A Modified Endoscopic Carpal Tunnel Release Surgery.

In this study, a modified version of the endoscopic carpal tunnel release surgery was introduced, which is safe and easy to handle. Moreover, the requirement for surgical instruments is low. Six patients with carpal tunnel syndrome underwent the modified procedure. No neurovascular injuries occurred in these patients. According to the one-year follow-up data, all the patients were satisfied with the outcomes. The modified endoscopic carpal tunnel release technique has been proven to be safe with satisfactory outcomes in six patients in this study.

Decorin suppresses stemness and migration potential of malignant peripheral nerve sheath tumor through inhibiting epidermal growth factor receptor signaling.

Cancer stem cells (CSCs) play pivotal roles in the growth, invasion, metastasis, chemo-resistance in malignant peripheral nerve sheath tumor (MPNST). The current characterization of CSCs in MPNST is not complete. Decorin is a critical regulator of microenvironment, but its expression and function in CSCs of MPNST has not been studied. In the current study, Decorin levels and its relationship with lung and liver metastasis were determined in clinical specimens. Decorin expression in CD133-positive or CD44-positive CSCs was analyzed by RT-qPCR on cytospun MPNST cells after flow cytometry-based cell sorting. Decorin-positive cells were separated from Decorin-negative cells in transfected MPNST cell lines using a designed plasmid expressing red fluorescent protein (RFP) under a Decorin promoter. Tumor sphere formation, tumor growth, cell invasion, cell migration, and the resistance to chemotherapy-induced apoptosis were determined on Decorin-positive versus Decorin-negative MPNST cells. In vivo tumor growth was analyzed in mice receiving subcutaneous transplantation of Decorin-positive versus Decorin-negative MPNSTs. We found that Decorin levels were significantly downregulated in MPNST specimens, compared to non-tumorous adjacent tissue. Significantly lower Decorin levels were detected in MPNSTs with lung or liver metastasis compared to those without. Poorer patient survival was detected in Decorin-low MPNST, compared to Decorin-high subjects. More Decorin-negative cells were detected in CD133-positive MPNST cells than CD133-negative MPNST cells, and in CD44-positive MPNST cells than in CD44-negative MPNST cells. Compared to Decorin-positive MPNST cells, Decorin-negative MPNST cells generated significantly more tumor spheres in culture, were more invasive and migratory, and were more resistant to chemotherapy-induced apoptosis, likely due to the inhibition of epidermal growth factor receptor signaling by Decorin. Decorin-negative MPNST cells grew significantly larger tumor in vivo. Thus, depletion of Decorin may occur in CSCs in MPNSTs, serving possibly as a new therapeutic target.

Study on the potential of sludge-derived humic acid as energy storage material.

As one of the main methods for sludge treatment, recovery of renewable biogas energy by anaerobic digestion (AD) is a promising strategy to deal with the conflict between carbon neutralization and sharply increase of sewage sludge. Humic acid (HA) in sludge is a major inhibitor of biogas yields and needs to be removed or pretreated. However, as the graphene oxide-like material, HA is an ideal precursor for the preparation of energy storage materials with high performance. Based on that, this study i) proposes the extraction and utilization of HA in sludge, ii) discusses the feasibility of HA-based materials after thermal reduction as electrodes for supercapacitor, and iii) investigates the factors with positive influences on the structure and electrochemical performance. It reveals that, with a synergistic effect of purification and activation at a low mass ratio, the HA-based material exhibits superior capacitive performance with the highest specific capacitance of 186.7 F/g (at 0.05 A/g), as well as excellent rate capability and cycling stability. Sludge is verified a cheaper and more abundant precursor resource of HA for energy storage application. The results of this study are expected to provide a new green, energy-efficiency and sustainability way for sludge treatment, which has the double benefits: efficient conversion and capture of bio-energy during AD process, and high value-added utilization of HA for supercapacitor.

Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study.

