Plexus Research Articles

Impact of resection margin status on survival after operation for pancreatic head cancer with extrapancreatic nerve plexus invasion

Extrapancreatic nerve plexus (PL) invasion of pancreatic ductal adenocarcinoma (PDAC) is an important factor for determining resectability and surgical method. We sought to clarify the characteristics of PDAC with PL invasion and clinical impact of the resection margin status on prognosis for PDAC with PL invasion. A total of 242 patients with pancreatic head cancer who underwent pancreatectomy were evaluated. Clinicopathological data and patient survival were analyzed. Pathological PL invasion was observed in 68 patients (28.1%). Patients with PL invasion had significantly shorter disease-free survival (DFS) and showed trends toward worse overall survival (OS) than those without PL invasion. While multivariate analysis revealed that PL invasion was not an independent prognostic factor, PL invasion was associated with extensive venous invasion and a high percentage of lymph node metastases, both of which were independent factors affecting DFS and OS. Among patients with PL invasion, there was no significant difference in DFS and OS between the R0 and R1 resection groups. PL invasion is a common pathological feature of aggressive PDAC with high propensity for invasiveness and metastatic potential. The microscopic resection margin status may not affect the survival of pancreatic head cancer patients with PL invasion.

Quantitative Measurement of Vascular Density and Flow Using Optical Coherence Tomography Angiography in Patients with Vasculitis; Can OCTA detect the vasculitis?

Methods: Patients with uveitis and vasculitis in at least one eye were included and compared with 50 eyes from healthy individuals. The OCTA was done for each patient and control subject. The images were analysed at three capillary plexuses layers (superficial and deep retinal capillary layers and choriocapillaris layer). contact lens was placed on the corneal surface. Corneal edema decreased gradually in one month post-operatively. Results: Fifty-five eyes from 28 patients were enrolled in the study. Studied eyes were categorized into 4 groups: 1-eyes with posterior vasculitis (38 eyes), 2-eyes with peripheral vasculitis without posterior vasculitis (7 eyes), 3-fellow uninvolved eyes of patients with unilateral vasculitis (10 eyes), and 4-eyes of healthy controls (50 eyes). The whole vascular density and parafoveal vascular density in both superficial and deep retinal capillary plexuses were reduced significantly from group 4 to group1. A decreasing trend in macular blood flow was also observed from group 4 followed by group 3, group 2 and group 1 in all three capillary layers including superficial retinal capillary plexus, deep retinal capillary plexus and choriocapillaris. By choosing the threshold of 26.2, the formula (-0.447×F1ch+75.82×VDdp) was the best model to differentiate the vasculitis group from the control group with an area under the curve (AUC) of 0.979, the sensitivity of 98% and specificity of 92.3%. (F1ch: flow in the central 1mm-radius-circle of the choriocapillaris, and VDdp: vascular density of parafoveal in the deep capillary network). Conclusion: In patients with vasculitis, especially in the cases with posterior pole involvement, OCTA showed reduced vascular density and flow in all three capillary layers. OCTA might be a helpful tool to give us additional information about the macular microvasculature changes under inflammatory conditions.

Magnesium sulfate versus clonidine as an adjuvant to ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: A double-blind randomized controlled trial

Objective: To compare the efficacy of clonidine and magnesium sulfate (MgSO4) when administered as an adjuvant to supraclavicular brachial plexus block in upper limb surgery. Materials and Methods: Sixty patients belonging to the American Society of Anesthesiologists classification (ASA) 1 and 2 undergoing upper limb surgical procedures were randomized to receive either 30 μg injection clonidine or 200 mg injection MgSO4 added to 18 ml of 0.5% levobupivacaine + 7 ml of 2% lignocaine with adrenaline. The primary objective of the study was to compare the duration of sensory (postoperative analgesia) and motor block between the two groups. The secondary objectives were to compare the onset time of motor and sensory block along with heart rate and mean arterial pressure between the two groups, which was recorded at regular intervals by the blinded anesthesiologist intraoperatively. Unpaired Student's t-test and repeated-measures analysis of variance were used for the analysis of parameters between the two groups. Results: There was no statistically significant difference between clonidine and MgSO4 groups in terms of primary outcome, i.e., the duration of postoperative analgesia (12.10 ± 3.86 h vs. 10.93 ± 3.68 h, P = 0.236) or duration of motor block (10.67 ± 3.70 h vs. 9.50 ± 2.89 h, P = 0.180). The mean onset time for motor block was relatively faster in clonidine group compared to MgSO4 with a borderline significance (P = 0.049). No clinically significant difference was observed in the mean onset of sensory block or hemodynamics between the two groups. Conclusion: Both, clonidine and MgSO4, as an adjuvant to supraclavicular brachial plexus block were found to have a similar onset time and duration of analgesia and motor block.

