Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple ampli- fication of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple ampli- fication of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were su- tured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction veloc- ity reached 22.63 _＋ 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ＋ 652 in the branches of pronator teres of donor, and 2,661 ~ 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.

Repair of the portal vein using a hepatic ligamentum teres patch for laparoscopic pancreatoduodenectomy: A case report

BACKGROUND Laparoscopic pancreatoduodenectomy (LPD) has been developed gradually with the advances in surgical laparoscopic techniques. It is technically challenging to perform LPD with portal vein resection and reconstruction. CASE SUMMARY A 71-year-old female patient was diagnosed with distal cholangiocarcinoma. After preoperative examination and rigorous preoperative preparation, the patient underwent LPD using 3D laparoscopy on July 17, 2018. During the surgery, we found that the tumor invaded the right wall of the portal vein;thus, pancreaticoduodenectomy combined with partial portal vein wall resection was performed. The defect of the portal vein wall was approximately 2.5 cm × 1.0 cm. The hepatic ligamentum teres was excised by laparoscopy and then recanalized in vitro. Following recanalization, the hepatic ligamentum teres was cut longitudinally and then trimmed into vascular patches that were then used to reconstruct the defect of the portal vein through 3D laparoscopy. The operative time was 560 min, and intraoperative blood loss was 100 mL. The duration of the blood occlusion time was 63 min. No blood transfusion was required. The patient underwent enhanced recovery after surgery procedures after the operation. The patient was discharged on postoperative day 11. Follow-up for 6 months after discharge showed no stenosis of the portal vein and good patency of blood flow. CONCLUSION It is safe and feasible to use the hepatic ligamentum teres patch to repair portal vein in LPD. However, the long-term patency of this technique for venous reconstruction requires further investigation.

Ligamentum teres hepatis as a graft for portal and/or superior mesenteric vein reconstruction:From bench to bedside

BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical procedure.There are various grafts currently used for PV and/or SMV reconstruction,but each of these grafts have certain limitations.Therefore,it is necessary to explore novel grafts that have an extensive resource pool,are low cost with good clinical application,and are without immune response rejection or additional damage to patients.AIM To observe the anatomical and histological characteristics of the ligamentum teres hepatis(LTH)and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy patients.METHODS In 107 patients,the post-dilated length and diameter in resected LTH specimens were measured.The general structure of the LTH specimens was observed by hematoxylin and eosin(HE)staining.Collagen fibers(CFs),elastic fibers(EFs),and smooth muscle(SM)were visualized by Verhoeff-Van Gieson staining,and the expression of CD34,factor VIII-related antigen(FVIIIAg),endothelial nitric oxide synthase(eNOS),and tissue type plasminogen activator(t-PA)were detected using immunohistochemistry in LTH and PV(control)endothelial cells.PV and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies,and the outcomes were retrospectively analyzed.RESULTS The post-dilated length of LTH was 9.67±1.43 cm,and the diameter at a pressure of 30 cm H2O was 12.82±1.32 mm at the cranial end and 7.06±1.88 mm at the caudal end.Residual cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH specimens.The relative amounts of EFs,CFs and SM in the LTH were similar to those in the PV[EF(%):11.23±3.40 vs 11.57±2.80,P=0.62;CF(%):33.51±7.71 vs 32.11±4.82,P=0.33;SM(%):15.61±5.26 vs 16.74±4.83,P=0.32].CD34,FVIIIAg,eNOS,and t-PA were expressed in both LTH and PV endothelial cells.The PV and/or SMV reconstructions were successfully completed in all patients.The overall morbidity and mortality rates were 38.46%and 7.69%,respectively.There were no graft-related complications.The postoperative vein stenosis rates at 2 wk,1 mo,3 mo and 1 year were 7.69%,11.54%,15.38%and 19.23%,respectively.In all 5 patients affected,the degree of vascular stenosis was less than half of the reconstructed vein lumen diameter(mild stenosis),and the vessels remained patent.CONCLUSION The anatomical and histological characteristics of LTH were similar to the PV and SMV.As such,the LTH can be used as an autologous graft for PV and/or SMV reconstruction in pancreaticobiliary malignancy patients who require PV and/or SMV resection.

