Ketamine suppresses endotoxin-induced NF-kappaB activation and cytokines production in the intestine

BACKGROUND

Ketamine has been advocated for anesthesia in endotoxemic and other severely ill patients because it is a cardiovascular stimulant. However, ketamine also suppresses serum levels of endotoxin-induced tumor necrosis factor-alpha, and reduces mortality in mice in endotoxin shock. Our study was designed to investigate the protective effect of ketamine on the endotoxin-induced proinflammatory cytokines and nuclear factor kappa B (NF-kappaB) activation in vivo.

METHODS

Adult male Wistar rats were randomly divided into six groups: saline controls; rats challenged with endotoxin (5 mg kg(-1)) and treated with saline; challenged with endotoxin (5 mg kg(-1)) and treated with ketamine (0.5 mg kg(-1)); challenged with endotoxin (5 mg kg(-1)) and treated with ketamine (5 mg kg(-1)); challenged with endotoxin (5 mg kg(-1)) and treated with ketamine (50 mg kg(-1)); and saline injected and treated with ketamine (50 mg kg(-1)). TNF-alpha, IL-6 and NF-kappaB were investigated in the tissues of the intestine (jejunum) after 1, 4 and 6 h.

RESULTS

Endotoxin caused transient production of TNF-alpha and IL-6 and activation of NF-kappaB in the intestine at peak times of 1, 4 and 1 h, respectively. Ketamine 0.5 mg kg(-1) suppressed endotoxin-induced TNF-alpha elevation and inhibited NF-kappaB activation in the intestine; a dose of 5 mg kg(-1) was required to inhibit IL-6.

CONCLUSION

Ketamine suppresses the production of proinflammatory cytokines such as TNF-alpha and IL-6 in the intestine, possibly via inhibition of NF-kappaB.

Naloxone increases vascular responsiveness in chronic morphine treated rats and facilitates intracellular signaling in cultured vascular cells

AIM

To probe the changes of vascular responsiveness and intracellular signaling during opiate withdrawal syndrome.

METHODS

Morphine withdrawal syndrome in rats was precipitated by iv naloxone following daily injection of increasing dose of morphine for 2 weeks, the changes in mean arterial blood pressure (MBP) caused by acetylcholine (ACh) were recorded. Isolated mesenteric vascular beds were perfused with Kreb's solution containing different concentration of drugs. The cytoplasmic Ca2+ ([Ca2+]i) in Fura 2-loaded cultured bovine aortic endothelial cells (aec) and smooth muscle cells (smc) were assayed. The positive immunoreaction to the phosphorylated cyclic AMP responsive element-binding protein (phospho-CREB) in cultured smc was calculated.

RESULTS

Naloxone 2 mg/kg iv following chronic morphine treatment precipitated severe opiate withdrawal signs in company with blunted hypotensive effect of Ach that was the same as chronic morphine treated rats before withdrawal. In the mesenteric vascular beds from chronic morphine treated rats, the EC50 of pressor effect of norepinephrine (NE) was decreased from (2.06 +/- 0.38) to (1.14 +/- 0.21) micromol/L (n = 8, P < 0.01) after the perfusion solution containing morphine 20 micromol/L was replaced by Kreb's containing naloxone 25 micromol/L. Furthermore, NE-induced perfusion pressure increases were completely prevented by Kreb's contained morphine 40 micromol/L. Morphine acutely applied to control smc produced some variable and naloxone-reversible [Ca2+]i changes, but naloxone did not. However, naloxone increased [Ca2+]i in two thirds of smc preincubated with morphine 0.1 or 0.5 mmol/L for 48 h from (97 +/- 20) to (167 +/- 29) nmol/L (n = 9, P < 0.01) and from (106 +/- 19) to (225 +/- 48) nmol/L (n = 10, P < 0.01), respectively, and it also increased the ratio of positive immunoreaction to phospho-CREB from (7.7 +/- 3.2) % to (19.6 +/- 4.7) % (n = 6, P < 0.01) in smc preincubated with morphine 0.5 mmol/L. In addition, naloxone decreased [Ca2+]i from (146 +/- 34) to (78 +/- 24) nmol/L in one third morphine-preincubated aec (n = 10, P < 0.01).

