Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.

Application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures

Objective:To study the application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures. Methods:Children who underwent upper limb fracture surgery in the First Women and Children's Hospital of Huizhou between June 2014 and April 2017 were selected as the research subjects and randomly divided into the combined group who accepted sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block and the control group who accepted sevoflurane light general anesthesia via laryngeal mask airway. The contents of inflammatory cytokines IL-1β, TNF-α, CRP, IL-10 and TGF-β as well as stress hormones FC, Ins, NE and E in serum were determined the same day and 3 days after operation.Results: The same day and 3 days after operation, the contents of IL-1β, TNF-α, CRP, IL-10, TGF-β, FC, Ins, NE and E in serum of combined group were significantly lower than those of control group.Conclusion: Sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block is more effective than sevoflurane light general anesthesia via laryngeal mask airway to suppress the inflammatory stress response in children with upper limb fracture surgery.

Lumbar-Sacral Plexus Block Anesthesia versus General Anesthesia for Total Hip Arthroplasty: Case Control Study

Background: Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. Methods: 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. Results: 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). Conclusions: In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.

Total brachial plexus injury： contralateral C7 root transfer to the lower trunk versus the median nerve

Contralateral C7（cC7） root transfer to the healthy side is the main method for the treatment of brachial plexus root injury. A relatively new modification of this method involves cC7 root transfer to the lower trunk via the prespinal route. In the current study, we examined the effectiveness of this method using electrophysiological and histological analyses. To this end, we used a rat model of total brachial plexus injury, and cC7 root transfer was performed to either the lower trunk via the prespinal route or the median nerve via a subcutaneous tunnel to repair the injury. At 4, 8 and 12 weeks, the grasping test was used to measure the changes in grasp strength of the injured forepaw. Electrophysiological changes were examined in the flexor digitorum superficialis muscle. The change in the wet weight of the forearm flexor was also measured. Atrophy of the flexor digitorum superficialis muscle was assessed by hematoxylin-eosin staining. Toluidine blue staining was used to count the number of myelinated nerve fibers in the injured nerves. Compared with the traditional method, cC7 root transfer to the lower trunk via the prespinal route increased grasp strength of the injured forepaw, increased the compound muscle action potential maximum amplitude, shortened latency, substantially restored tetanic contraction of the forearm flexor muscles, increased the wet weight of the muscle, reduced atrophy of the flexor digitorum superficialis muscle, and increased the number of myelinated nerve fibers. These findings demonstrate that for finger flexion functional recovery in rats with total brachial plexus injury, transfer of the cC7 root to the lower trunk via the prespinal route is more effective than transfer to the median nerve via subcutaneous tunnel.

Effect of Acupuncture Signal after Brachial Plexus Blockade on Cerebral Blood Perfusion and Brain Cell Function

Objective: Using single photon emission computed tomography (SPECT) to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetics. Methods: Thirty-one healthy volunteers were divided into two groups, the control group of 20 cases, and the brachial plexus blockade (BPB) group of 11 cases, with supraclavicular BPB route adopted. With the control group 2 acupoints were randomly selected (Hegu and Quchi of both sides), while with the BPB group Hegu and Quchi of anesthetic arm side were selected. Siemens ECAM/ ICON SPECT system was used to conduct brain imaging using double imaging assay before acupuncture and 99mTc-ECD imaging agent during acupuncture for cerebral perfusion. The data were quantitatively analyzed by blood functional changing rate (BFCR%) mathematics model. Results: Before acupuncture, the control and BPB groups showed insignificant change by SPECT, but after electro-acupuncture (EA), the control group displayed improved motor and sensory cortex excitability in basal nuclei, contra-lateral thal-amus, parietal and frontal lobe; while BPB group was characterized with reduction of the blood perfusion and cell function of contra-lateral thalamus of anesthetized arm. The difference between the two groups was significant (P<0.01) . Conclusion: (1) After BPB, the up-transmitting of the acupuncture signal via upper limb into the brain, and its strength was impaired or blocked; (2) After BPB, the effect of acupuncture on cerebral perfusion and brain cell function of contra-lateral thalamus was impaired or blocked.

Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.

Stability of motor endplates is greater in the biceps than in the interossei in a rat model of obstetric brachial plexus palsy

The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.

Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.

Expression of nitric oxide synthase in the spinal cord after selective brachial plexus injury

BACKGROUND: Some researches showed that motoneurons in spinal cord anterior horn wound die following brachial plexus injury, but the concrete mechanism of motoneurons death remains unclear. OBJECTIVE: To observe the expression of nitric oxide synthase (NOS) and survival of C7 motoneurons in spinal cord of rats after selective brachial plexus injury. DESIGN: A randomized controlled animal experiment. SETTING:Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University. MATERIALS: Totally 35 adult healthy male Sprague-Dawley rats with the body mass of 200-300 g were provided by Experimental Animal Center, Sun Yet-sen Medical College, Sun Yat-sen University. The rats were divided into control group (n =5) and experimental group(n =30) by random number table method, and the experimental group was divided into three injury subgroups: anterior root avulsion group, dorsal root transection group and spinal cord hemisection group, 10 rats in each group. There were horse anti-neuronal NOS (nNOS) polycolonal antibody (Sigma company) and nicotina mideadeninedinucleotide phosphate (NADPH-d) (Sigma Company). METHODS: The experiment was performed at Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University between September 2004 and April 2005. ①After anesthetizing the rats, the spinous process of second thoracic vertebra as a marker, the vertebra was exposed from C5 to T1 and the lamina of vertebra was unclenched, and spinal dura mater was carved to expose the spinal nerve dorsal roots of C5-T1. The right ventral root of C7 was avulsed, and the residual root was removed in anterior root avulsion group. The right ventral root of C7 was avulsed and the right dorsal roots of brachial plexus (C5-T1) were cut off in dorsal root transection group. In spinal cord hemisection group, the hemisection between the C5 and C6 spinal segment on right side and avulsion of right ventral root of C7 were made. In the control group, the vertebra from C5 to T1 was unclenched and the skin of wound was sutured. ②Three weeks after operation, behavior of rats was observed. The rats were killed after anesthesia. The C7 segment of spinal cord was removed and treated with NADPH-d staining, neutral red counterstaining and NOS immunohistochemistry staining to detect the expression of NOS. MAIN OUTCOME MEASURES: The expression of NOS and survival of C7 motoneurons in spinal cord of rats 3 weeks after operation. RESULTS: Among the 35 included rats, 3 rats died 2 weeks following operation, so totally 32 rats were involved in the result analysis. ①NADPH-d positive neurons of in anterior horn of C7 in the three groups: The NADPH-d positive neurons could be found in anterior horn of C7 in the three groups. The percentage of that in anterior root avulsion group to that of non-injury side of spinal cord was(20.98±2.65)%, (29.43±6.81)% in dorsal root transection group and (31.74±6.80)% in spinal cord hemisection group. There was significant difference among the three injury groups(F =5.135,P =0.016). There was significant difference in anterior root avulsion group with dorsal root transection group and spinal cord hemisection group (t =2.562,3.167,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group (P =0.534). ②survival rate of motoneurons in anterior horn of C7: There were dead motoneurons in the three injury groups, the percentages of surviving motoneurons to that of non-injured side of spinal cord were (69.22±4.04)%,(62.01±3.82)% and (56.74±6.86)%, respectively. There were significant differences among the three groups (F =9.508,P =0.002). The anterior root avulsion group was significantly different from the other two groups(t =2.764,4.587,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group(P =0.073). CONCLUSION: The selective brachial plexus injury can induce the up-regulation of NOS expression in motorneurons of spinal cord anterior horn and block descending pathway of cortex to cause the more significant up-regulation of NOS and low survival rate in motoneurons. It indicates that descending pathway of cortex can inhibit the NOS expression in motorneurons of spinal cord anterior horn, and the high NOS expression might induce the death of motorneurons in spinal cord anterior horn.