Purpose: Accurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with an electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury. Materials and methods: We performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other nontraumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph/Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was assessed by US and EPS as completely injured or incompletely injured, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated based on the correlation with intraoperative findings. The accuracy of US and EPS were compared using the McNemar test. The added benefit of US was evaluated by comparing the sensitivity and specificity between the combined tests with EPS using the McNemar test. Results: This study included 49 patients with traumatic BPI who underwent BP surgeries from October 2018 to September 2022. Surgical exploration confirmed 89 completely injured BP roots in 28 patients. US correctly detected 80 completely injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p = 0.03). When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p = 0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p = 0.000977). Conclusion: Preoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.

Brain CT registration using hybrid supervised convolutional neural network.

BACKGROUND: Image registration is an essential step in the automated interpretation of the brain computed tomography (CT) images of patients with acute cerebrovascular disease (ACVD). However, performing brain CT registration accurately and rapidly remains greatly challenging due to the large intersubject anatomical variations, low resolution of soft tissues, and heavy computation costs. To this end, the HSCN-Net, a hybrid supervised convolutional neural network, was developed for precise and fast brain CT registration. METHOD: HSCN-Net generated synthetic deformation fields using a simulator as one supervision for one reference-moving image pair to address the problem of lack of gold standards. Furthermore, the simulator was designed to generate multiscale affine and elastic deformation fields to overcome the registration challenge posed by large intersubject anatomical deformation. Finally, HSCN-Net adopted a hybrid loss function constituted by deformation field and image similarity to improve registration accuracy and generalization capability. In this work, 101 CT images of patients were collected for model construction (57), evaluation (14), and testing (30). HSCN-Net was compared with the classical Demons and VoxelMorph models. Qualitative analysis through the visual evaluation of critical brain tissues and quantitative analysis by determining the endpoint error (EPE) between the predicted sparse deformation vectors and gold-standard sparse deformation vectors, image normalized mutual information (NMI), and the Dice coefficient of the middle cerebral artery (MCA) blood supply area were carried out to assess model performance comprehensively. RESULTS: HSCN-Net and Demons had a better visual spatial matching performance than VoxelMorph, and HSCN-Net was more competent for smooth and large intersubject deformations than Demons. The mean EPE of HSCN-Net (3.29 mm) was less than that of Demons (3.47 mm) and VoxelMorph (5.12 mm); the mean Dice of HSCN-Net was 0.96, which was higher than that of Demons (0.90) and VoxelMorph (0.87); and the mean NMI of HSCN-Net (0.83) was slightly lower than that of Demons (0.84), but higher than that of VoxelMorph (0.81). Moreover, the mean registration time of HSCN-Net (17.86 s) was shorter than that of VoxelMorph (18.53 s) and Demons (147.21 s). CONCLUSION: The proposed HSCN-Net could achieve accurate and rapid intersubject brain CT registration.

Intercostal nerve transfer for restoration of the diaphragm muscle function after phrenic nerve transfer in total brachial plexus avulsion.

OBJECT: To determine the possibility of innervation of the diaphragm muscle using intercostal nerve after ipsilateral phrenic nerve transfer in total brachial plexus avulsion. METHODS: Bilateral phrenic nerves and the 9th intercostal nerves were observed inside the thorax. The point where the phrenic nerve entered the diaphragm muscle (point A), the point where the 9th intercostal nerve gave rise to the cutaneous branch (point B) and crossed the posterior axillary line (point C) and the point where the posterior axillary line met the insertion of the diaphragm muscle (point D) were identified. The distances between points B and C, points A and C and from points A through D to C were recorded respectively. The 9th intercostal nerve was transferred to the distal stump of the phrenic nerve in one patient after phrenic nerve transfer to avulsed brachial plexus. RESULTS: The mean distances between points B and C, points A and C and from points A through D to C were 12.20 ± 1.04 cm, 10.32 ± 1.02 cm and 16.43 ± 0.91 cm on the right side respectively, 11.78 ± 1.21 cm, 7.77 ± 0.85 cm and 11.74 ± 1.00 cm on the left side respectively. The 9th intercostal nerve was used to innervate the distal stump of the phrenic nerve in one patient after the phrenic nerve transfer to the avulsed brachial plexus. The diaphragm muscle function partially recovered one year after the operation. CONCLUSION: The 9th intercostal nerve can be transferred to the distal stump of the phrenic nerve to restore the diaphragm muscle function according to the anatomical study. The movement of the diaphragm muscle was partially restored in one clinical case.

