BACKGROUND Breast cancer is a leading cause of cancer-related mortality among women worldwide,with invasive ductal carcinoma(IDC)being the most prevalent subtype.Lymph node metastasis is the primary prognostic indicat...BACKGROUND Breast cancer is a leading cause of cancer-related mortality among women worldwide,with invasive ductal carcinoma(IDC)being the most prevalent subtype.Lymph node metastasis is the primary prognostic indicator,typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes.Contralateral axillary metastasis(CAM)without ipsilateral involvement is exceedingly rare,particularly in early-stage breast cancer.This report presents a case of CAM in a patient with triple-negative breast cancer(TNBC),underscoring diagnostic and therapeutic complexities.CASE SUMMARY A 73-year-old female presented with left-sided early-stage IDC in February 2023.Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes,a postoperative positron emission tomography(PET)scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla.Biopsy confirmed metastatic ductal carcinoma with triple-negative status,resulting in an upstaged diagnosis of metastatic breast cancer,stage IV,M1.The patient underwent six cycles of adjuvant chemotherapy,with follow-up PET imaging showing regression of the contralateral lesion.This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.CONCLUSION This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.展开更多
In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecti...In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.展开更多
Objective To observe the differences in therapeutic effects on primary trigeminat neuralgia between contralateral needling technique and routine acupuncture. Methods One hundred and thirty cases were randomly divided ...Objective To observe the differences in therapeutic effects on primary trigeminat neuralgia between contralateral needling technique and routine acupuncture. Methods One hundred and thirty cases were randomly divided into contralateral needling group and routine acupuncture group, 65 cases in each one. In contralateral needling group, contralateral needling technique was adopted on the acupoints on the opposite side corresponding to the affected face in neuralgia. According to the localization of trigeminal neuralgia, the points were selected. For example, for ophthalmologic branch, Yuyao （鱼腰 EX- HN 4） and Touwei （头维 ST 8） were selected as the main point. In routine acupuncture group, the corresponding acupoints were selected on the affected side of the face. The points were same as that in contralateral needling group, Three courses of treatment were required in two groups. The clinical efficacy was evaluated 4 weeks after the end of treatment. Results The total effective rate was 95.4% （62/65） in contralateral needling group, which was superior to that in routine acupuncture group E86.2% （56/65）1 （P〈0. 001）. Conclusion Contralateral needling technique achieves apparently superior effects on primary trigeminal neuralgia compared with routine acupuncture.展开更多
Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral...Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.展开更多
Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar ner...Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar nerve on the paralyzed side is harvested for transfer, which completely sacrifices its potential of recovery. In the present, novel study, we report on the anatomical feasibility of a modified contralateral C7 nerve transfer surgery. Ten fresh cadavers (4 males and 6 females) provided by the Department of Anatomy, Histology, and Embryology at the Medical College of Fudan University, China were used in modified contralateral C7 nerve transfer surgery. In this surgical model, only the dorsal and superficial branches of the ulnar nerve and the medial antebrachial cutaneous nerve on the paralyzed side (left) were harvested for grafting the contralateral (right) C7 nerve and the recipient nerves. Both the median nerve and deep branch of the ulnar nerve on the paralyzed (left) side were recipient nerves. To verify the feasibility of this surgery, the distances between each pair of coaptating nerve ends were measured by a vernier caliper. The results validated that starting point of the deep branch of ulnar nerve and the starting point of the medial antebrachial cutaneous nerve at the elbow were close to each other and could be readily anastomosed. We investigated whether the fiber number of donor and recipient nerves matched one another. The axons were counted in sections of nerve segments distal and proximal to the coaptation sites after silver impregnation. Averaged axon number of the ulnar nerve at the upper arm level was approximately equal to the sum of the median nerve and proximal end of medial antebrachial cutaneous nerve (left: 0.94:1;right: 0.93:1). In conclusion, the contralateral C7 nerve could be transferred to the median nerve but also to the deep branch of the ulnar nerve via grafts of the ulnar nerve without deep branch and the medial antebrachial cutaneous nerve. The advantage over traditional surgery was that the recovery potential of the deep branch of ulnar nerve was preserved. The study was approved by the Ethics Committee of Fudan University (approval number: 2015-064) in July, 2015.展开更多
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...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.展开更多