OBSERVATION ON EFFECT OF POINT INJECTION AS THE MAIN TREATMENT FOR OBSTETRIC BRACHIAL PLEXUS PALSY

To discuss the best way of treatment for obstetric brachial plexus palsy （OBPP）. Method： The 102 cases of OBPP were randomized into two groups： the observation group （51 cases） and the control group （51 cases）. The observation group was treated by point injection with nerve growth factor （NGF）, acupuncture, and moxibustion. The control group was treated by acupuncture and moxibustion. Result： The result was compared after two courses of treatment. The curative rate of observation group was 35.3% and that of control group 11.8%. The curative and remarkably effective rate was 78.4% and 43.2% respectively. In the two-two comparison, the difference was significant （ P〈 0. 01 ）. Conclusion： The effect of NGF point injection as the main treatment for OBPP was good, worth spreading.

Therapeutic observation of arthrolysis under brachial plexus anesthesia for adhesivecapsulitis of the shoulder

Objective:To objectively evaluate the short-term and long-term efficacies of arthrolysis under brachial plexus anesthesia in treating adhesive capsulitis of the shoulder(ACS).Methods:One hundred patients diagnosed with ACS were divided into two groups using the random number method.The two groups both received same active rehabilitation exercises.Besides,55 cases in the treatment group were given one session of arthrolysis under brachial plexus anesthesia,and 45 cases in the control group were given tuina treatment.Changes in the visual analog scale(VAS)score,Melle score and pressure pain index were observed I month and 3 months after treatment.The therapeutic efficacies were also compared.Results:The total effective rate was 96.4%at the 1-month follow-up and 96.4%at the 3-month follow-up in the treatment group.The total effective rate was 33.3%at the 1-month follow-up and 28.9%at the 3-month follow-up in the control group.There were significant differences between the two groups comparing the total effective rate at the two time points(both P<0.05).The scores of VAS,Melle and pressure pain were significantly different at the 1-month and 3-month follow-ups from those before treatment in the treatment group(all P<0.05);the three scores did not show significant differences at the 1-month and 3-month follow-ups compared with those before treatment in the control group(all P>0.05).Conclusion:Based on the active rehabilitation exercises,one session of arthrolysis under brachial plexus anesthesia can release the adhesion and restore the range of motion and function of shoulder joint in ACS patients.It is superior to rehabilitation exercises plus tuina treatment comparing both short-term and long-term efficacies.

Anatomy of the Brachial Plexus:A Rare Variation in the Laboratory of Anatomy of Bamako(Mali)

The brachial plexus (BP), established by the lap twigs of the last four cervical nerves and the first thoracic nerve, assures the driving and sensory innervation of the thoracic member. We bring back a case of rare anatomical variation of the brachial plexus. It is a 34-year-old corpse dissected in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in September 2017. The lap twig of the fourth cervical root (C4) participated in the constitution of the brachial plexus. The superior trunk was normally constituted. The average trunk was formed by the cervical roots C7 and C8 instead of only C7. And consequently the inferior trunk was constituted by the thoracic root T1. The posterior beam was only formed by the posterior branches of the superior and more average trunk. The medial beam was formed by all of the inferior trunk which did not give posterior branch for the formation of the posterior beam. The variations of the brachial plexus could entrain failures in the loco regional anesthesia of the brachial plexus.

Electroacupuncture attenuates neuropathic pain after brachial plexus injury

Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root （associated with upper-limb chronic neuropathic pain） were given electroacupuncture stimulation at bilateral Quchi （LIll）, Hegu （LI04）, Zusanli （ST36） and Yanglingquan （GB34）. After electroacupuncture therapy, chronic neuropathic pain in the rats＇ upper limbs was significantly attenuated. Immunofluorescence staining showed that the expression of β-endorphins in the arcuate nucleus was significantly increased after therapy. Thus, experimental findings indi- cate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulating β-endorphin expression.

Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as em-bryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site （1 × 106 cells/mL, 3μL/injection, 25 injections） immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also signiifcantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effec-tively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

Magnetic resonance imaging with three-dimensional fast imaging employing steady-state acquisition with phase-cycled and short T1 inversion recovery pulse sequence for evaluating brachial plexus injury

There is a large amount of fat in the postganglionic segment of the brachial plexus nerve.The use of short T1 inversion recovery pulse sequence may improve signal strength of the brachial plexus postganglionic segment.The present study revealed that the combination of three-dimensional fast imaging employing steady-state acquisition with phase-cycled and short T1 inversion recovery pulse sequence clearly displayed the anatomical morphology and structure of the brachial plexus nerve,together with maximum intensity projection,volume rendering and other three-dimensional reconstruction techniques.Our results suggested that this method is also suitable for providing accurate assessment and diagnosis of the site,severity and scope of brachial plexus injury.

Effect of lentiviral vector-mediated overexpression of hypoxia-inducible factor 1 alpha delivered by pluronic F-127 hydrogel on brachial plexus avulsion in rats

Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a critical molecule targeting several genes associated with ischemia-hypoxia damage and angiogenesis. In this study, a rat model of brachial plexus avulsion-reimplantation was established, in which C5–7 ventral nerve roots were avulsed and only the C6 root reimplanted. Different implants were immediately injected using a microsyringe into the avulsion-reimplantation site of the C6 root post-brachial plexus avulsion. Rats were randomly divided into five groups: phosphate-buffered saline, negative control of lentivirus, hypoxia-inducible factor 1α(hypoxia-inducible factor 1α overexpression lentivirus), gel(pluronic F-127 hydrogel), and gel + hypoxia-inducible factor 1α(pluronic F-127 hydrogel + hypoxia-inducible factor 1α overexpression lentivirus). The Terzis grooming test was performed to assess recovery of motor function. Scores were higher in the hypoxia-inducible factor 1α and gel +hypoxia-inducible factor 1α groups(in particular the gel + hypoxia-inducible factor 1α group) compared with the phosphate-buffered saline group. Electrophysiology, fluorogold retrograde tracing, and immunofluorescent staining were further performed to investigate neural pathway reconstruction and changes of neurons, motor endplates, and angiogenesis. Compared with the phosphate-buffered saline group, action potential latency of musculocutaneous nerves was markedly shortened in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor1α groups. Meanwhile, the number of fluorogold-positive cells and ChAT-positive neurons, neovascular area(labeled by CD31 around av ulsed sites in ipsilateral spinal cord segments), and the number of motor endplates in biceps brachii(identified by α-bungarotoxin) were all visibly increased, as well as the morphology of motor endplate in biceps brachil was clear in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor 1α groups. Taken together, delivery of hypoxia-inducible factor 1α overexpression lentiviral vectors mediated by pluronic F-127 effectively promotes spinal root regeneration and functional recovery post-brachial plexus avulsion. All animal procedures were approved by the Institutional Animal Care and Use Committee of Guangdong Medical University, China.

Small-worldness of brain networks after brachial plexus injury: a resting-state functional magnetic resonance imaging study