CONCLUSION

That naloxone enhances vascular responsiveness to NE in chronic morphine treatment rats may be relevant to [Ca2+]i transient facilitation in company with cAMP-dependent phosphorylation enhancement.

Phrenic nerve conduction study in patients with traumatic brachial plexus palsy

Phrenic nerve conduction studies were performed to assess the ipsilateral nerve in 100 patients with traumatic brachial plexus palsy. Open exploration and intraoperative recordings of somatosensory evoked potentials and nerve action potentials were used to confirm the level of root lesions. The relationship between C-5 preganglionic root lesion and the functional integrity of the ipsilateral phrenic nerve was examined. The phrenic nerves were normal in 80 cases, partially injured in 7, and severely injured in 13. We found C-5 preganglionic root lesions in 13 (100%) patients with severely injured, 5 (71.4%) with partially injured, and 24 (30%) with normal phrenic nerves. This correlation suggests phrenic nerve conduction study is a useful tool in the diagnosis of C-5 preganglionic root lesions in patients with traumatic brachial plexopathy.

Fluorescence immunoassay system based on the use of a pH-sensitive phase-separating polymer

Poly(N-isopropylacrylamide-co-methacrylic acid) [P(NIPAAm-co-MAA)], a linear water-soluble pH-sensitive phase-separating polymer, was synthesized and used as a novel separation carrier for the reactants in immunoassay. This polymer precipitates out of water below a critical pH 5.8 at 37 degrees C and redissolves when the pH of solution is above 6.2. The characteristic of this polymer makes it possible to carry out the immunochemical steps of an immunoassay in a true solution and then to quickly separate the resulting product from the reaction mixture. The above approach was applied to determination of alpha-fetoprotein with the competitive immunoassay format. Compared with traditional ELISA using the same reactants, the proposed method was much faster (the assay time decreased from 100-120 to 30 min) and showed similar sensitivity, i.e., 0.04 ng/mL. In addition, a sandwich immunoassay method for the determination of hepatitis B surface antigen was also studied, and the results showed that the pH phase-separating immunoassay could be carried out through a sandwich or a competitive method. This general technique may also be used for a wide variety of separation processes in addition to immunoassay, in which a specific component is to be isolated for analysis, recovery, or disposal.

[Culture of human muscle satellite cell]

OBJECTIVE

To investigate the biological characteristics of human muscle satellite cell cultured in vitro.

METHODS

Human muscle satellite cells were obtained from skeletal muscle biopsies of six patients during corrective orthopedic surgery, cultivated in growth medium for ten days, then in differentiation medium for additional five days. Human satellite cells were identified with monoclonal antibody against desmin. Cells were observed under phase contrast microscopy.

RESULTS

Human muscle satellite cells proliferated in growth medium, and fused to form myotubes in differentiation medium. After 24 hours in differentiation medium, the confluent satellite cells began to fuse actively and achieved the top level at 72 hours.

CONCLUSION

Human muscle satellite cell can proliferate and differentiate in appropriate culture condition. Immunocytochemical detection of desmin is the effective early method to determine satellite cell.

