ObjectiveTo observe the functional recovery of shoulder joint and the reduction of posterior dislocated humeral head in children with shoulder joint internal rotation contracture and humeral head posterior dislocation secondary to brachial plexus birth palsy treated by a modified surgical procedure through the anterior combined posterior approach of the shoulder. MethodsNinteen patients,ranging in age from 2.5 to 8.5 years (average 5 years),suffered posterior dislocation of the shoulder joint secondary to internal rotation contracture in brachial plexus birth palsy. The gleno-humeral joint deformity was confirmed by X-ray and CT examination and classified as type Ⅳ in 15 eases and typeⅤin 4 cases according to the modified water's criteria.The surgical procedure was as follows:the contracture soft tissue around the anterior of shoulder joint was released firstly through the anterior approach, and the posterior-inferior capsule of the shoulder was exposed and separated with the pseudoglenoid through the posterior approach,the humeral head was reduced by external rotation the arm,then the posterior-inferior capsule was retighten.A plaster cast was used to fix the shoulder at the neutral position of 0° for 4 weeks. ResultsAfter 12 to 36 months follow up(average of 20 months), the Mallet score of the shoulder was from 11.4 ± 1.7 (range 7-16)preoperative to 15.5 ± 1.8(range 13-19) postoperative,the difference was significantly (P ＜ 0.05).The central relocation of humeral head was achieved in 16 patients, but the humeral head was still dislocated to posterior in 3 cases.ConclusionsThe posterior-inferior capsule was separated with the pseudo-glenoid and retighten through the posterior approach,and reduction of the humeral head by soft tissue releaseing through the anterior approach can recover the concentric relationship of gleno-humeral joint and improve the function of shoulder joint with posterior dislocation secondary to internal rotated contracture deformity in brachial plexus birth palsy.

Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.

Objective To evaluate the role of two-dimensional ultrasound combined with contrast-enhanced ultrasonography (CEUS) in the classification of liver nodules in cirrhotic patients.Methods Consecutively cirrhotic patients with intrahepatic nodules at Xixi Hospital of Hangzhou were included from November 2015 to December 2016.All (142 nodules in 109 patiens) presented as non-cancerous focal lesions on conventional magnetic resonance imaging and CT examination and had available information of liver biopsy.Each lesion was percutaneous biopsied under the guidance of two-dimensional ultrasound.Ultrasonographic parameters evaluated were as following:(1) sizes of nodules under US;(2) ultrasonographic characteristics of the nodular;(3) CEUS enhancement features of the nodules.Four types of hepatic nodule suggesting different histology were defined according to the ultrasonographicparameters.x2 test was used to compare the difference of hepatocellular carcinoma (HCC) incidence among liver nodules with varying sizes and nodules with different enhancement features under CEUS.As for the statistical differences of HCC and high-grade dysplastic nodule (HGDN) incidence between type Ⅲ & Ⅳ nodules and type Ⅰ & Ⅱ nodules,x2 test was also used for analysis.Results A total of 142 eligible nodules were detected in 109 patients with cirrhosis,including 16 HCCs,2 intrahepatic cholangiocellular carcinomas (ICC),41 HGDNs,40 low-grade dysplastic nodules (LGDN) and 43 regenerative nodules (RN).In terms of diameter,all (6/6) the nodules larger than 2.0 cm,20.0％ (8/40) of middle size nodules (1.5-2.0 cm),were HCCs.The remained 2 lesions of HCC came from two subgroups with even small size nodules [1.0-1.4 cm (n=93),and ＜ 1.0 cm (n=3),in diameter],respectively.Two lesions of ICC were attributed to nodules with a 1.0-1.4 cm diameter.About 28 nodules with a diameter of 1.5-2.0 cm,13 nodules with a diameter of 1.0-1.4 cm were HGDN.HCC incidences between these 4 groups were different significantly (x2=61.425,P ＜ 0.001).Asfor the CEUS,14 nodules exhibited a rapid enhancement feature in arterial phase,12 of which were HCC.In56 nodules with a slow enhancement feature,4 nodules were HCC.HCC incidences between these 3 groups were different significantly (x2=75.752,P ＜ 0.001).Under the combined ultrasonography,HCC incidences of type Ⅲ and type Ⅳ nodules were significantly higher than that of type Ⅰ and type Ⅱ lesions [21.9％ (16/73)vs 0 (0/65),x2=15.222,P ＜ 0.001],similar result was observed in the comparison of HGDN incidences between type Ⅲ & Ⅳ and type Ⅰ & Ⅱ nodules[53.4％ (39/73) vs 3.1％ (2/65),x2=38.842,P ＜ 0.001].Conclusion The classification presented by this study,combining the three ultrasonographic parameters,which is nodule size,nodular echo characteristics and enhancement features of the nodules under CEUS,could be helpful for the diagnosis of HCC in cirrhotic patients with ill-defined nodule on routine image examination.

ObjectiveTo classify the type of lumbosacral plexus nerve root injury.MethodsFrom November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.ResultsLumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.ConclusionThis clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.

