Thoracic outlet syndrome (TOS) refers to a constellation of symptoms caused by a compression of brachial plexus, subclavian artery, and subclavian vein in the area of thoracic outlet. It is classified into neurogenic, arterial and venous TOS according to the structure of a compression. Neurogenic TOS (NTOS) shows various clinical symptoms and signs as well as lacks objective tests in adequate sensitivity or specificity constitutes approximately 90% of all TOS. To date, there is no consensus on diagnostic criteria around the world for TOS, and it has always been the focus point and challenge in TOS research. In last decades, Chinese surgeons paid increasing attentions to TOS, and it is evidenced by a great increase of numbers in Chinese literatures and reports. This article makes a brief review of the research progress reported in Chinese literature, and discusses the diagnosis and treatment of NTOS, based on the contributions made by Chinese researchers and relevant reports from abroad as well as the clinical experience from the author of this review article.

Objective:To observe the denervation and reinnervation of the neuromuscular junction (NMJ) and muscle spindle after sciatic nerve crush in mice.Methods:From January, 2019 to October, 2019, 18 C57BL/6 mice were randomly and evenly divided into injured groups (sciatic nerve crush group, 12 mice) and control groups (sham group, 6 mice). Mice in the injured group were sacrificed at day-1, day-2, day-3 and 4 weeks after the sciatic nerve injury. Mice in the control group were sacrificed at day-3 and 4 weeks from the day of experiment. The tibialis anterior muscles with crushed nerve were collected for immunohistochemistry staining by neurofilament (NF), synaptophysin (Syn) and α-bungarotoxin (α-BTX). Data were analysed by unpaired t-test. P<0.05 was considered significant difference. Results:The completely denervation of NMJ reached (92.4±8.85)% at day-3 after the nerve crush, compared with (5.19±1.32)% in the control group ( P<0.05). However, the muscle spindle lost γ-motor neuron innervation at day-2 after the nerve crush and completely denervated at day-3 after the surgery. For the reinnervation, no difference of no reinnervation of NMJ [(3.02±0.78)% vs. (4.22±2.08)%], partial reinnervation of NMJ [(6.44±1.91)% vs. (7.94±2.12)%] and completely reinnervation of NMJ [(90.54±10.44)% vs. (87.84±13.89)%] were observed between the control group and the injured group 4 weeks after the injury. While, for the muscle spindle, only the acetylcholine receptors at each end were partly reinnervated. The innervation of the middle part of the muscle spindle was thin and discontinued without typical spiral winding structure. Conclusion:The denervation speed of NMJ and muscle spindle was comparable after the peripheral nerve injury. The γ-motor neuron lost innervation ahead of the sensory neuron in the muscle spindle. The reinnervation of NMJ is earlier than that of the muscle spindle, and the re-innervation of the γ-motor neuron is prior to the sensory neuron in the muscle spindle.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective To investigate the anatomical basic of extensor carpi radialis brevis (ECRB) tendon transferring to extensor pollicis longus (EPL) tendon.Methods Twelve sides of ECRB and EPL in fresh adult cadaver's forearms were collected,and the anatomical model of ECRB transferring to EPL was set up in all the forearms.The anatomical parameters of EPL were measured before and after anatomical model established.Results The effective transferring length of ECRB was (3.5±0.8)cm;the maximum circumferential of ECRB and EPL were (8.5±0.8)cm and (3.6±0.3)cm (P ＞0.05),the ratio of muscle cross-sectional area was 5.57;After the anatomical model setting up,anatomic angles of EPL was (30±7)°,which was a decrease of (20±5) ° comparing with the preoperative angel of (50±9) ° (P ＞0.05);Thumb extension angle was (50± 12) °,which was a decrease of (8±3) ° comparing with the preoperative angel of (58 ± 16) ° (P＜0.05);The dorsal extension angle of first metacarpal was (12±5)o,which was a decrease of (3± 2) o comparing with the preoperative angle (15±8)° (P＞0.05);Thumb tip lifting height was (2.3±0.9) c m,which was a decrease of (1.2±0.6)cm comparing with the preoperative height (3.5±1.2)cm (P ＞0.05).Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL,the ECRB has enough length and muscle force to reconstruct the function of EPL.The thumb had a good extension appearance and accorded with the rule of biomechanics after setting up the anatomical model of ECRB transferring to EPL.This study will provide the anatomical evidence for further clinical application