A Novel Role of Interleukin 13 Receptor alpha2 in Perineural Invasion and its Association with Poor Prognosis of Patients with Pancreatic Ductal Adenocarcinoma.

Perineural invasion (PNI) is one of the major pathological characteristics of pancreatic ductal adeno-carcinoma (PDAC), which is mediated by invading cancer cells into nerve cells. Herein, we identify the overexpression of Interleukin-13 Receptor alpha2 (IL-13Rα2) in the PNI from 236 PDAC samples by studying its expression at the protein levels by immunohistochemistry (IHC) and the RNA level by in situ hybridization (ISH). We observe that ≥75% samples overexpressed IL-13Rα2 by IHC and ISH in grade 2 and 3 tumors, while ≥64% stage II and III tumors overexpressed IL-13Rα2 (≥2+). Interestingly, ≥36 % peripancreatic neural plexus (PL) and ≥70% nerve endings (Ne) among PNI in PDAC samples showed higher levels of IL-13Rα2 (≥2+). IL-13Rα2 +ve PL and Ne subjects survived significantly less than IL-13Rα2 –ve subjects, suggesting that IL-13Rα2 may have a unique role as a biomarker of PNI-aggressiveness. Importantly, IL-13Rα2 may be a therapeutic target for intervention, which might not only prolong patient survival but also help alleviate pain attributed to perineural invasion. Our study uncovers a novel role of IL-13Rα2 in PNI as a key factor of the disease severity, thus revealing a therapeutically targetable option for PDAC and to facilitate PNI-associated pain management.

A comparative study of supraclavicular block, interscalene block, and combination of supraclavicular with interscalene block using 0.5% ropivacaine and dexmedetomidine as adjuvant by nerve stimulation technique in upper limb surgery

Background: Anesthesia for upper limb surgeries may include general anesthesia, regional anesthesia, or combination of both. Compared with general anesthesia, brachial plexus regional anesthesia technique is preferred for upper limb surgeries. Aims and Objectives: A comparative study of supraclavicular block, interscalene block, and combination of supraclavicular and low interscalene blocks using 0.5% ropivacaine and dexmedetomidine as adjuvant by nerve stimulation technique in upper limb surgery in terms of the onset of sensory and motor block and duration of sensory and motor block. Materials and Methods: The patients in supraclavicular block group (n = 20) were given supraclavicular block, in interscalene block (IRD) group (n = 20) were given low interscalene block, and in combination of supraclavicular and interscalene block (ISRD) group (n = 20) were given combination of supraclavicular block and low interscalene block using nerve stimulator by injecting 30 ml 0.5% ropivacaine and 50 μg dexmedetomidine in each group. Results: The results showed that there was no statistically significant difference seen in demographic and hemodynamic parameters. Combined supraclavicular block and low interscalene block had statistically better outcomes than supraclavicular block and low interscalene block individually. Conclusion: The onset of sensory and motor block in combined supraclavicular and interscalene blocks as significantly faster with prolonged duration of sensory and motor block followed by low interscalene block and supraclavicular block, respectively. There were no significant complications encountered during the procedure.