Research on brain function after brachial plexus injury focuses on local cortical functional reorganization,and few studies have focused on brain networks after brachial plexus injury.Changes in brain networks may help understanding of brain plasticity at the global level.We hypothesized that topology of the global cerebral resting-state functional network changes after unilateral brachial plexus injury.Thus,in this cross-sectional study,we recruited eight male patients with unilateral brachial plexus injury（right handedness,mean age of 27.9±5.4years old）and eight male healthy controls（right handedness,mean age of 28.6±3.2）.After acquiring and preprocessing resting-state magnetic resonance imaging data,the cerebrum was divided into 90 regions and Pearson’s correlation coefficient calculated between regions.These correlation matrices were then converted into a binary matrix with affixed sparsity values of 0.1–0.46.Under sparsity conditions,both groups satisfied this small-world property.The clustering coefficient was markedly lower,while average shortest path remarkably higher in patients compared with healthy controls.These findings confirm that cerebral functional networks in patients still show smallworld characteristics,which are highly effective in information transmission in the brain,as well as normal controls.Alternatively,varied small-worldness suggests that capacity of information transmission and integration in different brain regions in brachial plexus injury patients is damaged.

Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity

In the treatment of brachial plexus injury, nerves that are functionally less important are transferred onto the distal ends of damaged crucial nerves to help recover neuromuscular function in the target region. For example, intercostal nerves are transferred onto axillary nerves, and accessory nerves are transferred onto suprascapular nerves, the phrenic nerve is transferred onto the musculocutaneous nerves, and the contralateral C7 nerve is transferred onto the median or radial nerves. Nerve transfer has become a major method for reconstructing the brachial plexus after avulsion injury. Many experiments have shown that nerve transfers for treatment of brachial plexus injury can help reconstruct cerebral cortical function and increase cortical plasticity. In this review article, we summarize the recent progress in the use of diverse nerve transfer methods for the repair of brachial plexus injury, and we discuss the impact of nerve transfer on cerebral cortical plasticity after brachial plexus injury.

Transplantation of human amniotic epithelial cells repairs brachial plexus injury:pathological and biomechanical analyses

A brachial plexus injury model was established in rabbits by stretching the C6 nerve root. Imme- diately after the stretching, a suspension of human amniotic epithelial cells was injected into the injured brachial plexus. The results of tensile mechanical testing of the brachial plexus showed that the tensile elastic limit strain, elastic limit stress, maximum stress, and maximum strain of the injured brachial plexuses were significantly increased at 24 weeks after the injection. The treatment clearly improved the pathological morphology of the injured brachial plexus nerve, as seen by hematoxylin eosin staining, and the functions of the rabbit forepaw were restored. These data indicate that the injection of human amniotic epithelial cells contributed to the repair of brachial plexus injury, and that this technique may transform into current clinical treatment strategies.

Glomus tumor of uncertain malignant potential of the brachial plexus: A case report

BACKGROUND Glomus tumor is an uncommon benign tumor usually presenting with a small mass occurring in the dermis or soft tissue of an extremity, especially subungual region. However, intraneural glomus tumor is sporadic. While most of the glomus tumors are benign, atypical glomus tumors with unusual features can be occasionally found, leading to distinctive malignant potential required different therapeutic approaches. Glomus tumor of uncertain malignant potential is one type of atypical glomus tumor with limited criteria for malignancy and without metastasis. CASE SUMMARY Herein, we report a case of a 48-year-old Thai male with a large painful mass in his axilla for one year without apparent neurological deficit. Magnetic resonance imaging showed a large heterogeneous mass encasing entire posterior cord of left brachial plexus and axillary artery. The tumor tissue from core needle biopsy histologically demonstrated the sheets and cords of relatively uniform tumor cells with foamy cytoplasm and round to oval hyperchromatic nuclei without atypia. The mitotic count was 0 per 50 high power field. A final diagnosis of glomus tumor of uncertain malignant potential was rendered. Complete surgical resection was performed, followed by adjuvant radiation due to positive margin. Neither local recurrence nor distant metastasis was observed at 2-year follow up. Unfortunately, postoperative incomplete brachial plexopathy without signs of reinnervation by electromyography was persisted. Later nerve grafting reconstruction was performed, followed by ongoing neurological rehabilitation. CONCLUSION Glomus tumor of uncertain malignant potential is exceedingly rare, especially around brachial plexus. Although the prognosis is good, careful histological diagnosis and treatment are needed to achieve an optimal outcome with lower morbidity.