Functional reconstruction following brachial plexus root avulsion

OBJECTIVE： To sum up the treatment of brachial plexus root avulsion and the progress in functional reconstruction and rehabilitation following brachial plexus root avulsion. DATA SOURCES： A search of Medline was performed to select functional reconstruction and rehabilitation following brachial plexus injury-related English articles published between January 1990 and July 2006, with key words of ＂brachial plexus injury, reconstruction and rehabilitation＂. Meanwhile, a computer-based search of CBM was carried out to select the similar Chinese articles published between January 1998 and July 2006, with key words of ＂brachial plexus injury, reconstruction and rehabilitation＂. STUDY SELECTION： The materials were checked primarily, and the literatures of functional reconstruction and rehabilitation of brachial plexus injury were selected and the full texts were retrieved. Inclusive criteria： ①Functional reconstruction following brachial plexus injury. ②Rehabilitation method of brachial plexus injury. Exclusive criteria： Reviews, repetitive study, and Meta analytical papers. DATA EXTRACTION： Forty-six literatures about functional reconstruction following brachial plexus injury were collected, and 36 of them met the inclusive criteria. DATA SYNTHESIS： Brachial plexus injury causes the complete or incomplete palsy of muscle of upper extremity. The treatment of brachial plexus is to displace not very important nerves to the distal end of very important nerve, called nerve transfer, which is an important method to treat brachial plexus injury. Postoperative rehabilitations consist of sensory training and motor functional training. It is very important to keep the initiativeness of exercise. Besides recovering peripheral nerve continuity by operation, combined treatment and accelerating neural regeneration, active motors of cerebral cortex is also the important factor to reconstruct peripheral nerve function. CONCLUSION： Consciously and actively strengthening functional exercise after operation is helpful to form cerebral plasticity and produce voluntary movements, can re-educate re-dominated muscle, obviously improves postoperative therapeutic effect and promote functional reconstruction.

Sustainable functional urethral reconstruction:Maximizing early continence recovery in robotic-assisted radical prostatectomy

Objective:To evaluate the safety profile and short-term functional outcome of sustainable functional urethral reconstruction(SFUR)in robotic-assisted radical prostatectomy(RARP).Methods:One hundred and sixty-two consecutive prostate cancer patients who underwent RARP were retrospectively analyzed,in which 53 had undergone SFUR while the other 109 had undergone conventional RARP procedures.Immediate,2-week,1-month and 3-month continence recovery and other perioperative data were compared to evaluate short-term surgical and functional outcome.Results:The median age was 68 and 67 years in the experimental group and control group,respectively(pZ0.206),with a median prostate-specific antigen(PSA)of 13.6 ng/mL(interquartile range[IQR],8.46e27.32 ng/mL)in the experimental group and 13.84 ng/mL(IQR,9.12e26.80 ng/mL)in control group(pZ0.846).Immediate,2-week,1-month and 3-month continence recovery rates between the groups were 34.0%vs.3.7%,50.9%vs.14.7%,62.3%vs.27.5%,and 79.2%vs.63.3%(all p<0.05).The morphological changes made by the new reconstruction technique were maintained on magnetic resonance imaging(MRI)3 months postoperatively.Nerve-sparing procedures and adoption of the new reconstruction technique were significantly relevant to continence recovery on logistics regression model(p<0.001).Conclusions:SFUR is a safe and easy-to-handle modification that may contribute to early continence return for RARP.Long-term follow-up and prospective studies are required to further evaluate its value in postoperative quality-of-life improvement.

Regenerating nerve fiber innervation of extraocular muscles and motor functional changes following oculomotor nerve injuries at different sites

In the present study, the oculomotor nerves were sectioned at the proximal （subtentorial） and distal （superior orbital fissure） ends and repaired. After 24 weeks, vestibulo-ocular reflex evaluation confirmed that the regenerating nerve fibers following oculomotor nerve injury in the superior orbital fissure had a high level of specificity for innervating extraocular muscles. The level of functional recovery of extraocular muscles in rats in the superior orbital fissure injury group was remarkably superior over that in rats undergoing oculomotor nerve injuries at the proximal end （subtentorium）. Horseradish peroxidase retrograde tracing through the right superior rectus muscle showed that the distribution of neurons in the nucleus of the oculomotor nerve was directly associated with the injury site, and that crude fibers were badly damaged. The closer the site of injury of the oculomotor nerve was to the extraocular muscle, the better the recovery of neurological function was. The mechanism may be associated with the aberrant number of regenerated nerve fibers passing through the injury site.

