Effect of Third-Stage Heat Treatments on Microstructure and Properties of Dual-Phase Titanium Alloy.

Two-phase TC21 titanium alloy samples were solution-treated at 990 °C (ß phase zone) and cooled by furnace cooling (FC), air cooling (AC), and water quenching (WQ), respectively. The second solution stage treatment was carried out at 900 °C (α + ß phase zone), then aging treatment was performed at 590 °C. The influence of the size and quantity of the α phase on the properties of the sample were studied. The experimental results showed as the cooling rate increased after the first solution stage treatment, wherein the thickness of primary layer α gradually decreased, and the tensile strength and yield strength gradually increased. After the second solution stage treatment, the tensile properties of samples increased due to the quantity of layers α increased. The aging treatment promoted the precipitation of the dispersed α phase and further improved the tensile strength. After the third solution stage treatments, the FC samples with more ß-phase had the best comprehensive mechanical properties.

Managing pediatric thoracic outlet syndrome.

BACKGROUND: Thoracic outlet syndrome (TOS) is largely overlooked in children and adolescents because the condition is not widely viewed as a pediatric disorder. This study aimed to clarify the causes, best treatment approaches, and prognosis for young patients with TOS. METHODS: A retrospective study was conducted on 13 patients, from 4 to 13 years of age, with TOS. Ten children underwent surgical treatment, and three were treated conservatively. All patients received local nerve blocks on two occasions and were followed-up for more than 2 years. RESULTS: Among the 10 children who underwent surgery, six school-aged children returned to school 10 to 14 days after surgery. Parents of the three children treated conservatively reported that activity within the affected limb and overall muscle strength had increased in their children and none of the three children had complained about discomfort in the affected limb. CONCLUSION: A diagnosis of TOS should be considered when a child or adolescent has neck and shoulder discomfort, hand numbness, and upper limb weakness. As with adults with TOS, detailed physical examination is the key to diagnosing pediatric TOS. Conservative treatment is effective for young TOS patients who have mild changes in the length and thickness of the affected limb and is an option when parents refuse surgical treatment.

Traumatic pseudoaneurysm of axillary artery combined with brachial plexus injury.

Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus.

[Diagnosis and treatment of upper arm radial neuritis by ultrasonography].

OBJECTIVE: To evaluate the application of ultrasonography in diagnosis and treatment of the upper arm radial neuritis. METHODS: From 2005.12 to 2011.7, 10 patients of the upper arm radial neuritis were selected and included 6 males and 4 females with an average age of 32 years old ranging from 20 to 40 years. The course of disease ranged from 4 months to 2 years. All patients feel pain on the outside of upper arm. Medical examination showed Tinel's sign masculine, and the muscle force included extension of wrist and fingers were reduced. Upper arm radial neuritis were diagnosed by clinical sign and medical examination. All patients underwent ultrasonography examination, electrophysiology examination and operation. The ultrasonography were compared to the results of electrophysiology examination,and ultrasonography were compared to intra-operative findings and pathology examination. RESULTS: The ultrasound images showed average diameter of affected limb radial nerve were (0.29+/-0.04) cm, average area were (0.23+/-0.05) cm2, and all of these were greater than uninjured side. Ultrasonograghic findings and orientation of radial neuritis were consistent with intra-operative findings,and the results of ultrasonography were consistent with the results of pathology examination. CONCLUSION: Ultrasonography examination provide morphological evidence for the diagnosis and treatment of the upper arm radial neuritis.

Full-length phrenic nerve transfer as the treatment for brachial plexus avulsion injury to restore wrist and finger extension.

INTRODUCTION: The functional restoration of wrist and finger extension after complete brachial plexus avulsion injury remains an unsolved problem. We conducted a prospective study to elucidate a new method for resolving this injury. METHODS: Six patients with complete brachial plexus avulsion injury underwent a new surgical procedure in which the full-length phrenic nerve was transferred to the medial portion of the radial nerve at the level of the latissimus dorsi insertion via endoscopic thoracic surgery. RESULTS: In 5 patients, extensor carpi ulnaris and extensor carpi radialis strength recovered to Medical Research Council grade ≥M3, and in 4 patients extensor digitorum strength recovered to ≥M3. CONCLUSIONS: Neurotization of phrenic nerve to the medial portion of the radial nerve at the level of latissimus dorsi insertion is a feasible means of restoring wrist and finger extension in cases of complete brachial plexus avulsion injury.