Atypical lipomatous tumor in the ligamentum teres of liver:A case report and review of the literature

A 61-year-old male was referred to our hospital with a three-month history of persistent epigastralgia and right hypochondralgia. Initial examination revealed a fist-size mass at the epigastric fossa. Ultrasonography showed a hemangioma and a mosaic echoic lesion in the ventromedian with poor blood-flow signal and linear hyperechoic part inside, and a clear border to the surroundings. Dynamic computed tomography revealed a highly enhanced effect from the portal-venous phase continuing to the equilibrium phase. T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced image revealed a high intensity effect at the early phase that continued to the next phase. On the other hand, it contained a low intensity area by a fat suppression of that image. In addition, a T2-weighted image did not show a high intensity effect. Laparotomy was performed on the second day of hospitalization. The tumor had arisen from the ligamentum teres of the liver, and no metastasis or invasion of other organs was noted. It consisted of a lipid component of mature adipocytes and a fibrous component of deep dyeing pleomorphic or multinuclear atypical stromal cells. Immunohistochemical study of the atypical stromal cells demonstrated that they were positive for MDM2 and CDK4. A pathological diagnosis of atypical lipomatous tumor(ALT) was made, and the patient was discharged on the eighth day following the procedure. At the 6-mo follow-up dynamic CT, the patient was free of recurrence or metastasis. We experienced a patient with ALT in the ligamentum teres of the liver. This case suggests the need for a careful and detailed examination when encountering patients presenting with a mass; when neoplastic lesion is confirmed by image inspection, we should thoroughly investigate, including further image investigations and pathologic examination. The latter is the most important.

Hepatectomy for gallbladder-cancer with unclassified anomaly of right-sided ligamentum teres: A case report and review of the literature

Right-sided ligamentum teres(RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70 s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct(RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1 r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8(i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.

A symptomatic cyst of the ligamentum teres of the liver: A case report

Cysts of the liver ligaments are extremely rare and cysts of the ligamentum teres of the liver have been sporadically reported in the literature during the last century. The present report describes a case of a symptomatic patient with a cyst of the ligamentum teres of the liver. The patient presented with right upper quadrant pain and indigestion during the last 2 years. Ultrasound and computed tomography scans revealed a water-density mass attached to the anterior abdominal wall, but definite diagnosis could not be reached. The cyst was completely excised during laparotomy. Cysts of the ligamentum teres of the liver, although infrequent, may produce clinical symptoms and require excision. Ultrasound and computed tomography scan preoperatively cannot rule out malignancy, thus exploratory laparotomy and total resection of these lesions are necessary.

Predicting portal venous anomalies by left-sided gallbladder or rightsided ligamentum teres hepatis: A large scale, propensity scorematched study

BACKGROUND Right-sided ligamentum teres(RSLT)is often associated with portal venous anomalies(PVA)and is regarded as a concerning feature for hepatobiliary intervention.Most studies consider RSLT to be one of the causes of left-sided gallbladder(LGB),leading to the hypothesis that LGB must always be present with RSLT.However,some cases have shown that right-sided gallbladder(RGB)can also be present in livers with RSLT.AIM To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres(LT)or gallbladder location is reliable to predict PVA.METHODS This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021[4483 men,4069 women;mean age,59.5±16.2(SD)years].We defined the surrogate outcome as major PVAs.The cases were divided into 4 subgroups according to gallbladder and LT locations.On one hand,we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable(n=36).On the other hand,we controlled LT location and computed PVA prevalence by gallbladder locations(n=34).Finally,we investigated LT location as an independent factor of PVA by using propensity score matching(PSM)and inverse probability of treatment weighting(IPTW).RESULTS We found 9 cases of RSLT present with RGB.Among the LGB cases,RSLT is associated with significantly higher PVA prevalence than typical LT[80.0%vs 18.2%,P=0.001;OR=18,95%confidence interval(CI):2.92-110.96].When RSLT is present,we found no statistically significant difference in PVA prevalence for RGB and LGB cases(88.9%vs 80.0%,P>0.99).Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations.The RSLT group had a significantly higher PVA prevalence after adjusted by PSM(77.3%vs 4.5%,P<0.001;OR=16.27,95%CI:2.25-117.53)and IPTW(82.5%vs 4.7%,P<0.001).CONCLUSION RSLT doesn't consistently coexist with LGB.RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.