If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show goo...If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root ＋ posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root ＋ posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root ＋ posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root ＋ posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve.展开更多
This pilot study is to assess the feasibility and the effect of a combination therapy of rehabilitation treatment and contralateral needling,which is manipulated at the foot of the unaffected side,for the recovery of ...This pilot study is to assess the feasibility and the effect of a combination therapy of rehabilitation treatment and contralateral needling,which is manipulated at the foot of the unaffected side,for the recovery of the paretic hand post-stroke.This prospective pilot clinical trial will recruit 72 stroke patients with paretic hands and a disease course of 14 to 90 d.Patients will be randomized into two groups:the control group will receive conventional Xingnao Kaiqiao acupuncture and basic treatment for the stroke;based on the control group,the observation group will receive the contralateral needling at the foot of the unaffected side combined with the rehabilitation movement of the paretic hand.12 sessions will be administrated for 2 weeks.The primary outcome,FuglMeyer Assessment,and the secondary outcomes,the handgrip strength,the range of motion,the modified Barthel index,and the Brunnstrom recovery stages,will be measured the recovery of the hand motor function during the 2 weeks'intervention.This study aims to investigate the instant effect of contralateral needling at the foot of the unaffected side combined with the rehabilitation treatment movement for patients with the paretic hand of Poststroke motor dysfunction and provide the previous evidence for the future large sample studies.展开更多
Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, an...Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, and results were improved by grafts laden with differentiated adipose stem cells. However, use of these tissue-engineered nerve grafts has not been reported for the treatment of brachial plexus injury. The aim of the present study was to evaluate the outcome of acellular nerve allografts seeded with differentiated adipose stem cells to improve nerve regeneration in a rat model in which the contralateral C7 nerve was transferred to repair an upper brachial plexus injury. Differentiated adipose stem cells were obtained from Sprague-Dawley rats and transdifferentiated into a Schwann cell-like phenotype. Acellular nerve allografts were prepared from 15-mm bilateral sections of rat sciatic nerves. Rats were randomly divided into three groups: acellular nerve allograft, acellular nerve allograft + differentiated adipose stem cells, and autograft. The upper brachial plexus injury model was established by traction applied away from the intervertebral foramen with micro-hemostat forceps. Acellular nerve allografts with or without seeded cells were used to bridge the gap between the contralateral C7 nerve root and C5–6 nerve. Histological staining, electrophysiology, and neurological function tests were used to evaluate the effect of nerve repair 16 weeks after surgery. Results showed that the onset of discernible functional recovery occurred earlier in the autograft group first, followed by the acellular nerve allograft + differentiated adipose stem cells group, and then the acellular nerve allograft group;moreover, there was a significant difference between autograft and acellular nerve allograft groups. Compared with the acellular nerve allograft group, compound muscle action potential, motor conduction velocity, positivity for neurofilament and S100, diameter of regenerating axons, myelin sheath thickness, and density of myelinated fibers were remarkably increased in autograft and acellular nerve allograft + differentiated adipose stem cells groups. These findings confirm that acellular nerve allografts seeded with differentiated adipose stem cells effectively promoted nerve repair after brachial plexus injuries, and the effect was better than that of acellular nerve repair alone. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University of China(approval No. 2016-150) in June 2016.展开更多
Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct re...Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017.展开更多
Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stag...Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Pre- vious studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth asso- ciated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function （including neuron differentiation and development, axonogenesis, and guidance）, microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light （NFL） and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteom- ic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer.展开更多