Modified C-7 neurotization in the treatment of brachial plexus avulsion injury.

OBJECT: Contralateral C-7 transfer is often used in patients with brachial plexus avulsion injury. Traditionally, the contralateral C-7 root has only been transferred to a single nerve, such as the median or radial nerve. In this study, the authors aimed to evaluate the efficacy of contralateral C-7 transfer to 2 different recipient nerves in patients with brachial plexus avulsion injuries. METHODS: Between 2004 and 2008, 10 patients with brachial plexus root avulsions underwent nerve reconstruction using a modified C-7 neurotization technique. In this procedure, the contralateral C-7 root was transferred via vascularized ulnar nerve grafts to both the musculocutaneous nerve and the median nerve on the affected side. RESULTS: The strength of the biceps muscles increased to M3 or M4 in 6 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of the wrist and finger flexors with improvement to M3 in 5 patients. Seven patients showed notable gains of sensory function (≥ S3). CONCLUSIONS: Contralateral C-7 transfer to 2 different recipient nerves is a feasible and efficient approach in patients with brachial plexus avulsion injuries when the donor nerve is limited.

Altered expression of inducible nitric oxide synthase after sciatic nerve injury in rat.

Nitric oxide is known to contribute to neuronal damage as well as to peripheral neuronal regeneration following injury. Sciatic nerve injury is a common and serious complication of intramuscular injections. In order to ascertain the role of inducible nitric oxide synthase (iNOS) in the injured sciatic nerve, we studied the expression of this enzyme by RT-PCR and immunohistochemistry, in a rat model of sciatic nerve injury. In sham-operated control rats iNOS expression was undetectable by immunohistochemistry and its mRNA level was also very low. In contrast, in the experimental group that was subjected to sciatic nerve injury, both mRNA and protein of iNOS were found to be significantly elevated. The protein level of iNOS, as revealed by positive immunostaining, peaked at 7 days post-surgery followed by a decrease. Similarly, the iNOS mRNA levels remained elevated at 1, 3, 7 days but declined to very low level by day 21, after surgery. This study indicates that the increased expression of iNOS after sciatic nerve injury in rats may contribute to nerve regeneration. Thus our results suggest that excessive expression of iNOS after nerve injury is not conducive to nerve regeneration.

Selective neurotization of the radial nerve in the axilla using a full-length phrenic nerve to treat complete brachial plexus palsy: an anatomic study and case report.

BACKGROUND: Current methods for the restoration of wrist and digit extension after a complete brachial plexus injury result in poor outcomes. OBJECTIVE: To determine the internal topography of the radial nerve in the axilla and present a method for selective neurotization of the radial nerve using a full-length phrenic nerve. METHODS: Internal topographic features of the fascicular groups of the radial nerve were observed at the level of latissimus dorsi insertion in 16 cadavers. Selective neurotization of the medial portion of the antebrachial part of the main trunk of the radial nerve was performed at this level using a full-length phrenic nerve in one patient with complete brachial plexus palsy. RESULTS: At the level of latissimus dorsi insertion in the axilla, the antebrachial part of the radial nerve, which innervates the forearm extensors, is located at the superior lateral part of the radial nerve trunk. It can be divided into medial and lateral portions. Transfer of a full-length phrenic nerve was used to selectively reinnervate the medial portion of the antebrachial part of the radial nerve in 1 patient with complete brachial plexus palsy. The patient's antebrachial extensor muscles regained Grade 4 power when assessed 3 years after surgery. CONCLUSION: The fibers that innervate the antebrachial extensors are located at the superior lateral part of the radial nerve trunk in the axilla. Selective neurotization of the radial nerve at this level with a phrenic nerve was performed successfully in 1 patient.

Contralateral C7 transfer for the treatment of upper obstetrical brachial plexus palsy.