Galvanic replacement mediated 3D porous PtCu nano-frames for enhanced ethylene glycol oxidation.

Three dimensional (3D) porous PtCu nano-frames with a unique hollow structure were obtained after a galvanic replacement reaction, exhibiting a high normalized mass activity of 23.1 A m-2 µg-1 towards ethylene glycol oxidation with excellent stability. The morphological evolution and catalytic mechanism were detailed.

A New Surgical Method to Reconstruct the Fingertip.

BACKGROUND: In our previous study, we used cross finger fascial flap combined with split-thickness toe nail bed graft to reconstruct large area defect of the nail bed with distal phalanx exposure. Fingertip avulsions are common injuries to the upper extremity and cause a great deal of distress for patients. Replantation, amputation and flap coverage are considered. However, all these methods have their limitations. METHODS: Five patients with fingertip avulsions were enrolled. We used the methods mentioned above combined with the reversed pedicled island flap to covered the defects of both the dorsal and volar sides and reconstruct the fingertip. RESULTS: All the 5 patients were followed for at least 3 months. The blood supply of the flaps and nail bed is good. All the patients were satisfied with their new fingertips. CONCLUSIONS: The method we introduced in this study is proved to be an effective surgical method for fingertip avulsions.

Decorin as a prognostic biomarker in patients with malignant peripheral nerve sheath tumors.

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft-tissue sarcomas. The prognosis of MPNSTs has been reported to differ among previous studies. However, there have been a number of reported prognostic biomarkers associated with MPNSTs. In the present study, a proteomics study was performed to discover the differential protein expression in patients with MPSNTs with different prognoses. The clinical data of 30 primary extremities of patients with MPNSTs, who underwent surgery at the Department of Hand Surgery, Huashan Hospital, Fudan University between January 2002 and December 2011, were acquired. A total of 16 patients succumbed to their diseases within 5 years, whereas 14 patients were disease-free for >5 years. Samples from the 9 patients who succumbed within 2 years were assigned to Group D, while samples from the 8 patients who were continuously disease-free for >5 years following diagnosis were assigned to Group L for the proteomics study. Label-free quantitative proteomics and mass spectrometry were performed to filtrate differential protein in patients with MPSNTs with different prognoses. Decorin was filtrated as a differential protein of note. The expression level of decorin was significantly lower in Group D compared with that in Group L (D/L=0.0948; P=0.0004). The result was verified by immunohistochemical staining in the 30 primary extremities of patients with MPNSTs. The 5-year survival rate of patients with positive expression of decorin was 78.57%, while the 5-year survival rate of patients negative for decorin expression was 18.75% (P=0.0014). Overall, a high level of decorin indicted a better prognosis in patients with MPNSTs. With further investigation, decorin may be a reliable prognostic biomarker for MPNSTs.

End-to-side neurotization with the phrenic nerve in restoring the function of toe extension: an experimental study in a rat model.

