Value of the imaging features of extrapancreatic nerve plexus in predicting the early postoperative recurrence of ductal adenocarcinoma of pancreatic head / 中华肝胆外科杂志

Objective:To study the value of imaging features of extrapancreatic nerve plexus in predicting early postoperative recurrence of ductal adenocarcinoma of pancreatic head.Methods:The clinical, imaging and pathological data of patients with ductal adenocarcinoma of pancreatic head undergoing pancreati-coduodenectomy at the Hepatobiliary Pancreatic Center of Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2014 to April 2022 were retrospectively analyzed. A total of 73 patients were included, including 51 males and 22 females, aged (66.1±9.0) years old. The patients were followed up by telephone or outpatient review, who were divided into two groups according to the recurrence within 6 months after surgery: the recurrence group ( n=26) and the non-recurrence group ( n=47). Streaks or soft-tissue densities in the distribution area of extrapancreatic nerve plexus, difference in CT values between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus, maximum tumor diameter, and regional lymph node enlargement were compared between the two groups. Results:The incidences of streaks or soft-tissue densities showing in the distribution area of extrapancreatic nerve plexus were 80.8%(21/26) in the recurrence group and 51.1%(24/47) in the non-recurrence group, respectively. A CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus occurred in 50.0%(13/26) patients of the recurrence group and 25.5%(27/47) of the non-recurrence group, respectively. Maximum tumor diameter ≥25 mm were found in 80.8% (21/26) patients of the recurrence group and 57.4% (27/47) of the non-recurrence group, respectively. ≥3 reginal lymph node enlargement showed in 65.4% (17/26) patients of the recurrence group and 31.9% (15/47) of the non-recurrence group, respectively (all P<0.05). The risk of early postoperative recurrence increased in patients with a CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus ( OR=3.609, 95% CI: 1.099-11.855), and regional lymph node enlargement ≥ 3 ( OR=4.665, 95% CI: 1.400-15.545) (all P<0.05). And these two independent risk factors were combined to predict early postoperative recurrence of ductal adenocarcinoma of pancreatic head with an area under receiver operating characteristic curve of 0.748, sensitivity of 92.3%, and specificity of 48.9% ( P<0.001). Conclusion:≥ 15 HU CT value difference between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus and ≥ 3 regional lymph node enlargement are independent risk factors for the early postoperative recurrence of pancreatic head ductal adenocarcinoma, which could provide more predictive information preoperatively.

Characteristics and risk factors of local recurrence in resected pancreatic cancer / 中华普通外科杂志

Objective:To investigate the characteristics and risk factors of local recurrence in resected pancreatic cancer.Methods:The clinicopathological data of 190 patients in whom recurrent sites can be identified after radical resection of pancreatic cancer from Sep 2013 to Aug 2020 at the Cangzhou Central Hospital were retrospectively analyzed. The survival time and clinicopathological characteristics of local recurrence were compared with those of other recurrence types. Cox risk regression model was used to analyze the risk factors of local recurrence.Results:The recurrence sites were local (49 cases, 25.8%), liver (53 cases, 27.9%), lung (35 cases, 18.4%), peritoneal (25 cases, 13.2%) and multiple sites (28 cases, 14.7%). Patients mRFS and mOS were 17.8 months and 30.9 months respectively. The clinicopathological features of patients with local recurrence were compared with those of other recurrence types [tumor diameter ( P=0.023), preoperative CA199 level ( P=0.021), peripancreatic nerve plexus invasion ( P=0.031), lymphovascular invasion ( P=0.004), surgical margin state ( P<0.001) and postoperative adjuvant chemotherapy ( P=0.038)]. Tumor diameter ( P=0.018), peripancreatic nerve plexus invasion ( P=0.002) and postoperative adjuvant chemotherapy ( P=0.004) were independent factors for local recurrence in resected pancreatic cancer, and only peripancreatic nerve plexus invasion was not associated with other recurrence types. Conclusions:Local recurrence in resected pancreatic cancer has important impact on the prognosis of patients. Peripancreatic nerve plexus invasion is an independent factor affecting local recurrence.