Fluorescence immunoassay of alpha-fetoprotein with iron(III) tetrasulfonatophthalocyanine as a mimetic enzyme labeling reagent

A new fluorimetric immunoassay for alpha-fetoprotein (AFP) has been developed using a novel promising mimetic peroxidase, iron(III) tetrasulfonatophthalocyanine (FeTSPc), as a labeling reagent to catalyze the fluorescence reaction of P- hydroxyphenylacetic acid (P-HPA) and hydrogen peroxide (H2O2). In the competitive immunoassay, anti-AFP antibody was coated on a 96-well plate (polystyrene) and a constant amount of FeTSPc-labeled AFP and a known amount of test solution were added. Non-labeled and FeTSPc-labeled AFP compete for binding to the plate-bound antibody. After the immunoreaction, the immunochemically adsorbed FeTSPc-AFP conjugate moiety was determined by measuring the fluorescence produced in a solution containing P-HPA and H2O2. AFP can be determined in the concentration range of 1-300 ng mL(-1) with a detection limit of 0.5 ng mL(-1).

Determination of nucleic acids based on shifting the association equilibrium between tetrasulfonated aluminium phthalocyanine and acridine orange

Based on the ability of nucleic acids to shift the association equilibrium of the ion-association complex of Acridine Orange and tetrasulfonated aluminium phthalocyanine, thus leading to an increase in the phthalocyanine fluorescence, a method is suggested for the fluorimetric determination of nucleic acids. Investigations were carried out on the spectral characteristics, order of addition of reagents, selection of the buffer system, effect of pH, influence of reaction time, effect of salt, the usage of reagents, interference of foreign substances and the effect of different acridine derivatives. Under the optimum conditions, the calibration graphs for the determination of calf thymus DNA (CT DNA), salmon DNA (SM DNA) and yeast RNA were linear over the ranges 0.04-1.2, 0.04-1.2 and 0.1-1.2 micrograms cm-1, respectively. The detection limits for CT DNA, SM DNA and RNA were 17, 24 and 98 micrograms cm-3, respectively. The relative standard deviation (n = 6) was within 4.6% for the detection of samples. The method was applied to the determination of Staphylococcus aureus DNA and the result was in agreement with that achieved by a UV method.

A new red-region substrate, tetra-substituted amino aluminium phthalocyanine, for the fluorimetric determination of H2O2 catalyzed by mimetic peroxidases

A new red-region fluorogenic substrate, tetra-substituted amino aluminium pthalocyanine, was developed for the selective determination of H2O2 based on the catalytic effect of mimetic peroxidases, viz., hemin or iron tetrasulfonatophthalocyanine (FeTSPc). Under the optimum conditions, the linearity of the calibration graph for the determination of H2O2 with hemin (or FeTSPc) as the catalyst was in the range from 0.0 to 3.0 x 10(-7) mol L-1 (or from 0.0 to 2.0 x 10(-6) mol L-1). The detection limits were 3.7 x 10(-9) and 4.9 x 10(-9) mol L-1 H2O2, respectively. The relative standard deviation (n = 7) was within 1.5% in the middle of the linear range. The peroxidase activity of the mimetic enzymes hemin and FeTSPc, the effects of some experimental conditions and the influence of foreign substances were investigated. With this substrate, 0.0-7.5 x 10(-8) mol L-1 hemin and 0.0-2.0 x 10(-6) mol L-1 FeTSPc can be determined with an accuracy and precision of about 1.3%. The potential application of the reagent was tested by the determination of H2O2 in rainwater.

Development of a chromosome-plasmid balanced lethal system for Lactobacillus acidophilus with thyA gene as selective marker

A chromosome-plasmid balanced lethal gene delivery system for Lactobacillus acidophilus based on the thyA gene was developed. The selected L. acidophilus DOM La strain carries a mutated thyA gene and has an obligate requirement for thymidine. This strain can be used as a host for the constructed shuttle vector pFXL03, lacking antibiotic-resistant markers but having the wild-type thyA gene from L. casei which complements the thyA chromosomal mutation. The vector also contains the replicon region from plasmid pUC19 and that of the Lactococcus plasmid pWV01, which allows the transfer between Escherichia coli, L. casei and L. acidophilus. Eight unique restriction sites (i.e., PstI, HindIII, SphI, SalI, AccI, XbaI, KpnI and SacI) are available for cloning. After 40-time transfers in modified MRS medium, no plasmid loss was observed. The vector pFXL03 is potentially useful as a food-grade vaccine delivery system for L. acidophilus.