The phrenic nerve being transferred to the posterior division of the lower trunk with end-to-end neurorrhaphy is reported to be effective in restoring the function of digit extension in literature. However, the phrenic nerve is extremely important in respiration. We designed an animal experiment to discover whether the phrenic nerve being transferred to the posterior division of the lower trunk with end-to-side neurotization was feasible and provided the theoretical basis. A sum of 36 Sprague-Dawley rats was randomly assigned to one of two groups. In Group A, the phrenic nerve was transferred to the posterior division of the lower trunk with end-to-side neurotization. In Group B, the posterior division of the lower trunk was directly sutured. The results of behavioral assessment, electrophysiology, histology and nerve fiber count and muscle weight at 12 weeks postoperatively were recorded. In Group A, none of the rats experienced tachypnea. The motion of slight toe extension was observed. The results of electrophysiology, histology and nerve fiber count and muscle weight in Group A were not as well as those of Group B, but gradually improved with time. The phrenic nerve being transferred to the posterior division of lower trunk with end-to-side neurotization can partially restore the function of toe extension in a rat model. Whether the function of digit extension can be restored by the phrenic nerve with end-to-side neurotization in humans still needs more practice in clinic.

Large malignant granular cell tumor with suprascapular nerve and brachial plexus invasion: A case report and literature review.

RATIONALE: Malignant granular cell tumor is a kind of rare and highly aggressive malignant tumor that commonly occurs in lower extremity, trunk, and peritoneal cavity. Huge malignant granular cell tumor (MGCT) with suprascapular nerve and brachial plexus invasion was extremely rare. PATIENT CONCERNS: We present a special case of a 48-year-old orthopedist who suffered from MGCT. The orthopedist had regarded that he suffered from scapulohumeral periarthritis. DIAGNOSES: The disease was noticed until a painless mass on his right neck was discovered 9 months later. MRI result confirmed a large occupying in axillary fossa, supraclavicular and infraclavicular region. INTERVENTIONS: During the operation, a tumor measuring 22 × 13 × 6 cm with suprascapular nerve and brachial plexus invasion was identified. The tumor was fractional resected carefully to maintain the integrity of nerves and vessels. Lymph nodes were simultaneously resected. OUTCOMES: The motor function and sensation of the upper extremity were same to that of preoperation. The postoperative histological diagnosis was MGCT. At a 12-month follow-up, there was no recurrence of the tumor showed by MRI. LESSONS: This study presents a rare case of large MGCT with suprascapular nerve and brachial plexus invasion that was successfully managed by surgery.

Reconstruction of large area defect of the nail bed by cross finger fascial flap combined with split-thickness toe nail bed graft: A new surgical method.

Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature.From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients.All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity.Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure.

Outcome Comparison of Nerve Transfer with Different Donor Nerves in a Rat Model.

OBJECTIVE: The phrenic nerve and the contralateral seventh cervical (C7) nerve root are the most commonly used donor nerves in the treatment of total brachial plexus avulsion. The aim of this study was to determine if the phrenic nerve or the contralateral C7 nerve root yields a superior outcome for nerve transfer. METHODS: A total of 60 Sprague-Dawley rats were randomly assigned to 1 of 3 groups. In Group A the phrenic nerve was used as the donor nerve; in Group B the contralateral C7 nerve root nerve was used as the donor nerve; in Group C the nerve was directly sutured. The results of behavioral assessment, electrophysiology, histology, nerve fiber count and muscle weight at 24 weeks postoperatively were recorded. RESULTS: Group A showed a faster recovery time compared to Group B; however Group B showed a better functional recovery at the final outcome assessment compared to Group A. CONCLUSION: The contralateral C7 nerve root was better as the donor nerve for nerve transfer in the treatment of total brachial plexus avulsion.

Large cervicothoracic myxoinflammatory fibroblastic sarcoma with brachial plexus invasion: A case report and literature review.