Evaluation of corneal nerve damage in diabetic patients after panretinal photocoagulation based on the wide-field mosaic analysis of corneal subbasal nerve plexus / 中华实验眼科杂志

Objective:To explore the damage of panretinal photocoagulation (PRP) to the subbasal nerve plexus (SNP) and its related mechanisms by comparing SNP changes in wide-field mosaic between before and after PRP treatment in diabetic patients.Methods:A randomized controlled study was conducted.Fifty-seven patients (114 eyes) with type 2 diabetes mellitus and binocular diabetic retinopathy (DR) stage IV to receive PRP treatment in Shanxi Eye Hospital from April to November 2019 were enrolled.The subjects were randomly divided into horizontal-vertical laser group and vertical-horizontal laser group according to a random number table.Twenty-nine eyes from 29 patients were assigned to the horizontal-vertical laser group with the photocoagulation sequence of temporal-nasal-inferior-superior.Twenty-eight eyes from 28 patients were assigned to the vertical-horizontal laser group with the photocoagulation sequence of inferior-superior-temporal-nasal.The severer eyes of each subject were chosen as the treatment eye and the contralateral eyes were chosen as the control eye.Corneal confocal laser scanning microscopy (CCM) was performed before PRP treatment, 1 week after each photocoagulation, and 1 month after the completion of PRP treatment to collect images of the SNP over an area of 2-3 mm around the whorl-like pattern.Captured images at each time were merged into one image by using the Photoshop CC 2017 image processing software, and then the nerve fiber length (NFL) of whorl-like pattern was measured by Neuron J image analysis software.McGill pain questionnaire was used to investigate the pain of patients after each photocoagulation.The NFL changes of SNP at different time points were compared between different eyes and different photocoagulation sequence groups.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Shanxi Eye Hospital (No.201804b). Written informed consent was obtained from each patient prior to entering the study cohort.Results:After PRP treatment, there were different degrees of neural structure loss of SNP nerve fibers in 11 treatment eyes, but there was no significant change in SNP nerve fibers in the control eyes.There were significant differences in NFL between the treatment eyes and the control eyes at various time points ( Feyes=2.020, P=0.039; Ftime=4.062, P=0.001). In the horizontal-vertical laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the first and second photocoagulation.In the vertical-horizontal laser group, different degrees of neural structure loss on the photocoagulation side were found in SNP nerve fibers after the third and fourth photocoagulation.There was no significant difference in NFL of treatment eyes between the two groups ( Fgroup=0.099, P=0.754), but there was a significant difference in NFL at various time points before and after treatment ( Ftime=5.231, P<0.001). There were 9 (9/57) patients who complained of pain after PRP, which occurred at the first time of photocoagulation in 7 of them. Conclusions:SNP damage may occur after PRP in patients with DR, and SNP is prone to be damaged on the photocoagulation side when performing horizontal photocoagulation.

Tumor de plexo braquial con extensión cervico torácica en paciente pediátrico / Brachial plexus tumor with cervical thoracic extension in a pediatric patient

Introducción: Los tumores de plexo braquial constituyen una entidad infrecuente. Cuando la lesión cumple con criterios quirúrgicos, el tratamiento ideal es la exéresis completa. Descripción del caso: Paciente pediátrica con antecedentes de neurofibromatosis que consulta por dolor leve y parestesias episódicas. Presenta masa palpable en región supraclavicular izquierda de consistencia duro elástica con signo de Tinel negativo. Se realiza una exéresis completa del neurofibroma mediante una cervicotomía anterior. Discusión: La indicación quirúrgica fue realizada en base al crecimiento tumoral y su efecto de masa sobre estructuras contiguas, los trastornos sensitivos y su antecedente de NF1, que predispone a variantes malignas. La clavícula suele ser el elemento anatómico que define las principales vías de abordaje al plexo braquial. Conclusión: Dejamos reportado un caso de neurofibroma de plexo braquial en una paciente pediátrica con neurofibromatosis. Describimos como la cervicotomía anterior fue una excelente vía a una masa extensión cervico torácica

Introduction: Brachial plexus tumors are an infrequent entity. When the lesion meets surgical criteria, the ideal treatment is its complete removal. Case report: A pediatric patient with a history of neurofibromatosis consults for mild pain and episodic paresthesias. The patient presented to the hospital for an elastic palpable mass in the left supraclavicular region testing negative for Tinel's sign. Complete removal of the neurofibroma was performed through an anterior cervicotomy. Discussion: The surgical indication was made based on the growth of the tumor and its mass effect on contiguous structures, the patient's sensory disorders and her neurofibromatosis history, which predisposes to malignant variants. The clavicle is usually the anatomical element defining the main approaches to the brachial plexus. Conclusion: The purpose of this article was to present a case of a of brachial plexus neurofibroma in a pediatric patient with neurofibromatosis. The anterior cervicotomy it would seem to be an excellent approach to a cervical thoracic extension mass