Objective: To analyze the therapeutic effect of contralateral needling in the treatment of scapulohumeral periarthritis. Methods: A total of 68 cases of scapulohumeral periarthritis were outpatients and were randomize...Objective: To analyze the therapeutic effect of contralateral needling in the treatment of scapulohumeral periarthritis. Methods: A total of 68 cases of scapulohumeral periarthritis were outpatients and were randomized into treatment group (n=36) and control group (n=32). In treatment group, Zhiyin (BL 67), Jinmen (BL 63) and Yanglao (SI 6) on the contralateral side of the affected shoulder and local tenderpoints (Ashi-points) were punctured once every other day, with 7 days being a therapeutic course; while in control group, local Ashi-points were used for injection of Procaine and Prednisolone Acetate, once every 7 days and with 3～4 sessions being a therapeutic course. Results: Following 2 courses of treatment, of the 32 cases in control group, 8 (25.0%) were cured, 17 (53.1%) experienced improvement and 7 failed in the treatment, with a total of effective rate of 78.1%; of the 36 cases in treatment group, 18 (50.0%) were cured, 16 (44.4%) experienced improvement and 2 (5.6%) failed in the treatment, with a total effective rate of 94.4%. The therapeutic effect of contralateral needling is significantly higher than that of Ashi-point blocking method (P<0.05). Conclusion: Contralateral needling is superior to Ashi-point in the treatment of scapulohumeral periarthritis.展开更多
An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the l...An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the left subclavian approach was performed on June 3,2017.A right ventricular active lead(TendrilTM STS 2088TC,St Jude Medical,Penang,Malaysia)and an atrial active lead(OptisenseTM 1999,St Jude Medical,Penang,Malaysia)were placed in the right ventricular apex and anterior wall of the right atrium,respectively.展开更多
Contralateral needling method is a common and effective one of acupuncture analgesicmethods.It is used to treat a local pain in the limbs and trunk with a short course of disease,pain and swelling will disappear or be...Contralateral needling method is a common and effective one of acupuncture analgesicmethods.It is used to treat a local pain in the limbs and trunk with a short course of disease,pain and swelling will disappear or be relieved immediately for one or two treatments.Really,there isan effect of relieving pain as soon as the needle is inserted.When the local contralateral needlingmethod is used,the key to improving the effectiveness lies in determining the pain position and its correspondingpoint correctly,the more correct the pain position and its corresponding point are determined,the better the effectiveness will be.In this group,80 cases soft tissue injury were treatedwith local contralateral needling method,the cure rate was 82％,and the total effective rate was100％.展开更多
Emerging evidence supports that the stress response to peripheral nerve injury extends beyond the injured neuron,with alterations in associated transcription factors detected both locally and remote to the lesion.Stre...Emerging evidence supports that the stress response to peripheral nerve injury extends beyond the injured neuron,with alterations in associated transcription factors detected both locally and remote to the lesion.Stress-induced nuclear translocation of the transcription factor forkhead class box O3a(FOXO3a)was initially linked to activation of apoptotic genes in many neuronal subtypes.However,a more complex role of FOXO3a has been suggested in the injury response of sensory neurons,with the injured neuron expressing less FOXO3a.To elucidate this response and test whether non-injured sensory neurons also alter FOXO3a expression,the temporal impact of chronic unilateral L4–6 spinal nerve transection on FOXO3a expression and nuclear localization in adult rat dorsal root ganglion neurons ipsilateral,contralateral or remote to injury relative to na?ve controls was examined.In na?ve neurons,high cytoplasmic and nuclear levels of FOXO3a colocalized with calcitonin gene related peptide,a marker of the nociceptive subpopulation.One hour post-injury,an acute increase in nuclear FOXO3a in small size injured neurons occurred followed by a significant decrease after 1,2 and 4 days,with levels increasing toward pre-injury levels by 1 week post-injury.A more robust biphasic response to the injury was observed in uninjured neurons contralateral to and those remote to injury.Nuclear levels of FOXO3a peaked at 1 day,decreased by 4 days,then increased by 1 week post-injury,a response mirrored in C4 dorsal root ganglion neurons remote to injury.This altered expression contralateral and remote to injury supports that spinal nerve damage has broader systemic impacts,a response we recently reported for another stress transcription factor,Luman/CREB3.The early decreased expression and nuclear localization of FOXO3a in the injured neuron implicate these changes in the cell body response to injury that may be protective.Finally,the broader systemic changes support the existence of stress/injury-induced humeral factor(s)influencing transcriptional and potentially behavioral changes in uninjured dorsal root ganglion neurons.Approval to conduct this study was obtained from the University of Saskatchewan Animal Research Ethics Board(protocol#19920164).展开更多
AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiot...AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiotherapy.METHODS:Thirty-four prospectively selected female patients with right breast cancer (pN0,negative surgical margins) were treated with breast-conserving surgery.A total dose of 42.5 Gy (2.66 Gy/fraction) was prescribed;it was requested that planning target volumes be covered by the 95% isodose line.The contralateral mam-mary gland was defined on CT simulation.The dose received was evaluated by dose volume histograms.RESULTS:The measured contralateral breast doses were:(1) Dose maximum:290-448 cGy [Equivalent (Eq) 337-522 cGy];(2) Mean dose:45-70 cGy (Eq 524815 cGy);and (3) Median dose:29-47 cGy (337-547 cGy) for total primary breast dose of 42.5 Gy in 16 equal fractions.The spearman rho correlation showed statistical significance between the contralateral breast volume and maximum dose (P=0.0292),as well as mean dose (P=0.0025) and median dose (P=0.046) to the breast.CONCLUSION:Minimizing the dose to the contralateral breast has to be one of the priorities of the radiation oncologist when using short schedules because of the radiosensitivity of this organ at risk.Further study is necessary to assess the long-term clinical impact of this schedule.展开更多
BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our ca...BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.展开更多
BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma...BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.展开更多
Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympa...Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympano metric parameters between asymptomatic and symptomatic contralateral ears.Design:Prospective analytical clinical study Setting:Specialized(Ear,Nose,and Throat)clinic of a tertiary health institution.Participants:Patients with UPN ear trauma who presented within the first week of the incident.Main outcome measures:Otologic symptoms in the contralateral ear in UPN ear trauma Results:Eighteen out of 53 patients(34.0%)experienced symptoms in the contralateral ear.The symptoms were tinnitus in 77.8%(14/18),hearing loss in 66.7%(12/18),and ear blockage in 27.8%(5/18).There was hearing loss in 38/53(71.7%)of contralateral ears.Hearing loss type and PTAv at the low frequencies were not significantly different(p=0.142),but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears(p<0.05 in all).Type C tympanogram was more prominent in the symptomatic contralateral ear.There was a statistically-significant difference in the type of tympanogram between the two categories of patients(p=0.018).There was no difference in acoustic reflex between the two categories of patients(p=0.095).Conclusions:The contralateral ear may be affected in up to one-third of patients with UPN ear trauma,and experience otologic symptoms similar to those of the traumatized ears.Audiologic and audiometric parameters were abnormal in most of the contralateral ears.The two ears must be assessed thoroughly in cases of UPN ear trauma.展开更多
Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of ...Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,展开更多
文摘BACKGROUND Breast cancer is a leading cause of cancer-related mortality among women worldwide,with invasive ductal carcinoma(IDC)being the most prevalent subtype.Lymph node metastasis is the primary prognostic indicator,typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes.Contralateral axillary metastasis(CAM)without ipsilateral involvement is exceedingly rare,particularly in early-stage breast cancer.This report presents a case of CAM in a patient with triple-negative breast cancer(TNBC),underscoring diagnostic and therapeutic complexities.CASE SUMMARY A 73-year-old female presented with left-sided early-stage IDC in February 2023.Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes,a postoperative positron emission tomography(PET)scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla.Biopsy confirmed metastatic ductal carcinoma with triple-negative status,resulting in an upstaged diagnosis of metastatic breast cancer,stage IV,M1.The patient underwent six cycles of adjuvant chemotherapy,with follow-up PET imaging showing regression of the contralateral lesion.This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.CONCLUSION This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.
文摘In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.
文摘Objective To observe the differences in therapeutic effects on primary trigeminat neuralgia between contralateral needling technique and routine acupuncture. Methods One hundred and thirty cases were randomly divided into contralateral needling group and routine acupuncture group, 65 cases in each one. In contralateral needling group, contralateral needling technique was adopted on the acupoints on the opposite side corresponding to the affected face in neuralgia. According to the localization of trigeminal neuralgia, the points were selected. For example, for ophthalmologic branch, Yuyao （鱼腰 EX- HN 4） and Touwei （头维 ST 8） were selected as the main point. In routine acupuncture group, the corresponding acupoints were selected on the affected side of the face. The points were same as that in contralateral needling group, Three courses of treatment were required in two groups. The clinical efficacy was evaluated 4 weeks after the end of treatment. Results The total effective rate was 95.4% （62/65） in contralateral needling group, which was superior to that in routine acupuncture group E86.2% （56/65）1 （P〈0. 001）. Conclusion Contralateral needling technique achieves apparently superior effects on primary trigeminal neuralgia compared with routine acupuncture.
文摘Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.