Optical Transfer Function Reconstruction in Incoherent Fourier Ptychography

An optical transfer function （OTF） reconstruction model is first embedded into incoherent Fourier ptychography （IFP）. The leading result is a proposed algorithm that can recover both the super-resolution image and the OTF of an imaging system with unknown aberrations simultaneously. This model overcomes the difficult problem of OTF estimation that the previous IFP faces. The effectiveness of this algorithm is demonstrated by numerical simulations, and the superior reconstruction is presented. We believe that the reported algorithm can extend the original IFP for more complex conditions and may provide a solution by using structured light for characterization of optical systems＇ aberrations.

DOA estimation method for wideband signals by block sparse reconstruction

For the direction of arrival（DOA） estimation,traditional sparse reconstruction methods for wideband signals usually need many iteration times.For this problem,a new method for two-dimensional wideband signals based on block sparse reconstruction is proposed.First,a prolate spheroidal wave function（PSWF） is used to fit the wideband signals,then the block sparse reconstruction technology is employed for DOA estimation.The proposed method uses orthogonalization to choose the matching atoms,ensuring that the residual components correspond to the minimum absolute value.Meanwhile,the vectors obtained by iteration are back-disposed according to the corresponding atomic matching rules,so the extra atoms are abandoned in the course of iteration,and the residual components of current iteration are reduced.Thus the original sparse signals are reconstructed.The proposed method reduces iteration times comparing with the traditional reconstruction methods,and the estimation precision is better than the classical two-sided correlation transformation（TCT）algorithm when the snapshot is small or the signal-to-noise ratio（SNR） is low.

Nerve function restoration following targeted muscle reinnervation after varying delayed periods

Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees.However,it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect restoration of function.In this rat nerve injury study,the median and musculocutaneous nerves of the forelimb were transected.The proximal median nerve stump was sutured to the distal musculocutaneous nerve stump immediately and 2 and 4 weeks after surgery to reinnervate the biceps brachii.After targeted muscle reinnervation,intramuscular myoelectric signals from the biceps brachii were recorded.Signal amplitude gradually increased with time.Biceps brachii myoelectric signals and muscle fiber morphology and grooming behavior did not significantly differ among rats subjected to delayed target muscle innervation for different periods.Targeted muscle reinnervation delayed for 4 weeks can acquire the same nerve function restoration effect as that of immediate reinnervation.

Three-dimensional digital technology-assisted precise tumor resection and reconstruction of the femoral trochanter and postoperative functional recovery:a retrospective study