Myxoinflammatory fibroblastic sarcoma is a rare sarcoma that develops in patients of all ages, which usually presents as a slow-growing painless mass in the distal extremities. To date, myxoinflammatory fibroblastic sarcoma with invasion of the brachial plexus has rarely been reported in the literature. In this study, a case of large cervicothoracic sarcoma, which invaded the brachial plexus, is presented. The patient reported no sensory disturbance or dyskinesia. The tumor was completely resected without injury of the brachial plexus. The postoperative histological diagnosis was myxoinflammatory fibroblastic sarcoma. Follow-up examination performed 24 months after surgery revealed no tumor recurrence and no sensory disturbance or dyskinesia was reported. This study presents a rare case of large myxoinflammatory fibroblastic sarcoma with brachial plexus invasion that was successfully managed by surgery.

Primary Brachial Plexus Tumors: Clinical Experiences of 143 Cases.

OBJECTIVE: Primary brachial plexus tumors are extremely rare and the treatment is challengeable. Our aim is to share the experiences in the treatment of primary brachial plexus tumors. METHODS: A retrospective analysis of 143 patients with primary brachial plexus tumors was made in our department from January 2001 to December 2012. The clinical presentation of the patients, the characteristics and pathological results of the tumors and the prognosis were described. RESULTS: Seventy-eight males and sixty-five female were enrolled. The mean age was 48.17 years old. A palpable mass was the most common clinical presentation occurred in 129 patients. The trunks of the brachial plexus were the locations where the tumors originated with high possibility, with 68 cases. Benign tumors were composed of 119 schwannomas and 12 neurofibromas, while malignant tumors were composed of 8 malignant peripheral nerve sheath tumors, 2 malignant granular cell tumors, 1 synovial sarcoma and 1 peripheral primitive neuroectodermal tumor. Appropriate surgical method, radiotherapy and chemotherapy were used according to the condition during operation, preoperative examinations and pathological result. The survival rate was 50.00% with a 3-year follow-up. Local recurrence happened in 7 patients. Five patients presented Metastasis. CONCLUSIONS: Appropriate surgical method is the key for the treatment of different brachial plexus tumors. Surgery has a great effect on the treatment of benign tumors. For malignant tumors, adjuvant radiotherapy or chemotherapy should be used according to the pathological result. The general prognosis for malignant brachial plexus tumors is less than ideal.

Pronator teres branch transfer to the anterior interosseous nerve for treating C8T1 brachial plexus avulsion: an anatomic study and case report.

BACKGROUND: The treatment of C8T1 avulsion is challenging for neurosurgeons. Various methods for the restoration of finger flexion are used. However, most of these methods have different disadvantages and cannot restore the full active range of motion of the fingers. OBJECTIVE: To determine the feasibility of the pronator teres branch transfer to the anterior interosseous nerve with anatomic study and to use this method in 1 case. METHODS: The upper limbs of 15 fresh cadavers were dissected to identify the main trunk of the median nerve, the pronator teres branch, and the anterior interosseous nerve. The mean number and length of the pronator teres branches were recorded. The anterior interosseous nerve was dissected atraumatically to the most proximal level where the fibers of the anterior interosseous nerve did not mingle with the fibers of the main trunk of the median, which was defined as the atraumatic level of the anterior interosseous nerve. A line joining the most protruding point of the medial condyle and lateral condyle of the humerus was used as a measurement landmark. Pronator teres branch transfer to the anterior interosseous nerve was performed in 1 patient with C8T1 avulsion. RESULTS: The mean number of the pronator teres branches was 2.37 ± 0.49. The mean length of the pronator teres branches was 9.64 ± 0.71 mm. The mean distance between the point where the pronator teres branches originated and the landmark line was 3.87 ± 0.34 mm. The mean distance between the atraumatic level of the anterior interosseous nerve and the landmark line was -5.46 ± 0.73 mm. Transfer of the pronator teres was used to innervate the anterior interosseous nerve in 1 patient with C8T1 avulsion. When assessed 14 months after the operation, a full active range of motion of the fingers had been restored, and the patient's finger flexor muscles had regained grade 4 power. CONCLUSION: The pronator teres can be transferred to the anterior interosseous nerve directly at the elbow level. This operation was performed successfully in 1 patient, who exhibited finger flexion recovery.