Effect of orthokeratology on sub-basal nerve plexus / 国际眼科杂志(Guoji Yanke Zazhi)

@#As the morbidity of myopia increasing gradually, the prevention-control of myopia has been given more attentions. Orthokeratology(OK-lens), is now widely approved and used in clinical treatment as a non-surgical measure. The OK-lens directly contact the corneal anterior surface, therefore having some effects on the morphology and biological characteristics of the cornea. The purpose of this paper is to put forward suggestions and advices for clinic, by reviewing the influence of OK-lens on the corneal sub-basal nerve plexus in the current studies.

Effect of orthokeratology on sub-basal nerve plexus / 国际眼科杂志(Guoji Yanke Zazhi)

@#As the morbidity of myopia increasing gradually, the prevention-control of myopia has been given more attentions. Orthokeratology(OK-lens), is now widely approved and used in clinical treatment as a non-surgical measure. The OK-lens directly contact the corneal anterior surface, therefore having some effects on the morphology and biological characteristics of the cornea. The purpose of this paper is to put forward suggestions and advices for clinic, by reviewing the influence of OK-lens on the corneal sub-basal nerve plexus in the current studies.

Confocal microscopy observation of corneal nerve plexus and Langerhans cells in patients with systemic diseases / 国际眼科杂志(Guoji Yanke Zazhi)

@#Corneal confocal microscope(CCM)is a non-invasive instrument for the study of living cornea and is increasingly being used to evaluate corneal nerve plexus and Langerhans cell lesions. This paper reviews the recent advances in corneal nerve plexus and Langerhans cell lesions from the perspective of the use of CCM in the study of systemic diseases such as diabetes mellitus, Sjogren's syndrome, multiple sclerosis, thyroid-associated ophthalmopathy, fibromyalgia, chronic migraine and Parkinson's disease.

Application of corneal laser confocal microscopy in diabetic retinopathy patients / 眼科新进展

Objective To investigate the value of corneal laser confocal microscope in the diagnosis of corneal subepithelial plexus,corneal cell density and morphological changes of patients with diabetic retinopathy (DR).Methods Together 94 cases of confirmed DR (114 eyes),including 41 cases of non-proliferative diabetic retinopathy (NPDR group,52 eyes) and 53 cases of proliferative diabetic retinopathy (PDR group,62 eyes) were selected from January 2016 to April 2017,and meanwhile,40 diabetic patients (40 eyes) with no fundus abnormality were grouped as control group.Corneal laser confocal microscopy was used to compare the corneal subepithelial plexus,corneal cell density and morphological changes in the three groups,Results The cell densities of the basal layer,the superficial stromal layer,the medium stromal layer and the deep stromal layer of the cornea in NPDR and PDR were significantly lower than those of the control group (all P ＜ 0.05),and the PDR group was significantly lower than the NPDR group (all P ＜ 0.05).The corneal endothelial cell density,hexagonal cell ratio,nerve fiber density,and nerve fiber length in the NPDR and PDR group were significantly lower than those in the control group (all P ＜ 0.05);and the variability of endothelial cell and nerve branch density in NPDR and PDR patients were significantly higher than those in the control group (all P ＜ 0.05).The corneal endothelial cell density,hexagonal cell ratio,nerve fiber density,and nerve fiber length in the PDR group was (1962.0-± 117.3) · mm-2,46.1％ ± 5.5％,(15.4 ± 3.3) · mm-2,(6.2 ± 2.7) mm · mm-2,respectively,which were significantly lower than those in the NPDR group [(2381.4 ± 144.0) · mm-2,58.2％ ±7.0％,(20.6 ±3.8) ·mm-2,(8.6 ± 2.4)mm · mm-2,respectively] (all P ＜ 0.05),but the variability of endothelial cell and nerve branch density in PDR group were significantly higher than those in the NPDR group (all P ＜ 0.05).Conclusion Corneal confocal microscopy can effectively observe the density and morphological changes in corneal subepithelial plexus and corneal cell in DR patients so as to provide guidance for clinical diagnosis and treatment.