Background The trochanter of the femur is a common site for bone tumors.However,locating the specificboundary of bone tumor infiltration and determining the surgical method can be challenging.The objective of thisstudy was to review the diagnosis,treatment,and surgical outcomes of patients with tumors or tumor-like changesin the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction ofthe trochanter.Methods From January 2005 to September 2020,11 patients with trochanteric tumors(aged:18–53 years;sixmales and five females)were treated in Guangzhou First People’s Hospital.The cases included aneurysmal bonecyst(n=1),giant cell tumor of bone(n=2),fibrous histiocytoma of bone(n=1),endochondroma(n=1),andfibrous dysplasia of bone(n=6).For patients with trochanteric tumors,computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion.Athree-dimensional digital model of bilateral lower limbs was reconstructed by computer technology,the boundary of tumor growth was determined by computer simulation,the process of tumor resection and reconstructionwas simulated,and the personalized guide template was designed.During the operation,the personalized guideplate guided the precise resection of the tumor,and the allogeneic bone was trimmed to match the shape of thebone defect.Results All 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction ofthe hip.In eight cases,the lesion was confined to the trochanter,which was fixed with large segment allogeneicbone,autologous iliac bone,and proximal femoral anatomic plate.In three cases,allogeneic bone,autologousiliac bone,and femoral reconstruction nail were used to fix the tumor under the trochanter.Postoperative Xray examination showed that the repair and reconstruction of the bone defect was effective,and callus bridgingbetween the allogenic bone and autogenous bone was observed 6 months after operation.All patients recoveredtheir walking function 3–6 months after operation.The duration of the follow-up period ranged from 6 monthsto 6 years.A patient experienced recurrence of endochondroma;pathological examination revealed chondrocyticsarcoma.The remaining 10 patients were treated with segmental resection and reconstruction.The operationtime ranged 2.5–4.5 h(average:3.2 h).Intraoperative blood loss ranged from 300 to 500 ml(average:368 ml).The local recurrence rate was 9.1%,and the overall survival rate was 100%.The average Musculoskeletal TumorSociety score was 27(excellent and good for eight and three patients,respectively).Conclusions Three-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique,which might markedly improve the surgical effect,shorten the surgical time,increase the overall survival rate of patients with tumors,reduce the local recurrencerate,assist in the digitization and programming of femoral trochanteric tumor surgery,and improve surgicalaccuracy.

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.

Application of Virtual Reconstruction 3D-Printed External Fixation Helmet in Early Functional Treatment of Facial Fracture

Facial fracture repair is time-dependent.Early reduction and fixation after trauma help with later repair.Abnormal healing caused by delayed repair increases not only the difficulty of reconstruction,but also the risk of aesthetic or functional defects.Digital technology was used to model local trauma in three dimensions.The fracture fragments were reset,and the facial shape was reconstructed on the reset model.After resampling,3D printing was used to construct a personalised external fixation helmet.Combined with the posterior nasal passage lift reduction technique,early reduction of the mid-face fractures was performed.Through the early application of a 3D-printed personalised external fixation helmet to a patient with a comprehensive fracture,the helmet manufacturing process and application methods were introduced,and the effect of this application was investigated.In the treatment of facial fractures,the early application of a 3D-printed personalised external fixation helmet is conducive to fracture reduction and fixation and reduces the difficulty of later reconstruction.

Effects of targeted muscle reinnervation on spinal cord motor neurons in rats following tibial nerve transection

Targeted muscle reinnervation(TMR)is a surgical procedure used to transfer residual peripheral nerves from amputated limbs to targeted muscles,which allows the target muscles to become sources of motor control information for function reconstruction.However,the effect of TMR on injured motor neurons is still unclear.In this study,we aimed to explore the effect of hind limb TMR surgery on injured motor neurons in the spinal cord of rats after tibial nerve transection.We found that the reduction in hind limb motor function and atrophy in mice caused by tibial nerve transection improved after TMR.TMR enhanced nerve regeneration by increasing the number of axons and myelin sheath thickness in the tibial nerve,increasing the number of anterior horn motor neurons,and increasing the number of choline acetyltransferase-positive cells and immunofluorescence intensity of synaptophysin in rat spinal cord.Our findings suggest that TMR may enable the reconnection of residual nerve fibers to target muscles,thus restoring hind limb motor function on the injured side.

Experimental Study of Acoustic Noise Correlation Technique for Passive Monitoring of Rails

The work presented in this paper aims at investigating the ability of acoustic noise correlation technique for railway infrastructure health monitoring. The principle of this technique is based on impulse responses reconstruction by correlation of random noise propagated in the medium. Since wheel-rail interaction constitutes a source of such noise, correlation technique could be convenient for detection of rail defects using only passive sensors. Experiments have been carried out on a 2 m-long rail sample. Acoustic noise is generated in the sample at several positions. Direct comparison between an active emission-reception response and the estimated noise correlation function has confirmed the validity of the equivalence relation between them. The quality of the reconstruction is shown to be strongly related to the spatial distribution of the noise sources. High sensitivity of the noise-correlation functions to a local defect on the rail is also demonstrated. However, interpretation of the defect signature is more ambiguous than when using classical active responses. Application of a spatiotemporal Fourier transform on data recorded with variable sensor-defect distances has allowed overcoming this ambiguity.