PURPOSE: The use of contralateral C7 is seldom indicated in infants with obstetrical brachial plexus palsy (OBPP). The purpose of this study was to evaluate the value of contralateral C7 transfer in infants with upper OBPP in order to define the application and outcome of this transfer in these infants more optimally. METHODS: Over a 5-year period, 15 infants with upper brachial plexus injuries underwent transfer of the contralateral C7 as part of the primary surgical reconstruction. The common trunk of the contralateral C7 root was transferred to the upper trunk or lateral cord on the affected side with nerve graft. The efficacy of the surgery and effects of patient age at the time of nerve transfer were analyzed. RESULTS: Patients were followed up for a mean duration of 46.8 months. Noteworthy function (≥M2+) was gained in 11 of 15 patients, and sensory function (≥S3, MRC grading system) was gained in all patients. Age was not the factor related to the outcome of this surgery. CONCLUSIONS: Contralateral C7 transfer is an effective procedure for the restoration of upper limb function in infants with OBPP and root avulsions.

Modified C7 neurotization for the treatment of obstetrical brachial plexus palsy.

Contralateral C7 transfer is used rarely in infants with obstetrical brachial plexus palsy (OBPP). We aimed to determine the efficacy of contralateral C7 transfer to two different recipient nerves in infants with OBPP. Between 2001 and 2005, 9 infants with brachial plexus root avulsions underwent nerve reconstruction using a modified C7 neurotization technique. In this procedure, the contralateral C7 root was transferred to both the musculocutaneous nerve and the median nerve on the affected side. The strength of the biceps muscles increased to M3 or M4 in 7 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of wrist and finger flexors with improvement to M3 or M4 in 5 patients. All patients showed notable gains of sensory function. Contralateral C7 transfer to two different recipient nerves is a feasible and efficient approach in infants with OBPP.

[Effect of extract of ginkgo biloba leaves on proliferation of SCs cultured in vitro].

OBJECTIVE: To investigate the effect of extract of ginkgo biloba leaves (EGb50) on the proliferation of SCs cultured in vitro. METHODS: The SCs were isolated from 3-day-old SD rats' sciatic nerves by the method of enzyme gradation digestion (n=20) and the purified 2nd passage of SCs were divided into 2 groups: the experimental group, in which SCs were cultured in FBS-DMEM medium with EGb50 (terminal concentration: 50 microg/mL); the control group, in which SCs were cultured in the FBS-DMEM medium without EGb50. The absorbance (A) value was detected by the 2, 3-bis- (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) method 1, 3, 5, 7 and 9 days after culture, then the growth curves was drawn. Cell cycle was detected by flow cytometry (FCM). Disintegration per minute (DPM) of SCs was detected by the method of 3H-thymine nucleoside (3H-TdR) 2 and 3 days after culture and nerve growth factor (NGF) synthesis in SCs culture media was detected by ELISA method. RESULTS: Most SCs were spindle-shaped with a purity above 90%. XTT detection showed that A value of SCs in the control group was gradually increased 3 days after culture, reached the peak 5 days after culture and gradually decreased from then; the A value in the experimental group experienced the similar changes, but it was higher than that in the control group at each time point (P < 0.01). 3H-TdR showed that the DPM of the experimental group was 1 961.78 +/- 231.13 and 4 601.51 +/- 605.08 at 2 and 3 days after culture, while for the control group, the A value was 1347.15 +/- 121.57 and 3740.42 +/- 158.73 at the same time point, indicating a significant difference between two groups (P < 0.01). FCM observation indicated that the SCs proliferation index of the experimental group and the control group was 18.6% +/- 3.2% and 9.7% +/- 2.9%, indicating a significant difference between two groups (P < 0.01). ELISA observation showed that the NGF concentration in the experimental and the control group was (0.0656 +/- 0.0039) ng/mL and (0.0386 +/- 0.0036) ng/mL, indicating a significant difference (P < 0.01). CONCLUSION: EGb50 is capable of enhancing the proliferation of SCs cultured in vitro, which may be one of the important mechanisms to promote peripheral nerve regeneration.

A dose-effect relationship of Ginkgo biloba extract to nerve regeneration in a rat model.

