Objective To study the anatomic relationship of the thoracic phrenic nerve and provide anatomic basis for harvesting whole length phrenic nerve under direct vision using thoracoscope in the treatment of brachial plexus root injuries. Methods The anatomy of thoracic phrenic nerve and its surrounding tissues were observed on 20 sides of 10 adult cadavers which were embalmed by 10% formalin. Video-assisted thoracoscopic transthoracic phrenic nerve harvesting was carried out in the surgical treatment of 17 cases of brachial plexus injuries. The results in these cases were summarized. Results If the cutting end of phrenic nerve was pulled out of the second intercostal space at the anterior axillary line,the ratio of its location in the upper arm was (38.60±13.10)% on the left side and (52.40±7.90)% on the right side. If the cutting end was pulled out of the thoracic outlet,the location ratio in the upper arm was (25.90±11.50)% on the left side and (39.00±6.90)% on the right side. The ratio of phrenic nerve between d (length from medial edge of the incision to the pleural top) and f (length from pleural top to the top of diaphragm) was (0.84±0.23) on the left and (0.96±0.15) on the right at third intercostal space,(1.02±0.21) on the left and (1.08±0.17) on the right at the fourth intercostals space. The ratio of phrenic nerve between e (length from medial edge of the incision to the insertion of diaphragm) and f (length from pleural top to the top of diaphragm) was (0.66±0.15) on the left and (0.60±0.21) on the right at third intercostal space,(0.55±0.04) on the left and (0.44±0.05) on the right at the fourth intercostals space. Endoscopic-assisted transthoracic phrenic nerve harvesting in 17 cases of brachial plexus root injuries obtained full length of the phrenic nerve that could be directly coapted to the muscle branch of the musculocutaneous nerve. No complications were noted.The strength of the biceps underwent good recovery,which was M2 to M4. Conclusion The phrenic nerve in the thoracic cavity is suitable for full-length dissection based on the anatomical characteristics. Endoscope-assisted transthoracic phrenic nerve harvesting is a simple and safe surgery with low requirement of special equipment,and can be carried out as a routine surgery.
Key words:
Brachial plexus; Phrenic nerve; Thoracoscopes
Background Nearly all anti-PD-1 antibodies are of the IgG4 isotype, and thus possess residual FcR effector functions. Such anti-PD-1 antibodies are also associated with immune tolerance and escape due to instability of the CH3 domain and Fc-Fc interaction. In this trial, we examined the efficacy and safety of penpulimab, a novel IgG1 anti-PD-1 antibody that does not bind to the Fc receptor, in patients with refractory or relapsed classical Hodgkin lymphoma (R/R cHL). Methods Adult patients (≥18 years of age) with R/R cHL received 200 mg penpulimab once biweekly until disease progression or unacceptable toxicities for a maximum of 24 months. The primary endpoint was objective response rate (ORR) based on the Independent Radiology Review Committee per Lugano 2014 criteria. Secondary endpoints included progression-free survival (PFS), overall survival (OS), treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs). Results A total of 94 patients were enrolled. The median follow-up was 15.8 months. The ORR was 89.4% (95% CI 80.8%, 95.0%) in the full analysis set (85 patients). Forty (47.1%) patients achieved complete remission, 36 (42.4%) patients achieved partial remission. The 12-month PFS rate was 72.1% (95% CI 60.5%, 80.8%) and the 18-month OS rate was 100%. Totally 97.9% (92/94) of patients experienced at least one TRAE. The rate of grade 3 and above TRAEs was 26.6% (25/94). In addition, 51 (54.3%) patients experienced an irAE, and 4 (4.3%) patients developed grade 3 or above irAEs. No irAE-related death occurred. Conclusions Penpulimab was effective and safe in patients with R/R cHL.
Histone deacetylase 3 (HDAC3) is a promising epigenetic drug target for multiple therapeutic applications. Direct interaction between the Deacetylase Activating Domain of the silencing mediator for retinoid or thyroid-hormone receptors (SMRT-DAD) is required for activation of enzymatic activity of HDAC3. The structure of this complex and the nature of interactions with HDAC inhibitors in solution are unknown. Using novel photoreactive HDAC probes, "nanorulers", we determined the distance between the catalytic site of the full-length HDAC3 and SMRT-DAD in solution at physiologically relevant conditions and found it to be substantially different from that predicted by the X-ray model with a Δ379-428 aa truncated HDAC3. Further experiments indicated that in solution this distance might change in response to chemical stimuli, while the enzymatic activity remained unaffected. These observations were further validated by Saturation Transfer Difference (STD) NMR experiments. We propose that the observed changes in the distance are an important part of the histone code that remains to be explored. Mapping direct interactions and distances between macromolecules with such "nanorulers" as a function of cellular events facilitates better understanding of basic biology and ways for its manipulation in a cell- and tissue-specific manner.