Aberrant Rotator Cuff Muscles: Coexistence of Triple-Tailed Teres Minor and Bi-Formed Infraspinatus (Major and Minor)

The teres minor and infraspinatus muscles bear a close anatomical relationship in the posterior aspect of the scapula and constitute part of the rotator cuff muscles. Although there are only occasional reports of variations of the rotator cuff muscles, this paper reports the first combined occurrence of triple-tailed teres minor and infraspinatus muscle possessing two distinct parts, infraspinatus major and minor which are of clinical and sporting importance. Aberrant variations of rotator cuff muscles need to be brought to the knowledge of radiologists, surgeons and anatomists.

Clear Cell Myo-Melanomas of Ligamentum Teres Hepatis: A Case Report and Literature Review

Introduction: Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy to misdiagnose. Objective: To report a case of a rare type of PEComa located in the ligamentum teres hepatis. Case Report: A 22-year-old Asian female was diagnosed with abdominal mass during physical examination in September 2018, and was admitted to the general surgery department of our hospital that month. She was diagnosed with abdominal mass, the nature of which remains to be determined is: teratoma, pheochromocytoma or ganglioma. At the time of admission, the patient had no symptoms or signs, and no other medical history. The patient was diagnosed with an abdominal mass by abdominal plain scan and enhanced CT, whose nature was to be determined: pheochromocytoma, paragangliomas or other mesenchymal tumors, or giant lymph node hyperplasia. The patient underwent abdominal mass resection and appendectomy without incident, without any complications at discharge, and there was no significant difference in follow-up. Conclusions: The clinical data, imaging features and pathological features of one patient diagnosed with CCMMT in our hospital were retrospectively analyzed, and the literature was reviewed in combination with the research progress of CCMMT, in order to improve the understanding and diagnostic accuracy of this disease.

Feasibility of surgical application of the ligamentum teres hepatis:a review

Ligamentum teres hepatis(LTH),a normal anatomical tissue in the liver,is frequently observed during abdominal surgery.Its unique positional and structural characteristics give it a wide range of potential clinical applications,including but not limited to repairing peptic perforation,preventing hemorrhage,treating hiatal hernia,and strengthening the biliary/pancreatic intestine anastomosis to prevent biliary and pancreatic leak.The current review summarizes kinds of methods of using LTH in abdominal surgery,especially some new clinical applications in recent years,involving various organs and fields.At the same time,domestic and foreign literature and research in the past five years are cited to demonstrate the feasibility of these applications.This review may guide surgeons to think and explore more new applications of LTH in all surgery fields.

AC-PDP驱动电路关键技术分析与比较

介绍了寻址-显示分离(ADS)技术、ALIS技术+重复行技术、TERES法(倒易维持技术)等3种PDP驱动技术,分析了各自的优缺点。介绍了目前实现这些驱动技术的主要芯片,并针对电路设计时的芯片选型给出了建议。

浅析AC-PDP驱动电路的关键技术

驱动电路是等离子(PDP)的重要组成部分,也是PDP中技术难度最大的部分。它对PDP的技术指标起着决定作用。介绍了寻址-显示分离(ADS)技术、ALIS技术+重复行技术、Teres法(倒易维持技术)等三种PDP驱动技术,分析了各自的优缺点。最后介绍了在选用相应驱动芯片时应考虑的技术指标。