Clinical Efficiency Analysis of Visceral Nerve Plexus Neurolysis through Post-curs of Diaphragm Approach in Pancreatic Cancer Pain Management / 中国医科大学学报

Objective To evaluate the clinical effect of computed tomography?guided visceral nerve plexus ethanol neurolysis through post?curs of diaphragm approach in the treatment of patients with pancreatic cancer pain using,and study the safety and life quality improvement of patients . Methods A total of 58 patients suffered from pancreatic cancer pain,who were treated in the department of pain medicine of the First Hospital of China Medical University from October 2013 to December 2014,were recruited for the study. The patients were divided into two groups according to the willing of the patients and their families,group A(32 cases)was treated with Visceral Nerve Plexus ethanol Neurolysis,while group B(26 cas?es)was treated with oral opioid drugs. The analgesic effect,changes in the amount of opioid drugs,changes in the PSQI scores and the improvement of quality of life were evaluated before treatment and 1 day(T1),15 days(T15),30 days(T30),60 days(T60)after treatment. Record the adverse reactions in the course of treatment. Results All the patients of group A successfully received visceral nerve plexus ethanol neurolysis,the VAS scores,Karnofsky scores,and PSQI scores of all the observed time points(after the operation)were statistically different compared to those before treatment and group B. Statistically difference was also observed in quality of life between two groups(P<0.05). The amount of opioid drugs of group B was statistically increased than that of group A(P<0.01).The most common side effects in Group A were postural hypotension(6 cases),diar?rhea(2 cases),and intercostal neuralgia,while nausea(20 cases),constipation(11 cases)and dizziness(8 cases)were seen in the Group B. Con?clusion Visceral nerve plexus ethanol neurolysis through post?curs of diaphragm approach by the guide of CT is effective and safe for the patients with pancreatic cancer pain,and the complications were totally acceptable.

Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers / 대한해부학회지

The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.

Topohistology of sympathetic and parasympathetic nerve fibers in branches of the pelvic plexus: an immunohistochemical study using donated elderly cadavers / 대한해부학회지

Although the pelvic autonomic plexus may be considered a mixture of sympathetic and parasympathetic nerves, little information on its composite fibers is available. Using 10 donated elderly cadavers, we investigated in detail the topohistology of nerve fibers in the posterior part of the periprostatic region in males and the infero-anterior part of the paracolpium in females. Neuronal nitric oxide synthase (nNOS) and vasoactive intestinal polypeptide (VIP) were used as parasympathetic nerve markers, and tyrosine hydroxylase (TH) was used as a marker of sympathetic nerves. In the region examined, nNOS-positive nerves (containing nNOS-positive fibers) were consistently predominant numerically. All fibers positive for these markers appeared to be thin, unmyelinated fibers. Accordingly, the pelvic plexus branches were classified into 5 types: triple-positive mixed nerves (nNOS+, VIP+, TH+, thick myelinated fibers + or -); double-positive mixed nerves (nNOS+, VIP-, TH+, thick myelinated fibers + or -); nerves in arterial walls (nNOS-, VIP+, TH+, thick myelinated fibers-); non-parasympathetic nerves (nNOS-, VIP-, TH+, thick myelinated fibers + or -); (although rare) pure sensory nerve candidates (nNOS-, VIP-, TH-, thick myelinated fibers+). Triple-positive nerves were 5-6 times more numerous in the paracolpium than in the periprostatic region. Usually, the parasympathetic nerve fibers did not occupy a specific site in a nerve, and were intermingled with sympathetic fibers. This morphology might be the result of an "incidentally" adopted nerve fiber route, rather than a target-specific pathway.

Fetal anatomy of the upper pharyngeal muscles with special reference to the nerve supply: is it an enteric plexus or simply an intramuscular nerve? / 대한해부학회지

We examined pharyngeal nerve courses in paraffin-embedded sagittal sections from 10 human fetuses, at 25-35 weeks of gestation, by using S100 protein immunohistochemical analysis. After diverging from the glossopharyngeal and vagus nerves at the level of the hyoid bone, the pharyngeal nerves entered the constrictor pharyngis medius muscle, then turned upward and ran superiorly and medially through the constrictor pharyngis superior muscle, to reach either the levator veli palatini muscle or the palatopharyngeus muscle. None of the nerves showed a tendency to run along the posterior surface of the pharyngeal muscles. Therefore, the pharyngeal nerve plexus in adults may become established by exposure of the fetal intramuscular nerves to the posterior aspect of the pharyngeal wall because of muscle degeneration and the subsequent rearrangement of the topographical relationship between the muscles that occurs after birth.