Objective To explore clinic effect and advantages of the free arm lateral neurocutaneous flap in repairing cutaneous defects of opisthenar.Methods Between July,2012 and December,2013,12 patients with skin and soft tissue defects in opisthenar caused by trauma factor,accident,machine injury,hot crush injury etc were treated with free arm lateral neurocutaneous flap at our institution.Vessels both in recipient and donor site were detect-ed by color Doppler ultrasound preoperatively.Relative cutaneous nervers were reserved in the flap during selective operation.The flap size resected range from 6 cm × 4 cm to 10 cm × 6 cm.The posterior cutaneous nerve of the forearm were included in the flap to restore sensory sesation after transection.The wound in the donor site was closed in in-tradermal suture primarily.Postoperative algesia,touch,temperature sensation,Weber test of flap were tested and reco-rded.The critia of follow-up in this study were donor site morbidity,abnormal sensations,functional outcomes and sat-isfaction.Results The success rate was 100 percent in the series cases.The average length of follow up was 35 months (range,24 to 41 months).The wound in recipient area healed primarily and flaps showed no pigmentation but fine overall appearance,texture,and elasticity.The functional recovery of protective sensation was S3+ in 4 cases,S3 in 6,S2 in 2.Patients with liner scar in donor site were higly satisfied with the flaps for the sake of no significant joint functional outcomes.In terms of sensory sesation,the excellent and good rate of flap reached to 83 percent.Conclusion The free arm lateral flap represented a constant vascular anatomy,rich blood supply.Easy dissection,pliable texture,skin colour close to dorsum of hand and the possibility to be innervated through the posterior cutaneous nerve of the arm acceptable donor side morbidity provide a good option for the reconstruction of cutaneous defects of opisthena.

Objective:To explore the expressions of Disabled-1 (Dab1 )in human breast epithelial cells and breast cancer cells,and to clarify its role in cell cycle.Methods:Real-time PCR was used to analyze the Dab1 mRNA expressions in breast epithelial cells MCF-10A and breast cancer cells MCF-7,BT-549,and MDA-MB-231. The Dab1 protein expressions in those cells were tested by Western blotting method. The BT-549 cells at logarithmic growth phase were divided into control,pKH3,and pKH3-Dab1 groups;the cell cycle was investigated by flow cytometry.Results:The Real-time PCR results showed that the Dab1 mRNA expression levels in MCF-7 cells (0.504 ± 0.037),BT-549 cells (0.302 ± 0.027),and MDA-MB-231 cells (0.330 ± 0.031 )were reduced compared with MCF-10A cells (0.998±0.020)(P <0.05).The Western blotting results showed that the Dab1 protein expression levels in breast cancer cells MCF-7 (0.134±0.014),BT-549 (0.076±0.01),and MDA-MB-231 (0.074±0.005)were reduced compared with MCF-10A cells (0.227±0.021)(P <0.05).Compared with control group and pKH3 group,the cell cycle in pKH3-Dab1 group was inhibited at G1 phase detected by flow cytometry analysis. Conclusion:The expression of Dab1 is down-regulated in breast cancer cells,and the over-expression of Dab1 can inhibit the cell cycle at G1 phase.