Techniques in Hand &Upper Extremity Surgery

The use of tendon transfer to restore functions of extremities was initially recognised in the 19th century, and its advancement was further amplified by the polio epidemic towards the turn of that century. Tendon transfer surgery extended to the use for traumatic reconstructive surgery during World War I, with key surgical pioneers, including Mayer, Sterling Bunnell, Guy Pulvertaft and Joseph Boyes. In 1921, Robert Jones first described the transfer of pronator teres (PT) to the wrist extensors for irreparable radial nerve paralysis in infantile hemiplegia. Although, a detailed description of its indication and surgical outcomes were not published until 1959 and 1970 by Stelling and Meyer, and Keats, respectively. Pronator teres is often the tendon of choice for reconstructing wrist extensors, and used in a multiple of pathologies, including radial nerve palsy, cerebral palsy, and tetraplegia. Reconstruction of finger extensors are less straightforward and options include flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and flexor digitorum superficialis (FDS). Our article describes the techniques and outcomes of 25 patients that undergone pronator teres transfer. A good understanding of the pronator teres anatomical location and potential variations, aids efficient harvesting and limits unnecessary tissue dissection. Pronator teres tendon harvest is best performed through a systematic and anatomic approach.

TERE1(UBIAD1)基因对膀胱癌细胞系T24凋亡的影响

目的研究外源导入TERE1(UBIAD1)基因对膀胱癌细胞系T24的影响。方法利用脂质体LipofectamineTM2000,将外源TERE1(UBIAD1)基因导入T24细胞。转染TERE1(UBIAD1)基因一定时间后,利用血球计数板计数细胞数目,MTT方法检测细胞活力,流式细胞仪检测细胞周期及凋亡。结果转染基因48 h后,较之对照组,实验组细胞数目减少了80.3%,差异有统计学意义(P=6.6E-07),且随转染时间的延长细胞数目逐渐降低。MTT方法检测到转染TERE1(UBIAD1)基因48 h后实验组细胞活力值为0.4178,较之对照组,细胞活力抑制率达65.6%,差异有统计学意义(P=0.00023)。流式细胞仪检测到转染TERE1(UBIAD1)基因48 h后实验组T24细胞出现凋亡峰,PI和ANNEXIN V-FITC双染实验发现处于凋亡期的细胞占总数的93.73%。结论外源导入TERE1(UBIAD1)基因后膀胱癌T24细胞的数目和活力降低,细胞走向凋亡。

POLARIZATION IMAGING AND SCATTERING MODEL OF CANCEROUS LIVER TISSUES

We apply diferent polarization imaging techniques for cancerous liver tissues,and compare the relative contrasts for difference polarization imaging(DPI),degree of polarization imaging(DOPI)and rotating linear polarization imaging(RLPI).Experimental results show that a number of polarization imaging parameters are capable of differentiating cancerous cells in isotropic liver tisues.To analyze the contrast mechanism of the cancer:-sensitive polarization imaging parameters,we propose a scattering model cont aining two types of spherical scatterers and carry on Monte Carlo simula tions based on this bi-component model.Both the experimental and Monte Carlo simulated results show that the RLPI technique can provide a good imaging contrast of cancerous tissues.The bi-component scattering model provides a useful tool to ana-lyze the contrast mechanism of polarization imaging of cancerous tissues.

Study on Raman and SERS spectra of filter paper and silica gel plate

Raman spectra and surface-enhanced Raman scattering （SERS） spectra of filter paper and silica gel plate are ob- tained at 785-nm excitation wavelength. The results show that filter paper has thirteen Raman lines in 800 - 1 500 cm 1 and silica gel plate has eight lines in the region of 400 - 1 200 cm-I. The frequencies and Raman active modes are assigned. By comparing their Raman spectra and SERS spectra, we find that the silver colloid could repress the Raman intensities of filter paper and silica gel plate, and reduce their effects on the combination of thin-layer chromatographic （TLC） and SERS. Ac- cording to SERS spectra, the bands at 997 cm 1,1 094 cm I ,1 118 cm-1 ,1 336 cm-1 and 1 378 cm-1 for filter paper and the peak of v l [ SO4] symmetric stretching vibration （--1 017 cm-1 ） for silica gel plate also have high intensities, and those lines should be paid enough attention in TLC-SERS.