The macular vascular density and the area of foveal avascular zone in the follow eyes of monocular retinal vein occlusion patients

Objective To observe the macular vascular density and the area of foveal avascular zone(FAZ) in the follow eyes of monocular retinal vein occlusion (RVO) patients. Methods Retrospective case-control study. From May to November 2018, 78 follow eyes of 78 monocular RVO patients who were clinically diagnosed in Changsha Aier Eye Hospital were included in the study. Among them, 44 were male and 34 were female. The average age was 53.17±10.12 years. There were 42 patients with central retinal vein occlusion(CRVO group) and 36 patients with branch retinal vein occlusion (BRVO group). Forty-two eyes of 33 gender and age matched healthy volunteers were selected as the control group. Among them, 17 were male (22 eyes) and 16 were female (20 eyes), with the mean age of 53.48±10.84 years. OCT angiography was performed on all eyes in CRVO group, BRVO group and control group. The scanning region in the macular area was 6 mm× 6 mm. Macular vascular density and FAZ area in the superficial and deep retinal capillary plexi were measured. Results The mean overall vascular density measured in the entire scan was lower in the CRVO group(t=-4.26, -4.93) and BRVO group (t=-4.79, -4.74) compared with the control group in both the superficial and deep capillary plexus (P 0.05). Conclusions The macular vascular density in the follow eyes of monocular RVO patients is lower than that of normal healthy eyes. The reduce degree of vascular density in the deep capillary plexus is higher than that in the superficial plexus. Compared with normal healthy eyes, the FAZ area in the follow eyes of monocular CRVO patients decreased, while it did not change significantly in the follow eyes of monocular BRVO patients. Key words: Retinal vein occlusion; Regional blood flow; Tomographyoptical coherence

Expression of hyperphosphorylated Tau protein in retrograde degeneration of neurons

Objective To explore the expression of hyperphosphorylated Tau protein in the retrograde degeneration of spinal central neurons after cervical 7 nerve transection, so as to provide a new idea for the protection of retrograde degeneration of central neurons after peripheral nerve injury. Methods Thirty-six adult female Sprague-Dawley rats were randomly divided into three groups (sham operation group, transection group, transection+drug intervention group). The rats in transection group and transection+drug intervention group were treated with bilateral cervical 7 nerve cutting to make models, and the rats in transection+drug intervention group were treated with 1 mmol/kg lithium chloride intraperitoneally every day. After 2 and 4 weeks, the spinal cords of cervical 7 of the rats were taken, and the apoptosis of neurons was analyzed by HE staining and flow cytometry. The expression of Tau protein and related protein was analyzed by Western blot. Results HE staining and flow cytometry showed that the apoptotic degree of the transection group at 2 weeks was less than that at 4 weeks. The resutls of Western blot showed that as time went on, the amount of total Tau protein decreased due to the transection of cervical 7 nerve, and the proportion of phosphorylated Tau protein increased. The difference was statistically significant. After lithium chloride administration, the degree of apoptosis and the proportion of phosphorylated Tau protein decreased significantly. Conclusion The mechanism of Tau protein hyperphosphorylation lies in the process of retrograde degeneration of spinal cord central neurons after cervical 7 transection, and lithium chloride can reduce the degree of retrograde degeneration. Key words: Tau proteins; Brachial plexus; Neuron retrograde degeneration; Hyperphosphorylation

Changes of foveal avascular zone size and correlation between foveal avascular zone size and metamorphopsia before and after idiopathic macular epiretinal membrane surgery

Objective To observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia. Methods A retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm2 and 0.202±0.03 mm2, respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia. Results At 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm2 and 0.240±0.019 mm2, respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased (F=8.484, 14.346; P<0.001,<0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline (F=5.044, 17.763, 13.545; P=0.001, <0.001, <0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score (r=-0.816, P<0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score (r=-0.422, -0.882; P=0.005,<0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score (r=-0.791,-0.716; P<0.001,<0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score (r=-0.343, -0.330, -0.732, -0.694; P=0.026, 0.033,<0.001,<0.001). Conclusions PPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA. Key words: Macula lutea; Membranes; Vitrectomy; Tomographyoptical coherence; Foveal avascular zone; Metamorphopsia

The changes of retinal capillary after anti-vascular endothelial growth factor therapy in patients with macular edema associated with retinal vein occlusion

