriction (TAC) group and EP + TAC group. The cardiac function and structure were evaluated by echocardiography, patholgical changes and HF biomarkers were examined for EP effect at 4 and 8 weeks after TAC.
Results:Compared with Sham-operation group, the cardiac function and structure had obvious changes in the other 2 groups. Compared with TAC group, the ejection fraction in EP+ TAC group increased 15%, the heart weight index and left ventricular weight index decrease 15.7%and 20%respectively at 8 weeks after TAC, all P<0.05. Compared with Sham-operation group, the mRNA and protein expressions of ANP and BNP increased in TAC group at 4 and 8 weeks after TAC, increased in EP+TAC group at 8 week after TAC. Compared with TAC group, the mRNA expressions of ANP and BNP in EP+TAC group decreased 47%and 62%at 4 weeks after TAC, decreased 44%and 28.1%at 8 weeks after TAC, all P<0.05;the protein expression of ANP and BNP in EP+TAC group decreased 22.3%and 48%at 4 weeks after TAC, decreased 21.5%and 38.3%at 8 weeks after TAC, all P<0.01.
Conclusion: EP may improve cardiac pathological hypertrophy in pressure over-loaded rats at the early stage, and delay the heart failure process.

Objective To discuss the diagnosis and surgical treatment of the primary right ventricular tumors.Methods The results of surgical treatment of 7 patientss (5 males,2 females; median age,48 years,range,37 to 68 years) with primary right ventricular tumors hospitalized from Jan,1999 to May,2012 were analyzed.By preoperation echocardiography,cardiac myxoma was diagnosed in 2 cases,and cardiac space-occupying lesion was diagnosed in 5 cases.Median sternotomy were performed in all the 7 cases for biopsy or resection of tumor.when resection of tumor,extracorporeal circulation and cardiac arrest were performed.Results The 7 patients accounted for 4.96％ of patients with cardiac tumors surgically treated in the corresponding period.Complete resection of tumor was performed in 5 cases,and only biopsy in 2 cases.The pathological diagnoses included myxoma in 2 cases,lipoma in 1 case,liomyoma in 1 case,undifferentiated sarcoma in 1 case,and mesenchymal sarcoma in 2 cases.There was no in-hospital death.During a follow-up of 1 ～ 51 months (median,38 months),the 3 cases of sarcoma died,and the other patients were good and showed no recurrence.Conclusion The incidence rate of primary right ventricular malignant tumor is relatively high.Echocardiography is the most important diagnosis method.The prognosis of right ventricular malignant tumor is poor.The results of surgical treatment of right ventricular benign tumor are satisfactory.

Objective To evaluate early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients. Methods We selected 165 renal transplant recipients who underwent transplantation from January 2007 to January 2009 and adhered to follow-up as research subjects. The samples of blood and urine were collected before transplantation, every 1 week from 2 to 8 weeks and every 2 weeks from 9 to 24 weeks after transplantation. The viral load of blood and urine was detected by fluorescence quantitative polymerase chain reaction (FQ-PCR). Once HCMV DNA load was more than 103 copies/ml, preemptive therapy was done immediately by ganciclovir. Results All the samples of blood and urine were negative before operation. HCMV DNA load could be detected in the concentrated urine at the second week and the peak of HCMV DNA loadoccurred from the sixth to eighth week after operation. At the same detection time, the number ofpositive recipients in the concentrated urine was more than in blood. In 30 cases HCMV DNA load was detected in the blood and the positive rate was 18.18%. In 64 cases HCMV DNA load was detected in the concentrated urine and the positive rate was 38.79%. The positive rate of the concentrated urine was significantly higher than in blood (P＜0.05). In 30 cases positive for HCMV DNA in the blood and urine, ganciclovir was given and the viral load was decreased gradually. But 8 recipients developed into CMV pneumonia and were cured through the comprehensive treatment. The clearance time of HCMV DNA in the concentrated urine was 10.2 ± 3.4 days. Thirty-four cases that were only positive for HCMV DNA in the urine were also treated by ganciclovir and no case developed into CMV pneumonia. The clearance time of HCMV DNA was 5.5 ± 2.1 days, and the clearance time was shortened as compared with that in those positive for HCMV DNA in the blood and urine (P＜0.05). Conclusion FQ-PCR can detect HCMV DNA in the concentrated urine in advance and increase the positive rate. Once the sample of the concentrated urine is positive, preemptive therapy has a good effect.

Objective To summarize the experience of diagnosis and surgical treatment of long distance ureteral stenosis after kidney transplantation. Methods Eleven cases of ureteral stenosis following renal transplantation were analyzed. Ureteral stenosis happened between 2-6 months after transplantation. The clinical manifestations were as follows: serum creatinine and weight elevated,urine decreased, graft area swelling. All cases were diagnosed using ultrasound, MRU or CTU. The ureteral obstruction length was 3-7 cm. In 5 patients a Boari flap technique was used, and the native ureter for pyelo-ureterostomy was used in 2 patients. Four patients were subjected to surgical operation using the native ureter for uretero-ureterostomy. Results All of the surgical treatments were successful and no operation-related complications occurred. The operation time was 2. 5 to 4 h.After reconstruction of ureter-bladder anastomosis, the urine was increased, the serum creatinine decreased to 75-156μmol/L, and uronephrosis disappeared or alleviated. The follow-up lasting 8 to 62 months showed no recurrence in all the cases. Conclusion For such cases, ultrasound should be routinely used for the possibility of stenosis. CTU or MRU is important to know the obstruction length and position. For the patients with long distance ureteral stenosis after kidney transplantation,surgical correction is the first choice.

Objective To discuss the clinical value of dynamic monitoring the copies of human cytomegalovirus(HCMV)-DNA in prophylaxis of HCMV pneumonia after renal transplantation.Methods There were 242 cadaveric renal transplantation recipients including 144 males and 98 females,with the average age of 41(from 17 to 71).They were divided into 2 groups(experimental group 127 cases,control group 115 cases).Recipients in experimental group were routinely monitored by blood preparation and urine aliquot FQ-PCR.The therapy was initiated when HCMC-DNA>1×103 copies/ml by blood preparation and/or urine aliquot FQ-PCR with intravenous ganciclovir for 4 weeks.The dosage was calculated according to creatinine clearance rate.FQ-PCR monitoring and Preemptive therapy was not performed in the control group.The pneumonia rate, death rate and survival between the two groups were compared. Results In experimental group, the HCMV pneumonia incidence rate was 6.3 % (8/127), onset time was 46-167 d, median time was 84 d, hospitalization time was 30-57 d,median time was 36 d, death rate was 12.5 % (1/8), breathing machine using rate was 12.5 % (1/8),concurrent other pathogen infection rate was 25 % (2/8), and + year renal graft survival rate was 98.4% (125/127).One was dead with graft function and the other dysfunction was because of acute rejection.In control group, the HCMV pneumonia incidence rate was 14.8%(17/115), onset time was 34-138 d,median time was 51 d, hospitalization time was 21-67 d,median time was 40 d,breathing machine using rate was 29.4% (5/17),concurrent other pathogen infection rate was 41.2%(7/17), death rate was 23.5% (4/17), and 1 year renal graft survival rate was 93.0% (107/115).Three was dead with graft function and the other one was dead of DGF.The other 4 cases of renal dysfunction were because of acute rejection.Significant difference existed between the 2 groups (P<0.05) except for hospitalization time (P> 0.05). Conclusion The preemptive therapy of CMV pneumonia after renal transplantation by dynamic monitoring the copies of HCMV-DNA in recipients could have a good effect, and the 1 year renal graft survival rate could be higher.

Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.