Sensitive fluorimetric determination of formaldehyde by the co-quenching effect of formaldehyde and sulfite on the fluorescence of tetra-substituted amino aluminium phthalocyanine

A novel and sensitive fluorimetric method was developed for the determination of formaldehyde based on the co-quenching effect of formaldehyde and sulfite on the fluorescence of tetra-substituted amino aluminium phthalocyanine. Formaldehyde in the concentration range 0.040-1.19 micrograms ml-1 can be determined with a limit of detection of 7.5 ng ml-1. The relative standard deviation for nine replicate measurements of 80.0 ng ml-1 formaldehyde is 1.8%. The method was applied to the analysis of real samples with satisfactory results.

High-pathogenicity island of Yersinia spp. in Escherichia coli strains isolated from diarrhea patients in China

The high-pathogenicity island (HPI) of Yersinia has been observed in 93% of 60 enteroadhesive Escherichia coli strains and 80% of E. coli strains isolated from blood samples. In the present study we investigated 671 fecal samples from patients with diarrhea in Shandong Province, China, and isolated HPI-harboring E. coli from 6. 26% of the samples. The isolation rates for patients with diarrhea in three age groups, 10 to 20, 30 to 40, and 50 to 60 years, were 6. 70, 12.35, and 10.81%, respectively. Therefore, HPI-harboring E. coli is the third most frequently isolated enteric pathogen from patients with diarrhea. Vomiting and abdominal pain were recorded for 33.33 and 66.67% of the patients, respectively. Stools with blood were observed for 9.52% of the patients. Twenty-four of 42 (57%) patients experienced a temperature over 37.4 degrees C. These observations indicate that HPI-harboring E. coli is one of the major causes of diarrheal disease in China and that the clinical symptoms caused by HPI-harboring E. coli differ from those caused by enteroadhesive E. coli.

A novel mimetic enzymatic fluorescence immunoassay for hepatitis B surface antigen by using a thermal phase separating polymer

Iron tetrasulfonatophthalocyanine (FeTSPc), a peroxidase mimic, was used as a labeling reagent and poly(N-isopropylacrylamide) (PNIP) as the separation support of the immune complex for the mimetic-enzymatic immunoassay of hepatitis B surface antigen (HBsAg). PNIP was precipitated from aqueous solution when the ambient temperature was higher than its lower critical solution temperature of 31 degrees C. In a sandwich immunoassay, the antigen (HBsAg) first reacted with mouse anti-human HBsAg antibody immobilized on PNIP (PNIP-antibody) and then further reacted with FeTSPc-labeled mouse anti-HBsAg antibody (antibody-FeTSPc) at room temperature in a homogeneous format. After changing the temperature to separate the PNIP-antibody-HBsAg-antibody-FeTSPc conjugate moiety, it was re-dissolved and determined by coupling with the fluorogenic reaction of hydrogen peroxide and p-hydroxyphenylpropionic acid. The sensitivity of this method (3 ng mL-1) was close to that of the traditional ELISA using the same reactants. However, the assay was much faster (the assay time decreased from 100-120 to 45 min). This method was applied to determine HBsAg in human serum with satisfactory results.

A novel method for the determination of total protein in human serum by near infrared fluorescence recovery

A novel fluorometric method has been developed for the determination of total protein in human serum with a new near-IR reagent as a fluorescence probe, based on the fluorescence recovery of the cyanine-CTAB system in the presence of protein. Maximum fluorescence is produced with maximum excitation and emission wave-lengths at 765 and 812 nm, respectively. Under optimal conditions, the calibration graphs are linear over the range 0.4-12.0 microg/mL for protein. The detection limit is 70 ng/mL, and the relative standard deviation of six replicate measurements is 1.14% for 6.0 microg/mL protein. The results are satisfactory.