At present, intravitreal injections of anti-VEGF agents is the main method for the treatment of macular edema secondary to retinal vein occlusion (RVO), which can significantly inhibit neovascularization, release macular edema and improve the vision of patients. However, VEGF is a survival factor of vascular endothelial cells, whether it can lead to the progress of retinal ischemia and it has an effect on retinal capillaries deserves our clinical attention. Most scholars currently think that the anti-VEGF agents will not aggravate the occlusion of retinal capillaries in the treatment of macular edema secondary to RVO from the aspects of the changes of perifoveal capillary arcade, the quantification of foveal avascular zone area, retinal nonperfusion area and retinal vascular density of the superficial and deep capillary plexus In addition, the changes of these indicators may be related to the number of times patients need treatment, visual prognosis and so on. In the future, with the gradual popularization of OCT angiography and the prolongation of the number and time of anti VEGF drug treatment, we look forward to the study of larger samples and longer follow-up time to further analyze the influence of the retinal capillary after anti-VEGF therapy in patients with macular edema associated with RVO. Key words: Retinal vein occlusion/complications; Macular edema/drug therapy; Angiogenesis inhibitors/therapeutic use; Capillaries; Review

The clinical outcome of Narakas II obstetric brachial plexus palsy by neurolysis and never grafting

Objective To explore the efficacy of neurolysis or nerve grafting in the treatment of the conducting neuroma of Narakas II obstetric brachial plexus palsy (OBPP), and provide the reference basis for choosing an optimal method. Methods From January, 2009 to December, 2014, 32 patients undergoing surgical treatment due to Narakas II OBPP were included in this study. Neurolysis was performed in 15 patients, and the procedure of nerve grafting was performed in 17 patients. The general information included gender, age, birth weight, injury cause, etc. were recorded and compared to each other between 2 groups. A followed-up study had been conducting after surgery, the functional rating systems of Gilbert and Raimondi were used for quantitative comparison between preoperative function and postoperative function of shoulder joint, elbow joint and hand. In addition, the differences of the measurement data were compared with the single factor analysis of variance and paired t-test by using SPSS 22.0 statistical software. When P<0.05, it was considered statistically significant. Results There was no statistically significant difference in the baseline information between 2 groups (P>0.05). The average time of follow-up was 58.44 (48-96) months. And the fourth year' average score of shoulder joint, elbow joint, hand of the neurolysis group improved from preoperative (1.07±0.85) , (2.07±0.77) and (3.47±0.62) score to (3.00±0.73), (4.13±0.62) and (4.53±0.72) score (P 0.05), respectively. In addition, the proportion of the patients who needed the secondary operation about functional reconstruction in the neurolysis group and the nerve grafting group was 73.33% and 35.29% respectively, besides the proportion of the shoulder joint and elbow joint in the surgical sites accounted for 82.35%, 17.65% respectively. Conclusion Nerve grafting is a better choice for the treatment of conducting neuroma of Narakas II OBPP at present. Key words: Obstetric brachial plexus palsy; Neurolysis; Never grafting; Neuroma

Anaesthesia effect of ropivacaine in different concentrations on intermuscular sulcus brachial plexus block under ultrasound guidance

Objective To explore the anesthetic effect of different concentrations of ropivacaine in intramuscular sulcus brachial plexus block under ultrasound guidance. Methods From April 2016 to April 2018, 120 patients with upper limb orthopedic surgery who received muscle under the ditch brachial plexus block guided by ultrasound in Jinhua Hospital of Traditional Chinese Medicine were randomly divided into group A (40 cases, application of 0.375% ropivacaine), group B (40 cases, application of 0.50% ropivacaine), group C (40 cases, application of 0.75% ropivacaine). The anesthetic effect, onset time of sensory block, onset time of motion block, duration of analgesia, recovery time of motion block, serum troponin level, creatine kinase isozyme level and incidence of adverse reactions in the three groups were compared. Results The excellent and good anesthesia rate of group A, group B and group C was 100.00%, and there was no statistically significant difference among the three groups (P>0.05). The onset time of sensory block[(5.29±1.32)min], the onset time of motion block[(7.42±1.36)min] in group C were shorter than those in group A[(9.32±1.52)min, (13.32±2.46)min] and group B[(7.89±1.63)min, (9.12±2.20)min](F=4.652, 6.365, all P 0.05). Conclusion With the increase of ropivacaine concentration, the onset time of anesthesia is shorter and the analgesic time is longer, but the incidence of adverse reactions is also higher.In a comprehensive consideration, 0.50% ropivacaine can be applied to patients with intermuscular sulcus brachial plexus block under ultrasound guidance. Key words: Anesthesia; Brachial plexus; Ultrasonography; Intermuscular groove; Analgesia; Ropivacaine

