Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis

ObjectivesThe specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis.Materials and methodsPRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity.ResultsThe meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19–3.84, p < 0.00001) and had superior improvement in range of motion compared to the rehabilitation group (SMD 2.88, 95% CI = 2.47–3.29, p < 0.00001). In addition, the spasticity in the paralyzed upper extremity significantly improved in patients with CC7 transfer (SMD −1.42, 95% CI = −1.60 to −1.25, p < 0.00001).ConclusionOur findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function

Three-dimensional biofabrication of nanosecond laser micromachined nanofibre meshes for tissue engineered scaffolds

There is a high demand for bespoke grafts to replace damaged or malformed bone and cartilage tissue. Three-dimensional (3D) printing offers a method of fabricating complex anatomical features of clinically relevant sizes. However, the construction of a scaffold to replicate the complex hierarchical structure of natural tissues remains challenging. This paper reports a novel biofabrication method that is capable of creating intricately designed structures of anatomically relevant dimensions. The beneficial properties of the electrospun fibre meshes can finally be realised in 3D rather than the current promising breakthroughs in two-dimensional (2D). The 3D model was created from commercially available computer-aided design software packages in order to slice the model down into many layers of slices, which were arrayed. These 2D slices with each layer of a defined pattern were laser cut, and then successfully assembled with varying thicknesses of 100 μm or 200 μm. It is demonstrated in this study that this new biofabrication technique can be used to reproduce very complex computer-aided design models into hierarchical constructs with micro and nano resolutions, where the clinically relevant sizes ranging from a simple cube of 20 mm dimension, to a more complex, 50 mm-tall human ears were created. In-vitro cell-contact studies were also carried out to investigate the biocompatibility of this hierarchal structure. The cell viability on a micromachined electrospun polylactic-co-glycolic acid fibre mesh slice, where a range of hole diameters from 200 μm to 500 μm were laser cut in an array where cell confluence values of at least 85% were found at three weeks. Cells were also seeded onto a simpler stacked construct, albeit made with micromachined poly fibre mesh, where cells can be found to migrate through the stack better with collagen as bioadhesives. This new method for biofabricating hierarchical constructs can be further developed for tissue repair applications such as maxillofacial bone injury or nose/ear cartilage replacement in the future

A mathematical model of blood loss during renal resection

In 2021, approximately 51% of patients diagnosed with kidney tumors underwent surgical resections. One possible way to reduce complications from surgery is to minimise the associated blood loss, which, in the case of partial nephrectomy, is caused by the inadequate repair of branching arteries within the kidney cut during the tumor resection. The kidney vasculature is particularly complicated in nature, consisting of various interconnecting blood vessels and numerous bifurcation, trifurcation, tetrafurcation, and pentafurcation points. In this study, we present a mathematical lumped-parameter model of a whole kidney, assuming a non-Newtonian Carreau fluid, as a first approximation of estimating the blood loss arising from the cutting of single or multiple vessels. It shows that severing one or more blood vessels from the kidney vasculature results in a redistribution of the blood flow rates and pressures to the unaltered section of the kidney. The model can account for the change in the total impedance of the vascular network and considers a variety of multiple cuts. Calculating the blood loss for numerous combinations of arterial cuts allows us to identify the appropriate surgical protocols required to minimise blood loss during partial nephrectomy as well as enhance our understanding of perfusion and account for the possibility of cellular necrosis. This model may help renal surgeons during partial organ resection in assessing whether the remaining vascularisation is sufficient to support organ viability

Near real-time estimation of blood loss and flow-pressure re-distribution during unilateral nephrectomy

Radical or partial nephrectomy, commonly used for the treatment of kidney tumors, is a surgical procedure with a risk of high blood loss. The primary aim of this study is to quantify blood loss and elucidate the redistribution of blood flux and pressure between the two kidneys and the abdominal aorta during renal resection. We have developed a robust research methodology that introduces a new lumped-parameter mathematical model, specifically focusing on the vasculature of both kidneys using a non-Newtonian Carreau fluid. This model, a first-order approximation, ac-counts for the variation in the total impedance of the vasculature when various vessels are severed in the diseased kidney (assumed to be the left in this work). The model offers near real-time estima-tions of the flow-pressure redistribution within the vascular network of the two kidneys and the downstream aorta for several radical or partial nephrectomy scenarios. Notably, our findings indi-cate that the downstream aorta receives approximately 1.27 times higher percentage of the redis-tributed flow from the diseased kidney compared to the healthy kidney, in nearly all examined cases. The implications of this study are significant, as they can inform the development of surgical protocols required to minimize blood loss and assist surgeons in evaluating the adequacy of the remaining kidney vasculature to support the organ

Presentation_2_Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis.pdf

ObjectivesThe specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis.Materials and methodsPRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity.ResultsThe meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19–3.84, p ConclusionOur findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function.</p

Presentation_1_Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis.pdf

ObjectivesThe specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis.Materials and methodsPRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity.ResultsThe meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19–3.84, p ConclusionOur findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function.</p

Additional file 1 of Recombinant L. lactis vaccine LL-plSAM-WAE targeting four virulence factors provides mucosal immunity against H. pylori infection

Supplementary Material

Phase II study of apatinib in combination with oral vinorelbine in heavily pretreated HER2-negative metastatic breast cancer and clinical implications of monitoring ctDNA

Apatinib is an oral TKI targeting VEGFR-2. Single-agent apatinib treatment has been shown to produce an objective response in patients with pretreated mBC. Oral vinorelbine also holds promise as a treatment of choice in patients with mBC. This study aimed to investigate the efficacy and safety of the oral vinorelbine-apatinib combination in patients with pretreated mBC. In addition, we detected gene variants in ctDNA to explore the therapeutic implications