Determination of proteins at nanogram levels by their quenching effect on large particle scattering of colloidal silver chloride

A novel quantitative method for the determination of proteins in aqueous solutions has been based on the quenching of the resonance scattering light of colloidal silver chloride in the presence of proteins. The detection limits for eight kinds of proteins (BSA, HSA, egg albumin, human gamma-IgG,alpha-chymotrypsin, E. Coli. alpsase, myoglobin, alpha-casein) were at about 8 ng/mL; the linear ranges of the calibration curves were 10-400 ng/mL under optimal conditions,except for human gamma-IgG (20-400 ng/mL), myoglobin (10-300 ng/mL), and alpha-casein (10-300 ng/mL). Three wavelengths (398 nm, 475 nm, 499 nm) were all suitable for the determination and any acidity from pH 3.0 to pH 9.0 could be chosen. A few non-protein substances at high concentration levels interfered with this method, but this problem could simply be overcome by diluting the samples before the assay. Mechanism studies showed that the quenching effect of proteins on the scattering light of colloidal silver chloride was mainly due to the coagulation of AgCl particles retarded by protein. The method was employed for the determination of total protein in human serum with satisfactory results.

Cationic cyanine as a near-infrared fluorescent probe for the determination of nucleic acids

A new method with a cationic near-IR cyanine as fluorescent probe was developed for the determination of nucleic acids. The near-IR cyanine shows maximum excitation and emission wavelengths at 765 and 790 nm, respectively, in aqueous solution. The method is based on the fluorescence decrease of near-IR cyanine in the presence of nucleic acids. Under optimal conditions, the ratio of fluorescence intensity in the absence and presence of nucleic acids was proportional to the concentration of nucleic acids over the range 0.10-1.2 microg/mL for CT (calf thymus) DNA or SM (salmon sperm) DNA, and 0.10-1.6 microg/mL for yeast RNA. The detection limits were 30 ng/mL for CT DNA, 25 ng/mL for SM DNA and 70 ng/mL for yeast RNA. The relative standard deviation (n = 6) was 2.1% for 500 ng/mL CT DNA, 2.4% for 500 ng/mL SM DNA and 2.7% for 500 ng/mL yeast RNA, respectively.

Vascular anatomic variations in second toe transfers

To devise a new classification of vascular variations in second toe transfer we analyzed the anatomic details of the first dorsal metatarsal artery in 304 cases of second toe transplantation and the venous structure in 200 cases. According to location, the arterial vascularity was classified as superficial (18% of cases), intramuscular (54%), inframuscular (23%), and absent (5%). According to diameter, it was classified into large (16%), medium (64%), and small (20%). Based on branching pattern, the artery was classified into ramifying type (88%), main trunk (4%), and fine branch type (8%). The venous drainage of the second toe was categorized as greater saphenous vein main trunk type, greater saphenous vein fine branch type, dorsal digital vein main trunk type, and dorsal digital vein fine branch type. Variations of the first dorsal metatarsal artery are common. Classification should be done according to its location, diameter, and branching pattern at the toe web. Regardless of location, big vessels entering the second toe are the most important attribute for successful outcome.

Application of magdala red as a fluorescence probe in the determination of nucleic acids

A fluorescence quenching method was developed for the rapid determination of DNA and RNA using magdala red as fluorescence probe. In weakly acidic medium, the fluorescence of magdala red (lambdaex/lambdaem = 540/555 nm) can be largely quenched by DNA or RNA. The calibration graphs are linear over the range 0.01-1.2 microg/mL for both calf thymus DNA (CT DNA) and salmon DNA (SM DNA), and 0.015-1.0 microg/mL for yeast RNA, respectively. The corresponding detection limits are 6.0 ng/mL for CT DNA, 7.0 ng/mL for SM DNA and 15.0 ng/mL for yeast RNA, respectively. CT DNA could be determined in the presence of 20% (w/w) yeast RNA, and the relative standard deviation of six replicate measurements is 3.18% for 400 ng/mL of CT DNA. Interference from coexisting substances in the determination of DNA was also examined. Real samples were determined with satisfactory results.