Endoscopic Ultrasound–Guided Celiac Plexus Neurolysis for Pancreatic Cancer Pain

Endoscopic ultrasound–guided celiac plexus neurolysis (EUS-CPN) remains a widely used method to treat pain in patients with pancreatic cancer. Most

Application of modified posture in prevention of brachial plexus injury in interventional treatment of congenital heart disease

Objective To study the effect of modified posture on preventing brachial plexus injury in interventional treatment of congenital heart disease. Methods From December 2016 to December 2017, 234 children with congenital heart disease received interventional therapy in this hospital were selected as observation subjects.According to the random number table method, they were divided into the observation group and the control group, with 117 cases in each group.The control group was placed on the supine position routinely, while the observation group was given modified posture nursing by communicating with the doctor to estimate the time and difficulty of operation.The incidence and satisfaction of postoperative brachial plexus injury in the two groups were compared. Results There was no brachial plexus injury in the observation group, which was significantly lower than 2 cases ( 1.71%) in the control group, and the difference was statistically significant(P<0.05). The satisfaction rate of the observation group was 97.31%, which was significantly higher than that of the control group 83.66%, and the difference was statistically significant(P<0.05). Conclusions The modified posture placement method has a significant effect on preventing brachial plexus nerve injury in children undergoing cardiac intervention.It can be popularized. Key words: Posture; Congenital heart disease; Interventional therapy; Brachial plexus injury

Comparative study of bupivacaine with dexmedetomidine as an adjuvant versus bupivacaine alone in ultrasound-guided supraclavicular brachial plexus block

Background: Skillful usage of adjuvants in peripheral nerve blocks can resolve the key issue of postoperative pain. This study was conducted to compare the effects of dexmedetomidine as an adjuvant with bupivacaine in terms of the duration of analgesia (DOA), onset and duration of sensory and motor block. Materials and Methods: This prospective, randomized, double-blind trial consists of total 72 patients undergoing elective upper limb elective procedures, divided into two groups, 36 in each. Group-C received ultrasound-guided (USG) supraclavicular brachial plexus block using injection 0.25% bupivacaine 20 ml + 0.9% normal saline diluted to total 22 ml and Group D received USG supraclavicular brachial plexus block using injection 0.25% bupivacaine 20 ml + dexmedetomidine 1 μg/kg diluted to total of 22 ml with 0.9% normal saline. The parameters recorded were onset and duration of sensory and motor block, DOA, and side effects. Results: In both the groups, demographic data were similar. Sensory and motor block onset was significantly shorter (P Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in USG supraclavicular plexus block shortens the onset and prolongs the duration of sensory and motor block and DOA.

Treatment strategy of traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion of the humeral head

Objective To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head. Methods Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion), which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head, who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed. Seven males and 1 female have been included in the case series, with the age between 30-70 years (mean 44.5±12.3 years), 6 on the right shoulder and 2 on the left. 7 were acute injuries and 1 chronic. One patient received closed reduction under brachial plexus block anesthesia, and the rest cases underwent open surgeries. Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid. The other 6 patients received modified delto-pectoral approach. 4 concomitant rotator cuffswere found during the procedures, including1 full thickness tears 3 partial. One patient received McLaughlin surgery, allograft and anchor suture fixation. 2 underwent cannulated screw fixation. Allograft and PHILOS fixation was placed on 4 cases. All 8 patients were required maintaining in mild abduction and external rotation the affected arms, with the protection of the casts. All patients were followed up for 20.6±8.4 months (range, 9-36 months). Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up. Results Infection occurred in 1 case, the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty. Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery, with no limitation of the range of motion of the shoulder. Stage 1 wound closure and bony union were witnessed on the rest 6 patients. No neuromuscular injures or re-dislocations on the affected shoulders was found. The range of motion of the affected shoulder has been recorded at the latest follow-up: 123.8°±30.1° (90°-180°) in flexion, 124.4°±34.2° (80°-180°) in abduction, 36.9°±20.9° (0°-70°) in external (neutral position), 58.8°±10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score. Among the 8 patients, 7 patients were at the rank of VAS 0-3, and 1 of 4-6. Conclusion Optimal treatment options should be chosen based on the humeral head defect status, in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion. Closed reduction can be tried on < 20% humeral head defect with the help of anesthesia, and surgical option is the optimal one for the defect between 20%-40%. Key words: Shoulder joint; Shoulder dislocation; Wounds and injuries