Clinical and electrophysiological study of diabetic lumbosacral radiculoplexus neuropathy / 中国综合临床

Objective To explore the clinical and electrophysiological characteristics of diabetic lumbosacral radiculoplexus neuropathy (DLRPN). Methods The clinical, electrophysiological and neuroimaging changes in 15 cases of DLRPN were investigated. Results The major clinical manifestations of 13 cases were unilateral or asymmetrical pain and progressive muscular weakness and atrophy of the proximal lower limb. The nerve conduction studies in affected nerves showed absent or reduced compound muscle action potential amplitudes and sensory responses with proportionate slowing of the conduction velocities. F waves and H reflexes were of long latencies or absent. Electromyography of affected muscles showed positive sharp waves and fibrillation potentials involving lumbar paraspinal muscles. Assessment of the motor unit action potentials (MUAPs) revealed high amplitude, long duration, and polyphasic MUAPs with reduced recruitment 50% cases have much lower R-R interval variation. Conclusions DLRPN presents disabling pain and muscular weakness and elctrophysiological examination has a paramount value in the diagnosis and evaluation of this disease

Anatomic Basis of Sharp Pelvic Dissection for Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation for Rectal Cancer

Optimal goals of rectal cancer surgical treatment should include appropriate local control, higher survival rates, scrupulous operation procedures and good quality of life with maintained sexual and voiding function through the conservation of anal sphincter. Complete surgical removal of rectal cancer mass and adjacent lymph nodes in en-bloc package decreases the risk of local recurrence. Furthermore heightened awareness of better surgical techniques has created much interest in the anatomy involved in total mesorectal excision (TME), with particular focus on the fascial planes, nerve plexuses and their relationship to the surgical planes of excision. Total mesorectal excision focuses on several technical components and the quality of operated specimen. Sharp anatomic pelvic dissection along the visceral pelvic fascia must avoid any breach from the mesorectum haboring metastatic tumor deposits and lymph nodes. Also any coning down or blunt dissection should not be allowed. The rectal cancer mass and its surrounding mesorectum must be removed as one complete unit. Circumferential and distal resection margin must be also adequately obtained. Such sharp pelvic dissection instead of blunt dissection requires precised knowledge of the pelvic anatomy. Studying the hemisected cadevaric pelvis shows a clear relationship between the fascia and rectum. Also pelvic autonomic nerves can be saved to preserve the patient's sexual and voiding functions. Therefore the clincial importances of anatomical structures must be emphasized at each step of surgery. Upon such understanding of techniques, TME was performed in rectal cancer patients routinely and was able to obtain fair oncologic results and improved quality of life regarding sexual and voiding functions.

Study on the changes in cholinergic nerves and nitrergic nerves in colonic myenteric plexus in rats with slow transit constipation / 解放军医学杂志

s Objective To study the changes in cholinergic nerves and nitrergic nerves in colonic myenteric plexus in rats with slow transit constipation. Methods Slow transit constipation model of rat was reproduced by feeding Diphenoxylate. The changes in cholinergic nerves and nitrergic nerves in colonic myenteric plexus were studied by histochemical technology. Results In the rats with slow transit constipation, the numbers of nitriergic cells and cholinergic cells in the myenteric nerves were significantly decreased compared with control group. The volume of neuron in AchE ganglia was larger than that of control. Conclusion Dysfunction of colon transit was related with the changes in cholinergic nerves and nitrergic nerves of colonic myenteric nerve plexus in rats with slow transit constipation.

NEURON SPECIFIC ENOLASE IMMUNOHISTOCHEMICAL OBSERVATION ON THE PARALYMPHATIC NEURONS IN SUBMUCOUS NERVE PLEXUS IN THE GUT OF GUINEA PIGS / 解剖学报

We have reported previously a peculiar type of neurons in the submucous nerve plexus in the intestine of guinea pigs, and named them tentatively the ′paralymphatic neurons′. In order to further study this type of neurons, the immunohistochemical observation for neuron specific enolase (NSE) reactivity of the enteric nerve plexus in guinea pigs was carried out in this investigation. We found that all the neurons in the enteric nerve plexus showed NSE positive reaction. The paralymphatic neurons located closely against to lymphatic vessels in submucous nerve plexus in small intestine and colon also exhibited same NSE positive reaction as other neurons. All the smooth muscle and connective tissue cells were NSE negative. Most of the paralymphatic neurons exhibited typical morphological features of neurons. Although some cells did not show obvious neuronal characters, but they all presented the same positive reactivity. Hence, this study provide another reliable evidence to confirm the exact neuronal nature of the paralymphatic neurons.