基金supported by the National Natural Science Foundation of China,No.81572127(to JL)
文摘Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar nerve on the paralyzed side is harvested for transfer, which completely sacrifices its potential of recovery. In the present, novel study, we report on the anatomical feasibility of a modified contralateral C7 nerve transfer surgery. Ten fresh cadavers (4 males and 6 females) provided by the Department of Anatomy, Histology, and Embryology at the Medical College of Fudan University, China were used in modified contralateral C7 nerve transfer surgery. In this surgical model, only the dorsal and superficial branches of the ulnar nerve and the medial antebrachial cutaneous nerve on the paralyzed side (left) were harvested for grafting the contralateral (right) C7 nerve and the recipient nerves. Both the median nerve and deep branch of the ulnar nerve on the paralyzed (left) side were recipient nerves. To verify the feasibility of this surgery, the distances between each pair of coaptating nerve ends were measured by a vernier caliper. The results validated that starting point of the deep branch of ulnar nerve and the starting point of the medial antebrachial cutaneous nerve at the elbow were close to each other and could be readily anastomosed. We investigated whether the fiber number of donor and recipient nerves matched one another. The axons were counted in sections of nerve segments distal and proximal to the coaptation sites after silver impregnation. Averaged axon number of the ulnar nerve at the upper arm level was approximately equal to the sum of the median nerve and proximal end of medial antebrachial cutaneous nerve (left: 0.94:1;right: 0.93:1). In conclusion, the contralateral C7 nerve could be transferred to the median nerve but also to the deep branch of the ulnar nerve via grafts of the ulnar nerve without deep branch and the medial antebrachial cutaneous nerve. The advantage over traditional surgery was that the recovery potential of the deep branch of ulnar nerve was preserved. The study was approved by the Ethics Committee of Fudan University (approval number: 2015-064) in July, 2015.
基金supported by the National Natural Science Foundation of China,No.81572127
文摘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.
基金supported by the National Natural Science Foundation of China,No.H0605/81501871
文摘If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root ＋ posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root ＋ posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root ＋ posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root ＋ posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve.
基金the Exploration and Innovation Project from the First Teaching Hospital of Tianjin University of TCM(201921)。
文摘This pilot study is to assess the feasibility and the effect of a combination therapy of rehabilitation treatment and contralateral needling,which is manipulated at the foot of the unaffected side,for the recovery of the paretic hand post-stroke.This prospective pilot clinical trial will recruit 72 stroke patients with paretic hands and a disease course of 14 to 90 d.Patients will be randomized into two groups:the control group will receive conventional Xingnao Kaiqiao acupuncture and basic treatment for the stroke;based on the control group,the observation group will receive the contralateral needling at the foot of the unaffected side combined with the rehabilitation movement of the paretic hand.12 sessions will be administrated for 2 weeks.The primary outcome,FuglMeyer Assessment,and the secondary outcomes,the handgrip strength,the range of motion,the modified Barthel index,and the Brunnstrom recovery stages,will be measured the recovery of the hand motor function during the 2 weeks'intervention.This study aims to investigate the instant effect of contralateral needling at the foot of the unaffected side combined with the rehabilitation treatment movement for patients with the paretic hand of Poststroke motor dysfunction and provide the previous evidence for the future large sample studies.
基金supported by the National Natural Science Foundation of China,No.81601057(to JTY)
文摘Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, and results were improved by grafts laden with differentiated adipose stem cells. However, use of these tissue-engineered nerve grafts has not been reported for the treatment of brachial plexus injury. The aim of the present study was to evaluate the outcome of acellular nerve allografts seeded with differentiated adipose stem cells to improve nerve regeneration in a rat model in which the contralateral C7 nerve was transferred to repair an upper brachial plexus injury. Differentiated adipose stem cells were obtained from Sprague-Dawley rats and transdifferentiated into a Schwann cell-like phenotype. Acellular nerve allografts were prepared from 15-mm bilateral sections of rat sciatic nerves. Rats were randomly divided into three groups: acellular nerve allograft, acellular nerve allograft + differentiated adipose stem cells, and autograft. The upper brachial plexus injury model was established by traction applied away from the intervertebral foramen with micro-hemostat forceps. Acellular nerve allografts with or without seeded cells were used to bridge the gap between the contralateral C7 nerve root and C5–6 nerve. Histological staining, electrophysiology, and neurological function tests were used to evaluate the effect of nerve repair 16 weeks after surgery. Results showed that the onset of discernible functional recovery occurred earlier in the autograft group first, followed by the acellular nerve allograft + differentiated adipose stem cells group, and then the acellular nerve allograft group;moreover, there was a significant difference between autograft and acellular nerve allograft groups. Compared with the acellular nerve allograft group, compound muscle action potential, motor conduction velocity, positivity for neurofilament and S100, diameter of regenerating axons, myelin sheath thickness, and density of myelinated fibers were remarkably increased in autograft and acellular nerve allograft + differentiated adipose stem cells groups. These findings confirm that acellular nerve allografts seeded with differentiated adipose stem cells effectively promoted nerve repair after brachial plexus injuries, and the effect was better than that of acellular nerve repair alone. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University of China(approval No. 2016-150) in June 2016.