Fibrillation potential amplitude to quantitatively assess denervation muscle atrophy

Denervated muscle fibers exhibit spontaneous, repetitive single muscle fiber discharges and display fibrillation potentials detectable by electromyography. To explore the changing pattern of fibrillation potential amplitude after peripheral nerve injury and its relationship to the degree of muscle atrophy, fibrillation potential amplitudes were recorded on completely denervated biceps brachii of 173 patients with brachial plexus injury. Biceps brachii biopsies were taken at the same sites as the electromyogram recordings in 63 patients. The biopsies were analyzed by ATPase staining and the cross-sectional areas of fast and slow-twitch fibers were calculated. We found that the fibrillation potential amplitude and the cross-sectional areas of denervated muscle decay over time (P < 0.05), and both correlate negatively with denervation time (P < 0.01-0.05) within the first 15 months. The fibrillation potential amplitude correlates positively with both type I and II fiber cross-sectional areas (P < 0.0005-0.01). Our results show that fibrillation potential amplitude is closely correlated with muscle fiber size during the first 15 months after nerve injury, and it may therefore serve as a convenient index to evaluate quantitatively the degree of atrophy of denervated muscles. Electromyographic studies thus may help in designing treatment strategies.

[Immunohistochemical study of S-100 protein in degenerative nerve after different pathological brachial plexus injuries]

OBJECTIVE

To explore the regularity of the change of S-100 protein in degenerative nerve after different pathological brachial plexus injuries.

METHODS

Eighty SD rats were randomly divided into two groups, right C5, C6 preganglionic injury, and postganglionic injury. The distribution and content of S-100 protein in distal degenerative nerve were detected after 1, 2, 3 and 6 months of injury by immunohistochemical methods.

RESULTS

The S-100 protein was mainly distributed along the axons. The S-100 protein positive axons of each time interval decreased after operation, with significant difference from normal nerves (P < 0.01). There was no statistically significant difference among 1, 2, 3 and 6 months group (P > 0.05). The S-100 protein stain of postganglionic group was negative.

CONCLUSION

In preganglionic injury, the functional expression of Schwann's cells in the distal stump keeps at a certain level and for a certain period. Since Schwann's cell has inductive effect on nerve regeneration, it suggests that the distal nerve stump in preganglionic injury can be used as nerve grafts.

[Experimental study of morphology and electrophysiology on denervated skeletal muscle]

OBJECTIVE

In order to provide the scientific basis to find out a practical and effective method to evaluate the degree of muscle atrophy and a better method of prevention and treatment of skeletal muscle atrophy.

METHODS

Forty-two adult Spray-Dawley rats were used and the model of denervated gastrocnemius muscle was established by cutting off the tibial nerve. The muscle wet weight, diameter and cross section area of myocyte were measured. The motor end-plate, fibrillation potential amplitude and frequency of denervated skeletal muscle were observed.

RESULTS

The muscle wet weight rapidly reduced within 4 weeks. Afterwards, it maintained about 30 per cent of normal value, and the diameter and cross section area of myocyte progressively reduced. The motor end-plate slightly changed within 4 weeks, but its degeneration accelerated in 6 weeks and disappeared after 16 weeks. The fibrillation potential amplitude was maximum at 2 weeks and it progressively reduced after 12 weeks of muscle denervation. The changes of amplitude and frequency were consistent with the degeneration of end-plate.

