Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis: A case report.

INTRODUCTION: C7 nerve transfer alone can improve upper limb motor function and partial spasticity. Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. We propose a novel possible improvement of contralateral C7 (CC7) nerve transfer through the posterior vertebral approach, which was combined with SPR of the affected cervical nerve. PATIENT CONCERNS: A 33-year-old male patient presented with cerebral hemorrhage of the left basal ganglia, paralysis of the right limbs, and hypesthesia 8 months earlier. The dysfunction of the affected hand was already present at admission. The patient reported a previous history of hypertension for several years and oral antihypertensive drugs, and blood pressure was controlled within a normal range. DIAGNOSIS: Central upper limb spastic paralysis. The muscle strength of the right lower limb was grade IV. The Fugl-Meyer score of the right upper limb was 7 points, and the modified Ashworth score was 10. INTERVENTIONS: The patient underwent CC7 transfer and SPR. OUTCOMES: The patient successfully underwent CC7 transfer and SPR without complications. On the day after surgery, the left upper limb motions were normal. The Fugl-Meyer score was 9, and the modified Ashworth score of the right upper limb was 2. CONCLUSIONS: CC7 nerve transfer through the posterior vertebral approach combined with SPR of the affected cervical nerve can possibly improve the surgical outcomes of selected patients with upper limb motor dysfunction and partial spasticity. This method has not been reported in the literature before, and additional studies are necessary.

Treatment of Central Paralysis of Upper Extremity Using Contralateral C7 Nerve Transfer via Posterior Spinal Route.

BACKGROUND: Contralateral C7 nerve transfer is widely applied for the treatment of brachial plexus injuries or central paralysis of the upper extremities. The surgical approach has evolved from the precervical subcutaneous route to the prespinal route, which is currently the most commonly used one. We report a patient with central paralysis of the right upper extremity treated with contralateral C7 nerve transfer via the posterior spinal route. CASE DESCRIPTION: A 59-year-old female patient was admitted on 3 July, 2018 with right hemiplegia. The muscle strength of the right lower and upper extremities was grade 4 and 0, respectively. On the basis of magnetic resonance imaging, she was diagnosed with central paralysis of the right upper extremity. Considering the short length of the patient's healthy C7 nerve, contralateral C7 nerve transfer via the posterior spinal route was performed. No intraoperative complication was encountered. The patient reported slight numbness of the volar side of the left thumb, middle finger, and index finger after surgery. The patient showed a right shrug movement 1.5 months after surgery. CONCLUSION: We propose carrying out contralateral C7 nerve transfer via the posterior spinal route because of the shorter distance, no need for nerve transplantation, and low occurrence of the complications encountered with the prespinal route (such as vertebral artery injuries, esophageal fistula, and upper extremity pain when swallowing).

Immunopontentiating and antitumor activities of a polysaccharide from Pulsatilla chinensis (Bunge) Regel.

One water-soluble polysaccharide (PCPw) was isolated and purified from the roots of Pulsatilla chinensis by DEAE cellulose-52 and Sephadex G-100 column chromatography, and its antitumor activity was evaluated on 4T1 tumor-bearing mice through transplantable animal tumor. After 10 days of PCPw (50, 100 and 200 mg/kg) treatment once daily in tumor-bearing mice, PCPw oral administration could not only significantly inhibit the growth of transplantable 4T1 tumor in mice but also promote concanavalin A (Con A), lipopolysaccharide (LPS)-stimulated splenocytes proliferation, the serum lysozyme level and 2,4-dinitrofluorobenzene (DNFB)-induced delayed-type hypersensitivity (DTH) reactions, especially at the dose of 100 mg/kg. Meanwhile, significant improvements in peripheral blood abnormality and anemia were observed in PCPw-treated group. These results suggested that PCPw could improve both cellular and humoral immune response and might be explored as a potential natural antitumor drug.