Advances in functional limb reconstruction in the irradiated setting

The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage has been the main goal. More commonly, this is being achieved with a combination of neo-adjuvant radiotherapy,followed by wide excision and soft tissue reconstruction in the form of vascularised soft tissue transfer. Although limb salvage is now readily achievable, the resultant functional disabilities following excision of major musculotendinous and neurovascular structures can be life changing. In recent years, there has been a move towards functional limb reconstruction in the form of free functioning muscle transfer. This paper reviews the advances in functional limb reconstruction in the setting of preoperative radiation and reports our experience in this challenging reconstructive field.

Soft tissue reconstruction of the lower extremity in the pediatric population

Lower extremity defects are a source of significant functional and psychosocial morbidity for pediatric patients and require complex reconstructions to restore form and function.The advent of microsurgical reconstruction along with advances in wound care techniques and technologies have empowered reconstructive surgeons to perform limb salvage surgery in patients that would traditionally require amputation;however,the indications for performing reconstructive surgery for complicated cases are not ironclad.While this is the case,applying the principles of lower extremity reconstruction in adults to the pediatric population is often sufficient to achieve a satisfactory outcome.This overview discusses the evaluation and management of soft tissue defects of the leg in pediatric patients.

Exploring the mechanism of neural-function reconstruction by reinnervated nerves in targeted muscles

A lack of myoelectric sources after limb amputation is a critical challenge in the control of multifunctional motorized prostheses. To reconstruct myoelectric sources physiologically related to lost limbs, a newly proposed neural-function construction method, targeted muscle reinnervation(TMR), appears promising. Recent advances in the TMR technique suggest that TMR could provide additional motor command information for the control of multifunctional myoelectric prostheses. However, little is known about the nature of the physiological functional recovery of the reinnervated muscles. More understanding of the underlying mechanism of TMR could help us fine tune the technique to maximize its capability to achieve a much higher performance in the control of multifunctional prostheses. In this study, rats were used as an animal model for TMR surgery involving transferring a median nerve into the pectoralis major, which served as the target muscle. Intramuscular myoelectric signals reconstructed following TMR were recorded by implanted wire electrodes and analyzed to explore the nature of the neural-function reconstruction achieved by reinnervation of targeted muscles. Our results showed that the active myoelectric signal reconstructed in the targeted muscle was acquired one week after TMR surgery, and its amplitude gradually became stronger over time. These preliminary results from rats may serve as a basis for exploring the mechanism of neural-function reconstruction by the TMR technique in human subjects.

Using nerve segment insert grafting to reconstruct neural pathways of brain-derived paralysis

Since 1992,task groups have used free nerve auto grafts to bridge partially transected nerves from the dominant area of the normal cerebral cortex to nerves that innervate spastic muscles from a diseased cerebral cortex,using transplanting sutures to alleviate the muscle spasm of cerebral palsy caused by different diseases. This has facilitated rebuilding of some of its neurological function. In this study,80 such patients were followed up,including 20 patients with traumatic brain injury,32 patients with stroke,and 28 pediatric patients with cerebral palsy. After postoperative follow-up of 3 to 21 years,the efficacy rate of this operation was 100% and the excellent and good spasm relief rate was 82.5%.

Application of SNi PER framework to BESⅢ physics analysis

A fast physics analysis framework has been developed based on SNi PER to process the increasingly large data sample collected by BESⅢ.In this framework,a reconstructed event data model with Smart Ref is designed to improve the speed of Input/Output operations,and necessary physics analysis tools are migrated from BOSS to SNi PER.A real physics analysis e~＋e^-→ π~＋π^-J/ψ is used to test the new framework,and achieves a factor of10.3 improvement in Input/Output speed compared to BOSS.Further tests show that the improvement is mainly attributed to the new reconstructed event data model and the lazy-loading functionality provided by Smart Ref.