基金supported by the National Natural Science Foundation of China,No.81572130(to LQG)and 81601057(to JTY)the National Key Research and Development Plan of China,No.2016YFC1101603(to XLL)the Natural Science Foundation of Guangdong Province of China,No.2015A030310350(to JTY)
文摘Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017.
文摘Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Pre- vious studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth asso- ciated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function （including neuron differentiation and development, axonogenesis, and guidance）, microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light （NFL） and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteom- ic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer.
文摘Objective: To analyze the therapeutic effect of contralateral needling in the treatment of scapulohumeral periarthritis. Methods: A total of 68 cases of scapulohumeral periarthritis were outpatients and were randomized into treatment group (n=36) and control group (n=32). In treatment group, Zhiyin (BL 67), Jinmen (BL 63) and Yanglao (SI 6) on the contralateral side of the affected shoulder and local tenderpoints (Ashi-points) were punctured once every other day, with 7 days being a therapeutic course; while in control group, local Ashi-points were used for injection of Procaine and Prednisolone Acetate, once every 7 days and with 3～4 sessions being a therapeutic course. Results: Following 2 courses of treatment, of the 32 cases in control group, 8 (25.0%) were cured, 17 (53.1%) experienced improvement and 7 failed in the treatment, with a total of effective rate of 78.1%; of the 36 cases in treatment group, 18 (50.0%) were cured, 16 (44.4%) experienced improvement and 2 (5.6%) failed in the treatment, with a total effective rate of 94.4%. The therapeutic effect of contralateral needling is significantly higher than that of Ashi-point blocking method (P<0.05). Conclusion: Contralateral needling is superior to Ashi-point in the treatment of scapulohumeral periarthritis.
文摘An 89-year-old woman[body mass index(BMI)=20.27 kg/m^2)]with hypertension underwent implantation of a dual-chamber pacemaker because of dizziness and syncope due to sick sinus syndrome.Pacemaker implantation via the left subclavian approach was performed on June 3,2017.A right ventricular active lead(TendrilTM STS 2088TC,St Jude Medical,Penang,Malaysia)and an atrial active lead(OptisenseTM 1999,St Jude Medical,Penang,Malaysia)were placed in the right ventricular apex and anterior wall of the right atrium,respectively.
文摘Contralateral needling method is a common and effective one of acupuncture analgesicmethods.It is used to treat a local pain in the limbs and trunk with a short course of disease,pain and swelling will disappear or be relieved immediately for one or two treatments.Really,there isan effect of relieving pain as soon as the needle is inserted.When the local contralateral needlingmethod is used,the key to improving the effectiveness lies in determining the pain position and its correspondingpoint correctly,the more correct the pain position and its corresponding point are determined,the better the effectiveness will be.In this group,80 cases soft tissue injury were treatedwith local contralateral needling method,the cure rate was 82％,and the total effective rate was100％.