Objective To examine the effect of valproic acid (VPA) on concentration of Intracellular Ca2+ and on cell apoptosis in spinal cord motor neurons after brachial plexus injury in rats. Methods Totally 210 adult male Wistar rats were randomly divided into Sham operation group (disposed the brachial plexus nerve root, but not cutted it off), control group (rats with brachial plexus nerve root amputating wound)and VPA group(rats with brachial plexus nerve root amputating wound and fed by VPA water),with 70 rats in each group.The specimens were taken at 12,24,48,72 h,1,2 and 4 weeks after operation.Whole-cell patch-clamp recording techniques were used to assayed the L-type calcium channel of motoneuron and monitored the changes in intracellular concentration of Ca2+ with spectrofluorometer. The motoneruron apoptosis was detected by TUNEL. Results The set of indicators did not change in the sham group.From 12h to 1 weeks after the operation, the electrical current of L-type calcium channel and the intra-cellular Ca2+ concentration of the neuron were obviously more in control group than in sham operation group (P ＜0.05). From 12 h to 4 weeks after the injury, there were more apoptosis neurons in control group than in sham operation group (P ＜ 0.05). There was no obviously difference in electrical current of L-type calcium channel between the VPA group and the control group at each time point(P ＞ 0.05).Compared to the control group,the intra-cellular Ca2+ concentration was lower in VPA group from 48 h to 1 week after nerve injury (P ＜ 0.05) ; the number of apoptosis neurons were less in VPA group from 24 h to 2 weeks after the injury (P ＜ 0.05). Conclusions Brachial plexus nerve root amputating wound in rats can increase the intra-cellular Ca2+ concentration and apoptosis of the motor neuron.VPA can reduce the intra-cellular Ca2+ concentration and apoptosis,but has no effect on the L-type calcium channel of the motor neuron.

Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.

BACKGROUND: Injury of axillary nerve leads to the inability of abduction in the upper limb which needs surgery treatment. However, which way of operative approach is more preferable is still uncertain. Whether one-stage posterior operation of nerve transfer can achieve better effects remains unclear, the choice of approach method is an argument.OBJECTIVE: To explore the therapeutic effect of the transposition operation of the branch to long head of triceps branchii to recover the anterior branch of axillary nerve that can restore the function of deltoid muscle and refrain from the deprivation of function to extend elbow.METHODS: A total of 13 cases with axillary nerve injury without any recovery sign admitted at the Department of Hand Surgery, China-Japan Union Hospital of Jilin University were selected, including 11 males and 2 females, aged 18-55 years, mean aged 28.4 years; Under 10-times operating microscope, the anterior branch of axillary nerve was chosen to coincide the branch to long head of triceps branchii in use of 11 -0 atraumatic nylon in posterior approach. The standard issued by the Hand Surgery Society of Chinese Medical Association was adopted to assess the upper limb function postoperatively.RESULTS AND CONCLUSION: All patients were followed-up for 6-53 months with an average of 21 months. All incisions after surgery gain primary healing. The function of shoulder abduction had recovered in some degree. Among of total, 7 cases had deltoid strength of M4 or even more; 4 cases had deltoid strength of M3; one had M2 and one had M1. The effective rate was 92%, and excellent rate was 85%. There was no impact on the extension of elbow in all cases. It was a reliable and convenient technique to recover shoulder abduction with the branch to long head of triceps brachii from radial nerve in restoration of the function of deltoid muscle. It was beneficial to the restoration of axillary nerve with partially injured brachial plexus, and severe quadril.

BACKGROUND: Following peripheral nerve transplantation, the time phases and law of growth associated protein 43 (GAP-43) expression in sensory neuron soma of the corresponding dorsal root ganglia remain unclear.OBJECTIVE: To investigate the expression of GAP-43 at the corresponding dorsal root ganglia following sciatic nerve transplantation in rats.METHODS: Adult male Wistar rats were randomly divided into 2 groups: control group (sham-operated group) and experimental group (nerve transplantation group). The rats were killed at 3 days, 1, 2, 4, 6, and 8 weeks after operation and the dorsal root ganglia U-s of every rat was taken for observation. The expression of GAP-43 mRNA and protein in the corresponding segments of spinal cord were detected by RT-PCR and Western-blot techniques.RESULTS AND CONCLUSION: GAP-43 mRNA showed a low level of expression in the control group, which had no obvious changes in different phases. In the experimental group, GAP-43 mRNA expression was observed remarkably in the dorsal root ganglia at the first week, reached a peak at the second week and gradually descended from the sixth week. The GAP-43 protein expression showed the same laws as that of GAP-43 mRNA. The results demonstrated that there exists damage reactivity change in the regeneration ability of neurons.