Photodetection-induced relative timing jitter in synchronized time-lens source for coherent Raman scattering microscopy

Synchronized time lens source is a novel method to generate synchronized optical pulses to mode-locked lasers,and has found widespread applications in coberent Raman scattering microscopy.Relative timing jitter between the mode-locked laser and the synchronized time-lens source is a key parameter for evaluating the synchronization peformance of such synchronized laser sys-tems.However,the origins of the relative timing jitter in such systens are not fully determined,which in turn prevents the experimental efforts to optimize the synchronization perfornance.Here,we demonstrate,through theoretical modeling and mumerical simulation,that the photo-detction could be one physical origin of the relative timing jitter.Comparison with relative timing jitter due to the intrinsic timing jitter of the mode-locked laser is also demonstrated,revealing different qualitative and quantitative behavios.Based on the nature of this photo-detection-induced timing jitter,we further propose several strategies to reduce the relative timing jitter.Our thoretical results will provide guidelines for optimizing synchronization performance in experiments.

TERE1基因在小鼠胚胎双前肢正常发育和异常发生中的表达

[目的]观察移行上皮反应基因(TERE1)在小鼠胚胎双前肢正常发育和异常发生中的表达,探讨TERE1在短肢发生中的作用。[方法]ICR小鼠受孕后,将其随机分为实验、对照两组,各64只。于孕第10天(GD10),经口灌胃一次给予实验组孕鼠80 mg/kg的全反式视黄酸(atRA)、对照组孕鼠给予等体积的大豆油,并分别于GD11～GD18取两组胎鼠的双前肢。于GD12取下小鼠胚胎双前肢,以atRA诱导,培养72 h后收获肢。利用实时荧光定量聚合酶链反应方法检测TERE1在各样本中的表达情况。[结果]在整体动物试验中,atRA可诱致小鼠胚胎明显的短肢畸形;在体外试验中,atRA可诱致小鼠胚胎前肢多种骨骼发育异常。TERE1在正常、异常肢及培养肢芽中均有表达。在正常和异常肢中,TERE1的表达模式一致;除GD15外,实验肢中TERE1的表达均低于相同时点正常肢的表达水平。在体外培养肢,各组的表达量随培养时间的延长而增加。实验组在培养24 h,atRA各剂量组的表达量均低于对照组(P<0.05);培养48 h和72 h,在2.5×10-6 mol/L～1.0×10-5 mol/L剂量范围有随剂量增加表达量增加的趋势,但在高剂量组(2.0×10-5 mol/L)表达又下降。[结论]TERE1与小鼠胚胎前肢的发育过程有关,atRA在诱致小鼠前肢异常发生中可引起TERE1 mRNA的表达改变。

TERE1基因在小鼠胚胎腭发育和腭裂形成中的表达

目的观察TERE1基因在正常小鼠腭发育和全反式视黄酸诱导的小鼠腭裂形成过程中的表达变化,探讨TERE1基因在腭裂发生中的作用。方法 ICR小鼠受孕后,将其随机分为实验组和对照组,各64只小鼠。于孕10 d(gestational day 10,GD10),经口灌胃一次给予实验组孕鼠80 mg/kg的全反式视黄酸、对照组孕鼠给予等体积的大豆油,并分别于GD11～GD18取两组胎鼠的腭板。于GD12取下小鼠胚胎腭移植体,以10-9～10-5 mol/L全反式视黄酸(all-trans retinoic acid,atRA)诱导,培养72 h后收获腭板。利用实时荧光定量PCR方法(quantitative real-time polymerasechain reaction,QRT-PCR)检测TERE1基因在正常腭组织和全反式视黄酸诱导的腭裂组织中的表达情况。结果 TERE1在正常、异常腭及培养腭板中均有表达。在GD11,异常腭中该基因的表达丰度高于正常腭,而在GD12～GD17,其表达丰度则低于正常腭(P<0.05)。10-9 mol/L atRA组和对照组的TERE1基因表达丰度差异无统计学意义(P>0.05),其他各atRA组该基因的表达丰度均低于对照组。结论在该试验条件下,atRA会抑制TERE1在腭中的表达,提示TERE1在腭的发生过程中可能起作用。

与时俱进的三大平板成像显示方式

近年来,各种平板成像显示方式的监视器、显示器、电视机等频频在世界各地的展览会上亮相,而且此类产品的市场也开始随之红火起来。可以明显看到的是,显示屏的屏幕越来越大、机身越来越薄、画质越来越高、颜色越来越真。其中最让人心动,极具诱惑力的用途之一首推大屏幕高清晰度平板电视机。各类平板电视机中。