AIM To explore whether there is relationship between iron homeostasis disorder and neurodegeneration induced by aluminum(Al) overload. METHODS AlCl_3 solution 3 μL with the Al concentrations of 0.125% , 0.25% , and 0.5% was injected intothe lateral ventricle of mice once a day for 5 d(d 1- d 5) , respectively, in order to establish Al overload model. On d 10, d 20 and d 30 after administration of AlCl_3 solution, the learning and memory function of mice, pathomorphology of hippocampus, monoamine oxidase-B (MAO-B) activity and ferritin level of hippocampus, and brain iron level were determined. RESULTS Al overload decreased the learning and memory function of mice, caused karyopyknosis and loss of neurons in hippocampus CA1 area, raised brain iron level, decreased ferritin level and elevated MAO-B activity of hippocampus, in dose- and time-dependent manners. CONCLUSION Al overload may interfere with brain iron homeostasis, which may be responsible for neurodegeneration induced by Al toxicity.
The magnetic correlations at the superconductor/ferromagnet (S/F) interfaces play a crucial role in realizing dissipation-less spin-based logic and memory technologies, such as triplet-supercurrent spin-valves and "{\pi}" Josephson junctions. Here we report the coexistence of an induced large magnetic moment and a crypto ferromagnetic state at high-quality nitride S/F interfaces. Using polarized neutron reflectometry and d. c. SQUID measurements, we quantitatively determined the magnetization profile of S/F bilayer and confirmed the induced magnetic moment in the adjacent superconductor only exists below TC. Interestingly, the direction of the induced moment in the superconductors was unexpectedly parallel to that in the ferromagnet, which contrasts with earlier findings in S/F heterostructures based on metals or oxides. The first-principles calculations verify the observed unusual interfacial spin texture is caused by the Heisenberg direct exchange coupling through d orbital overlapping and severe charge transfer across the interfaces. Our work establishes an incisive experimental probe for understanding the magnetic proximity behavior at S/F interfaces and provides a prototype epitaxial building block for superconducting spintronics.
Highlights Operators reporting stress had 1.9 times as many injuries per year compared to those who did not report stress. Stress, sleep deprivation, and fatigue showed a similar positive association with injuries. Hearing loss and exposure to animal and/or chemical-based allergens were also risk factors for injury. Musculoskeletal pain/discomfort was strongly associated with injuries, making it a potential risk factor or a consequence. Abstract. This study evaluated the association of self-reported occupational stress and injury among farm and ranch operators in the central United States. Randomly sampled operators received mail surveys with questions related to injuries, chronic health conditions, work exposures, and preventive measures in 2018 and 2020. Injury risk factors were analyzed using Poisson regression analysis. Out of 6,744 participants, 836 (12%) reported at least one injury in the past 12 months and 1,766 (26%) reported work-related stress. The percentage of those reporting stress was 24% among those with no injuries, 36% among those with one injury, and 66% among those with two or more injuries. Similar percentages across the three injury categories were found for sleep deprivation (21%, 30%, and 51%) and fatigue (25%, 39%, and 66%). A high perceived stress level was a risk factor for injury in the final adjusted model (adjusted Rate Ratio (aRR): 1.93, 95% CI: 1.65 to 2.25) when controlling for hearing loss (aRR: 1.25, CI: 1.25 to 1.75) and exposure to animal and/or chemical based allergens (aRR: 1.49, CI: 1.17 to 1.91). With musculoskeletal symptoms (MSS) in the model, the association of stress and injuries was attenuated (aRR: 1.54, CI: 1.32 to 1.79) while MSS had a strong association with injuries (aRR: 3.79, CI: 3.00 to 4.78). Stress, sleep deprivation, and fatigue were associated with injuries in a dose-response manner. Preventing injuries among farmers and ranchers requires a focus on stress reduction and related health conditions. Keywords: Agriculture, Fatigue, Hearing Loss, Injury, Musculoskeletal discomfort, Stress.
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