CONCLUSION

The muscle wet weight, diameter and cross section area of myocyte, fibrillation potential amplitude and frequency could be considered as the morphological and electrophysiological indexes of muscle atrophy degree. It's suggested that the repairing operation of peripheral nerve should be performed before the disappearance of motor end-plate.

gamma-Radiation Synthesis of the Nanocrystalline Semiconductors PbS and CuS

The nanocrystalline semiconductors PbS and CuS were prepared by gamma-irradiation at room temperature in an ethanol system for the first time. Carbon disulfide was used as the sulfur source; lead acetate and copper chloride were used as metal ion sources. X-ray Powder Diffraction was used to characterize the products and Transmission Electron Microscopy to determine their morphology. The purity and compositions of the products were examined by X-ray photoelectron spectra. The photoluminescence property of as-prepared PbS was studied. A blue shift was observed in the PL spectra, indicating the quantum size effect on nanocrystalline PbS. Copyright 1999 Academic Press.

Interaction of a novel red-region fluorescent probe, Nile blue, with DNA and its application to nucleic acids assay

A novel fluorimetric method was developed for the rapid determination of DNA and RNA based on their quenching effect on the cationic red-region fluorescent dye Nile Blue (NB). In the investigation of the interaction of NB with DNA by steady-state polarization measurements, thermal denaturing study, determination of absorption and fluorescence characteristics, salt effect study and electrophoresis experiments, the results supported the suggestion that NB served as an intercalator to the stack base pairs of nucleic acids. Further evidence showed that the quenching could be ascribed to the static quenching mode. A binding constant of about 10(6) M-1 and a binding site size of about three base pairs were obtained by spectral methods. Under optimum conditions, the calibration curves for the determination of calf thymus DNA (CT DNA) and yeast RNA were linear over the ranges 3.0 ng mL-1-2.0 micrograms mL-1 and 27 ng mL-1-10 micrograms mL-1, respectively. The detection limits were 3.0 ng mL-1 for CT DNA and 27 ng mL-1 for RNA. The relative standard deviation (n = 6) was within 2.1% in the middle of the linear range. Interferences from some interesting co-existing substances in the determination of DNA were also examined.

An apoptotic response by J774 macrophage cells is common upon infection with diarrheagenic Escherichia coli

Representative strains of the different diarrheagenic Escherichia coli virotypes were tested for their potential cytotoxicity in the J774 macrophage cell line. All the seven virotypes of E. coli were cytotoxic to J774 macrophages, and in most cases the bacteria induced an apoptotic response. With the exception of the enterotoxigenic E. coli (ETEC) strain, all the other six virotypes caused induction of apoptosis as evidenced by quantitative analysis of the characteristic DNA fragmentation at the individual cell level. These results suggest that apoptosis could be one of the mechanisms contributing to the diarrheal disease development.

Femoral nerve transfer for treatment of brachial plexus root avulsion

Femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was performed to determine its protective effect on the hand intrinsic muscles. Seven cases of brachial plexus root avulsion treated from May of 1989 to October of 1991 were involved. The femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was done at the same stage of multiple neurotization. The muscular branches derived from the femoral nerve were isolated and coapted with the thenar muscle branch of the median nerve and the deep branch of the ulnar nerve. A groin flap was harvested simultaneously to form a skin-tube pedicle that covered the nerve bridge. At the second stage, when regeneration of the median and ulnar nerves was found to reach as far as the level of the wrist, the femoral nerve was divided and the muscular branches of the thenar and hypothenar muscles were anastomosed with the regenerated median and ulnar nerves. All the cases were followed up for more than 6 years. Six months after femoral nerve transfer, muscle power of the interosseous muscles and adductor pollicis recovered to MRC3, whereas that of the abductor pollicis brevis recovered to MRC1 to 2. Five cases underwent second-stage transfer. Four to five years of follow-up revealed that the muscle power of the interosseous muscles and adductor pollicis was MRC2 in one case, MRC1 in three cases, and MRC0 in one case. As for the donor area, muscle power of the quadriceps femoris reduced to M3 to 4 within 1 month after femoral nerve transfer and recovered to normal at 3 months. In conclusion, femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles has some protective effect on the hand intrinsic muscles. The outcome of the second stage, however, is not satisfactory.