Objective To investigate the characteristics of bone marrow megakaryocytes in patients with idiopathic thrombocytopenic purpura (ITP) complicated with positive for antinuclear antibody (ANA) but cannot be diagnosed as rheumatic immune diseases. Methods Newly diagnosed ITP patients in the First Hospital Affiliated to Sun Yat-sen University were retrospectively selected and divided into ITP1 group (ITP patients with positive ANA) and ITP2 group (ITP patients with negative rheumatic indicators). Degree of thrombocytopenia, the total number of bone marrow megakaryocytes, and the ratios of various types of megakaryocytes at the initial diagnosis were compared between the two groups. Results A total of 42 newly diagnosed ITP patients were included, with 20 cases in the ITP1 group and 22 cases in the ITP2 group. There were no significant differences in general information such as gender and age between the two groups (P>0.05). The platelet (PLT) count was (7.55±0.96)×10⁹/L in the ITP1 group, which was lower than (10.23±1.21)×10⁹/L in the ITP2 group, but there was no significant between-group difference (t=1.697, P=0.097). Compared with the ITP2 group, the total number of megakaryocytes in the ITP1 group was significantly decreased (t=3.071, P < 0.01), and the ratio of granular megakaryocytes was significantly increased while the ratio of naked nuclear megakaryocytes was significantly decreased (P < 0.05); there were no significant differences in the ratios of immature and platelet-producing megakaryocytes between the two groups (P>0.05). Conclusion Patients with ITP and positive ANA have a tendency of decreased PLT, and a more significant maturation disorder of bone marrow megakaryocytes, with a lower degree of megakaryocyte proliferation compared to patients without positive ANA. ANA may exacerbate the severity of ITP by aggravating the developmental disorder of bone marrow megakaryocytes.

Objective:To investigate the role of ferroptosis in testicular injury in adolescent male mice induced by TDCIPP.Methods:In December 2021, 30 healthy 3-week-old male C57BL/6 mice, with a body weight of (13±2) g, were selected and fed adaptive for one week. They were divided into control group, low-dose group, medium-dose group, high-dose group and iron death inhibitor group according to a random number table, with 6 mice in each group. Mice in low, medium and high dose groups were treated with 5, 25 and 125 mg/ (kg·d) TDCIPP for 28 days, respectively, while the control group was treated with the same amount of corn oil for 28 days. The iron death inhibitor group was given 125 mg/ (kg·d) TDCIPP intragastric administration for 28 days, and 30 mg/kg DFO saline solution was intraperitoneally injected three times a week. After the treatment, the mice were killed, the epididymis was separated, and sperm count was performed. HE staining was used to observe the morphological changes of mouse testis, and iron content in testis was detected by tissue iron detection kit. The level of reactive cxygen species, MDA content, and the mitochondrial membrane potential level of mice were detected. Western blot analysis of testicular glutathione peroxidase (GPX4) and internal cyclooxygenase-2 (COX2) protein expression.Results:Compared with the control group, the spermatogenic cells in the testes of mice treated with medium-and high-dose of TDCIPP were disorderly arranged, showing a vacuolar structure. the number of sperm in the epididymis was significantly reduced ( P=0.009, 0.004), while the sperm deformity rate was significantly increased ( P=0.010, 0.000). Moreover, the content of ROS, iron ion and MDA in the testes increased significantly ( P<0.05), and the mitochondrial membrane potential of mouse testicular cells decreased significantly ( P<0.05). The expression of GPX4 proteins decreased ( P<0.05). while the expression of COX2 increased significantly ( P<0.01). Compared with high-dose group group, spermatogenic cells in ferroptosis inhibitor group were closely arranged and normal, and ROS and Fe contents in testicular tissue were significantly decreased ( P<0.01) ; GPX4 protein expression was significantly increased while COX2 protein expression was significantly decreased ( P<0.05) . Conclusion:Ferroptosis is involved in TDCIPP-induced testicular damage in male pubertal mice.

The prefrontal cortex and hippocampus may support sequential working memory beyond episodic memory and spatial navigation. This stereoelectroencephalography (SEEG) study investigated how the dorsolateral prefrontal cortex (DLPFC) interacts with the hippocampus in the online processing of sequential information. Twenty patients with epilepsy (eight women, age 27.6 ± 8.2 years) completed a line ordering task with SEEG recordings over the DLPFC and the hippocampus. Participants showed longer thinking times and more recall errors when asked to arrange random lines clockwise (random trials) than to maintain ordered lines (ordered trials) before recalling the orientation of a particular line. First, the ordering-related increase in thinking time and recall error was associated with a transient theta power increase in the hippocampus and a sustained theta power increase in the DLPFC (3-10 Hz). In particular, the hippocampal theta power increase correlated with the memory precision of line orientation. Second, theta phase coherences between the DLPFC and hippocampus were enhanced for ordering, especially for more precisely memorized lines. Third, the theta band DLPFC → hippocampus influence was selectively enhanced for ordering, especially for more precisely memorized lines. This study suggests that theta oscillations may support DLPFC-hippocampal interactions in the online processing of sequential information.
Adult ; Female ; Humans ; Young Adult ; Epilepsy ; Hippocampus ; Memory, Short-Term ; Mental Recall ; Prefrontal Cortex ; Theta Rhythm ; Male

Magnetic anchoring and traction technique is one of the core technologies of magnetic surgery. With the "non-contact" traction force of the outer magnet on the inner magnet, we can drive the inner magnet and the gripper to multiple directions, and pull tissue or organ to required position in operations, so as to get a clearer surgical field of view. On the basis of the previous animal experiments, we applied magnetic anchoring and traction device in 3 human (males aged 63-71 years) thoracoscopic esophagectomies. Using the magnetic anchoring device, we could pull the esophagus dorsally or ventrally to assist in exposing the anatomical plane without special equipment or pleural puncture for retraction of the esophagus. The interference between operating instruments reduced. The mean blood loss in operation was 83 mL, the mean total operation time was 253 min and the mean length of hospital stay was 10 d. Postoperative follow-up showed that all 3 patients had good short-term prognosis. There was no swellling or pain in magnetic anchoring zone of chest wall.