基金supported by Canadian Institutes of Health Research(CIHR)grants#74747 and#14238(both to VMKV)Natural Sciences and Science and Engineering Research Council(NSERC)of Canada grant(to VM)supported by University of Saskatchewan College of Graduate and Postdoctoral Studies Scholarships。
文摘Emerging evidence supports that the stress response to peripheral nerve injury extends beyond the injured neuron,with alterations in associated transcription factors detected both locally and remote to the lesion.Stress-induced nuclear translocation of the transcription factor forkhead class box O3a(FOXO3a)was initially linked to activation of apoptotic genes in many neuronal subtypes.However,a more complex role of FOXO3a has been suggested in the injury response of sensory neurons,with the injured neuron expressing less FOXO3a.To elucidate this response and test whether non-injured sensory neurons also alter FOXO3a expression,the temporal impact of chronic unilateral L4–6 spinal nerve transection on FOXO3a expression and nuclear localization in adult rat dorsal root ganglion neurons ipsilateral,contralateral or remote to injury relative to na?ve controls was examined.In na?ve neurons,high cytoplasmic and nuclear levels of FOXO3a colocalized with calcitonin gene related peptide,a marker of the nociceptive subpopulation.One hour post-injury,an acute increase in nuclear FOXO3a in small size injured neurons occurred followed by a significant decrease after 1,2 and 4 days,with levels increasing toward pre-injury levels by 1 week post-injury.A more robust biphasic response to the injury was observed in uninjured neurons contralateral to and those remote to injury.Nuclear levels of FOXO3a peaked at 1 day,decreased by 4 days,then increased by 1 week post-injury,a response mirrored in C4 dorsal root ganglion neurons remote to injury.This altered expression contralateral and remote to injury supports that spinal nerve damage has broader systemic impacts,a response we recently reported for another stress transcription factor,Luman/CREB3.The early decreased expression and nuclear localization of FOXO3a in the injured neuron implicate these changes in the cell body response to injury that may be protective.Finally,the broader systemic changes support the existence of stress/injury-induced humeral factor(s)influencing transcriptional and potentially behavioral changes in uninjured dorsal root ganglion neurons.Approval to conduct this study was obtained from the University of Saskatchewan Animal Research Ethics Board(protocol#19920164).
文摘AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiotherapy.METHODS:Thirty-four prospectively selected female patients with right breast cancer (pN0,negative surgical margins) were treated with breast-conserving surgery.A total dose of 42.5 Gy (2.66 Gy/fraction) was prescribed;it was requested that planning target volumes be covered by the 95% isodose line.The contralateral mam-mary gland was defined on CT simulation.The dose received was evaluated by dose volume histograms.RESULTS:The measured contralateral breast doses were:(1) Dose maximum:290-448 cGy [Equivalent (Eq) 337-522 cGy];(2) Mean dose:45-70 cGy (Eq 524815 cGy);and (3) Median dose:29-47 cGy (337-547 cGy) for total primary breast dose of 42.5 Gy in 16 equal fractions.The spearman rho correlation showed statistical significance between the contralateral breast volume and maximum dose (P=0.0292),as well as mean dose (P=0.0025) and median dose (P=0.046) to the breast.CONCLUSION:Minimizing the dose to the contralateral breast has to be one of the priorities of the radiation oncologist when using short schedules because of the radiosensitivity of this organ at risk.Further study is necessary to assess the long-term clinical impact of this schedule.
基金Supported by The Project of Shanghai Municipal Health Commission,No. 20214Y0223
文摘BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.
文摘BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.
文摘Objectives:To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive(UPN)ear trauma and to compare the audio metric and tympano metric parameters between asymptomatic and symptomatic contralateral ears.Design:Prospective analytical clinical study Setting:Specialized(Ear,Nose,and Throat)clinic of a tertiary health institution.Participants:Patients with UPN ear trauma who presented within the first week of the incident.Main outcome measures:Otologic symptoms in the contralateral ear in UPN ear trauma Results:Eighteen out of 53 patients(34.0%)experienced symptoms in the contralateral ear.The symptoms were tinnitus in 77.8%(14/18),hearing loss in 66.7%(12/18),and ear blockage in 27.8%(5/18).There was hearing loss in 38/53(71.7%)of contralateral ears.Hearing loss type and PTAv at the low frequencies were not significantly different(p=0.142),but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears(p<0.05 in all).Type C tympanogram was more prominent in the symptomatic contralateral ear.There was a statistically-significant difference in the type of tympanogram between the two categories of patients(p=0.018).There was no difference in acoustic reflex between the two categories of patients(p=0.095).Conclusions:The contralateral ear may be affected in up to one-third of patients with UPN ear trauma,and experience otologic symptoms similar to those of the traumatized ears.Audiologic and audiometric parameters were abnormal in most of the contralateral ears.The two ears must be assessed thoroughly in cases of UPN ear trauma.
文摘Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,