The effect of Ginkgo biloba extract (EGb(50)) on nerve regeneration and its dose-effect relationship was investigated in a rat model. Sciatic nerve transection and repair was done in 120 Sprague-Dawley rats. The animals were divided into four groups and given normal saline, low-dose EGb(50) (50 mg kg(-1) d(-1)), moderate-dose EGb(50) (100 mg kg(-1) d(-1)), and high-dose EGb(50) (200 mg kg(-1) d(-1)), respectively. Electrophysiological, histological examinations, and functional evaluation were conducted at various postoperative intervals. Sensory regeneration distance, sciatic functional index (SFI), motor nerve conduction velocity, compound muscle action potential, axon regeneration index, and muscle mass were significantly higher in EGb(50) groups than in saline groups. All but SFI of those parameters were better in high-dose group when compared with those in moderate- and low-dose groups. EGb(50) has the effect of promoting regeneration of injured peripheral nerve. The higher the dose, the better the result.

[Effect of extract of Ginkgo biloba leaves on expression of inducible nitric oxide synthase after sciatic nerve injury: experiment with rats].

OBJECTIVE: To investigate the effect of extract of Ginkgo biloba leaves (EGb50) on the expression of inducible nitric oxide synthase (iNOS) after sciatic nerve injury. METHODS: 156 male SD rats were randomly divided into 3 groups: experiment group (n=72), undergoing section and anastomosis of sciatic nerve and then gastric perfusion of EGb50 200 mg.kg-1.d-1; injury control group (n=72), undergoing section and anastomosis of sciatic nerve and then gastric perfusion of normal saline daily; and sham operation group (n=12), undergoing sham operation and gastric perfusion of normal saline daily. The rats were killed at different time points: 1, 3, 7, 14, 21, and 28 days after the operation. The sciatic nerve distant to the anastomotic sites with a length of 0.5 cm was cut out to undergo immunohistochemistry and RT-PCR to detect the protein and mRNA expression of iNOS. RESULTS: No obvious iNOS protein and mRNA expression was seen in the sham operation group. 3, 7, 14, and 21 days after operation the mean values of absorbance of iNOS in the sciatic nerve specimens of the experiment group were all significantly lower than those of the injury control group (P<0.05, P<0.01). High mRNA expression of iNOS began to be shown in the sciatic nerve specimens since 1day after the operation and remained at a high level till 7 days after and then began to decrease in the injury control group. The levels of mRNA expression of iNOS in the sciatic nerve specimens 1, 3, and 7 days after the operation of the experiment group were all significantly lower than those of the injury control group (all P<0.01), and there was no significant difference in the levels mRNA expression of iNOS 14, 21, and 28 days after the operation between the experiment group and injury control group (all>0.05). CONCLUSION: The extract of Gingko biloba promotes the regeneration of nervous tissues, probably by inhibiting the expression of iNOS.

[Impact of loss of sympathetic innervation on peripheral nerve regeneration: an experimental study with rats].

OBJECTIVE: To investigate the impact of loss of sympathetic innervation on peripheral nerve regeneration. METHODS: Thirty-two SD rats underwent resection of the right middle cervical ganglion and excision and re-anastomosis of bilateral medium nerve, and then were randomly divided into 4 equal groups to undergo the following experiments. One, 2, 3, and 4 weeks later the sensory nerve action potentials (SNAPs) of bilateral medium nerves 5 mm from the anastomotic stoma and the compound muscle action potentials (CMAPs) of bilateral superficial digital flexor muscles were measured with stimulating and recording electrodes. Specimens of the distal part of bilateral medium nerves 5 mm from the anastomotic stoma were collected to calculate the number of modulated fibers by electron microscopy. The tendons of bilateral superior digital flexor muscles were cut ant the wrist, isolated to the terminal points, ligated, and connected to a sensor so as to record the maximum contraction power. The superior digital flexor muscle was completely resected to be weighted. RESULTS: CMAP failed to be recorded 1 week later. The wave amplitude of the nerve at the affected side increased along with time, however, the CMAP wave amplitudes of the affected side were all significantly lower than those of the healthy side (all P < 0.05). The SNAP wave amplitudes of the medium nerve of both sides increased along with the time. The SNAP levels 4 and 8 weeks later of the affected side were both lower than those of the healthy side (both P < 0.05). The number of modulated fibers of the medium nerve increased along with the time, however, the number of the affected side were significantly lower than those of the healthy side (all P < 0.05). Electron microscopy showed degeneration of medulla in bilateral medium nerves 1 week later, and newborn modulated fibers began to be seen since 2 weeks later. However, there were a greater number and more complete structure in the healthy side in comparison with the affected side. The wet weights of bilateral superior digital flexor muscles decreased 2 weeks later and then began to increase gradually. However, the wet weight 4 and 8 weeks later were significantly greater in the healthy side then in the affected side (both P < 0.05). CONCLUSION: Resection of sympathetic nerve is advantageous on nerve regeneration.

Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study.

BACKGROUND: In recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect. METHODS: From January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5. RESULTS: In the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally. CONCLUSIONS: The accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

[Etiologic investigation of chronic granulomatous inflammation of hand by polymerase chain reaction and DNA sequencing].

OBJECTIVE: To explore the causative pathogens in littoral hand infections which exhibited chronic granulomatous inflammation, the relationship between chronic granulomatous inflammation and mycobacteria and to discuss the prospects of PCR in clinical application for diagnosis of granulomatous inflammation. METHOD: With 16S-rDNA as the target sequence, Nest-PCR was used to detect mycobacteria directly from 37 cases of chronic granulomatous inflammations, and identified them by gene sequencing. RESULTS: Twenty-four of 37 cases were positive for mycobacteria by Nest-PCR, in which 17 were M.marinum, 1 M.chelonae, 2 M.avium, 2 M.kansasii, and 2 M.tubercular through gene sequencing. CONCLUSIONS: Nest-PCR combining gene sequencing proved to be a liable and sensitive method to detect Non-tubercular mycobacteria (NTM) in fresh tissue. NTM is the major factor of hand specific chronic infections other than tubercular. Pathological changes are difficult to differentiate TB from NTM and bacterial evidence was necessary.

[Surgical treatment of suprascapular nerve compression syndrome through posterior approach].

OBJECTIVE: To discuss the optimal approach to treat suprascapular nerve compression syndrome. METHODS: From January 2000 to June 2003, 8 cases of suprascapular nerve compression syndrome were treated by surgical intervention to cut the transverse scapular ligament through posterior approach. Of the 8 patients, there were 2 males and 6 females (age ranged from 21 to 53) with duration of 6 months to 3 years. The change of symptom, muscle power, and muscle atrophy after operation were observed. RESULTS: One week after operation, pain around the scapular disappeared, muscle power of supraspinatus and infraspinatus muscles recovered to normal. One, 6, 12 and 16 months after the operation, the patients were followed up. No recurrence was observed. Muscle atrophy didn't recover. CONCLUSION: To treat suprascapular nerve compression syndrome with operation through posterior approach is easy to operate. When the suprascapular nerve is entrapped in scapular notch, this approach is a good choice.

[The etiological study, diagnose and therapy of hand special chronic infections in littoral area].

OBJECTIVE: To explore the etiological factors of hand special chronic infections and their relationship with tuberculosis, and to give evidence for clinical diagnosis as well as treatments. METHODS: From 2002 to 2004 pathologic inspection, acid-fast stain, bacterial cultication, mycobacterial cultivation were performed in all 29 cases of hand special chronic infections. RESULTS: All cases showed granulomatous lesions in pathological appearance, 2 positive in acid-fast stain, 12 positive in bacteria cultivation, and 1 nocardiosis, 1 staphylococcus epidermidis, 7 M.marinum, 1 M.tuberculosis, 1 M.fortuitum, 1 M.kansasii. CONCLUSIONS: Non-tuberculo-mycobacterium (NTM) especially M.marinum are far more important as the major factor than tuberculosis and other bacterial in hand special chronic infections. Bacteria cultivation should be routine examined for all cases.

[Early microsurgical treatment of upper obstetrical brachial plexus injury].

OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.