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region

Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes. Key words: Brachial plexus root avulsion; Seventh cervical nerve; Nerve transfer; Limb coordination

Safety evaluation of ultrasound location in axillary venipuncture

Objective To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney). Method A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded. Results Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method. Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method. Key words: Axillary vein; Central vein catheterization; Ultrasound; Complications; Magney method

Peer-assisted teaching at the University of Zimbabwe, College of Health Sciences: A prospective observational study

Objectives: We describe the effects of peer-assisted learning, focusing on the practical proficiency of the trainees to perform one particular regional anaesthesia technique. We also describe the effect the peer assisted learning had on patient service provision. Design: This was a prospective observational study of the23 students in the department at the time. It was conducted at the two teaching hospitals Parirenyatwa and Harare Central Hospitals in 3 stages. Stage 1 Initial assessment of the trainees and audit of theatre registers, stage 2 the setup and implementation of the module and stage 3 reassessment after the setup and implementation. The Data was analysed using a Students t test, Chi square test and descriptive statistics used to report. Setting: Special Referral Hospital. Subjects: Medical students in the department of Anaesthesia and Critical Care Medicine. Main Outcome Measures: Performance of the Supraclavicular Brachial Plexus Block. Results: There was a statistically significant increase in the number of trainees who had performed a supraclavicular brachial plexus block from 2 (8.7%) to 15 (65.3%), [p=0.001]. The number of blocks performed increased from 0-47.6% [p=0.000] and 1.7%-20.8% [p=0.0005] at Parirenyatwa and Harare Central Hospitals respectively. Twenty two of the 23 students thought the module beneficial. Conclusion: Introduction of a peer assisted learning module improved learning of fellow trainees and ensured more had acquired the skill. This resulted in more patients in whom the technique was indicated receiving the beneficial service. Thus peer assisted teaching functioned as a good adjunct to traditional methods.

Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study

Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS). Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstrom criteria. Results The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P 0.05). Conclusion Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes. Key words: Radius fractures; Anesthesia; Ultrasonography; Brachial plexus; Closed reduction

Correlation between fetal cranial nervous system malformation and chromosome abnormality

Objective To investigate the correlation between fetal cranial nervous system malformation and chromosome abnormality. Methods The pregnant women with fetal cerebral nervous system dysplasia were collected from January 2013 to August 2018 at the Prenatal Diagnostic Center of the Sixth Affiliated Hospital of Guangzhou Medical University.The fetus was diagnosed by ultrasonography and karyotype analysis. Results A total of 18 cases of abnormal karyotypes were detected from 85 patient samples, and the abnormal rates were 21.18%.Single cranial nervous system malformation was found in 47 cases, abnormal karyotypes in 4 cases, multiple system malformation in 38 cases, and abnormal karyotypes in 14 cases, and the abnormal karyotype rate of multiple system malformation was higher than that of single cranial nervous malformation (36.84% vs.8.51%, χ2=10.101, P=0.001 5). And the 88.89%(16/18 cases)of abnormal karyotypes were founded in the early and middle pregnancy (≤28 weeks). The abnormal karyotype detection rates of cranial nervous system malformation associated with cardiovascular, skeletal and limb, facial neck abnormalities were 58.82% (10/17 cases), 50.00% (6/12 cases) and 50.00% (9/18 cases), respectively.In the fetal phenotypes, the abnormal karyotype detection rates of choroid plexus cysts were up to 64.29%, followed by arachnoid cysts (50.00%), craniocerebral abnormalities (45.45%) and holoprosencephaly (36.36%). Conclusions Chromosomal aneuploidy or structural abnormalities can lead to abnormal development of the fetal cranial nervous system, in which the rates of abnormal karyotypes on fetal cranial nervous with cardiovascular malformation and choroid plexus cysts are the highest. Key words: Fetal cranial nervous malformation; Chromosome karyotype; Trisomy 18; Early and middle pregnancy; Choroid plexus cysts