Deep branch of the radial nerve in lateral surgical approaches to the radial head - A cadaveric study

INTRODUCTION

The traditional Kocher approach for lateral radial head exposure may be complicated by injury to the deep branch of the radial nerve (DBRN) and the radial collateral ligament. Kaplan approach is less commonly used, due to its known proximity to the DBRN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of radial collateral ligament injury. The comparison of the proximity of the DBRN to the surgical dissection at the level of radial head among approaches to the radial head has not previously been evaluated. We aimed to determine the anatomical proximity of the DBRN in these 3 common radial head approaches and to define a safe zone of dissection for the surgical exposure.

METHODS

Cadaveric dissections of 9 pairs of fresh frozen upper extremities were performed using EDC splitting, Kaplan and Kocher approach to the radial head sequentially in a randomized order. A mark was made on the radial head upon initial exposure during dissection. Measurements from the marked point of the radial head to the DBRN were made at the level of radial head.

RESULTS

The distance of DBRN to the radial head was 20 (17-22) mm in EDC splitting approach, 7 (3-11) mm in Kaplan approach and 29 (25-33) mm in Kocher approach. The EDC splitting approach was associated with a significantly lower chance of encountering the DBRN at the level of radial head as compared to the Kaplan approach (P<0.001). In all cases, lateral ligamentous complex was not exposed in Kaplan and EDC approaches, but were encountered in Kocher approach, risking injury to the radial collateral ligament.

CONCLUSIONS

The EDC splitting approach provides adequate exposure without the need to elevate or retract the EDC and ECU muscle mass that could risk injuring the DBRN. The Kaplan approach should be done by experienced surgeons who are familiar with the anatomy in this region, with extreme caution due to proximity of the DBRN to the surgical dissection at the level of the radial head. Caution of the DBRN should be taken during anterior elevation and retraction of the muscle mass in Kocher approach.

LEVEL OF EVIDENCE

IV.

Cardiovascular MRI with ferumoxytol

The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.

Association of glutathione S-transferase (GST) genetic polymorphisms with treatment outcome of cisplatin-based chemotherapy for advanced non-small cell lung cancer in a Chinese population

The aim of this study was to evaluate the association of GSTM1 null/present, GSTT1 null/present, and GSTP1 IIe105Val polymorphisms with the chemotherapy response and overall survival of advanced NSCLC. Two hundred and sixty-two patients with histologically confirmed advanced NSCLC (inoperable TNM stages IIIA, IIIB, and IV) were enrolled to this hospital-based study between May 2009 and May 2012. The GSTM1 null/present, GSTT1 null/present, and GSTP1 IIe105Val polymorphisms were genotyped by polymerase chain reaction coupled with restriction fragment length polymorphism. A logistic regression analysis revealed a correlation between the null genotype of GSTM1 and improved response to chemotherapy [odds ratio = 1.82; 95% confidence interval (CI) = 1.06-3.14]. Analyses with the Cox proportional hazards model also indicated that the null genotype of GSTM1 was associated with lower risk of death (hazard ratio = 0.40; 95%CI = 0.23-0.69). In conclusion, the null genotype of GSTM1 was found to be correlated with improved response to chemotherapy and lower risk of death in advanced NSCLC patients.

Plant centromeres

Plant centromeres are generally composed of tandem arrays of simple repeats that are typical of a particular species, but that evolve rapidly. Centromere specific retroelements are also present. These arrays associate with a centromere specific variant of histone H3 that anchors the site of the kinetochore. Although such DNA arrays are typical of the centromere, the specification of centromere activity has an epigenetic component as shown by the fact that centromeres are formed in the absence of such repeats and that centromeres in dicentric chromosomes regularly undergo inactivation.

Scaffolding protein Homer1a protects against NMDA-induced neuronal injury

Excessive N-methyl-D-aspartate receptor (NMDAR) activation and the resulting activation of neuronal nitric oxide synthase (nNOS) cause neuronal injury. Homer1b/c facilitates NMDAR-PSD95-nNOS complex interactions, and Homer1a is a negative competitor of Homer1b/c. We report that Homer1a was both upregulated by and protected against NMDA-induced neuronal injury in vitro and in vivo. The neuroprotective activity of Homer1a was associated with NMDA-induced Ca²⁺ influx, oxidative stress and the resultant downstream signaling activation. Additionally, we found that Homer1a functionally regulated NMDAR channel properties in neurons, but did not regulate recombinant NR1/NR2B receptors in HEK293 cells. Furthermore, we found that Homer1a detached the physical links among NR2B, PSD95 and nNOS and reduced the membrane distribution of NMDAR. NMDA-induced neuronal injury was more severe in Homer1a homozygous knockout mice (KO, Homer1a^−/−) when compared with NMDA-induced neuronal injury in wild-type mice (WT, Homer1a^+/+). Additionally, Homer1a overexpression in the cortex of Homer1a^−/− mice alleviated NMDA-induced neuronal injury. These findings suggest that Homer1a may be a key neuroprotective endogenous molecule that protects against NMDA-induced neuronal injury by disassembling NR2B-PSD95-nNOS complexes and reducing the membrane distribution of NMDARs.

Increased expression of the lncRNA PVT1 is associated with poor prognosis in pancreatic cancer patients

AIM

Long non-coding RNA PVT1 (lncRNA PVT1) has been identified and it plays an oncogenic role in various human cancers. However, its roles in pancreatic cancer remain unclear. The aim of this paper was to explore the PVT1 expression levels and relationship with survival of patients with pancreatic ductal adenocarcinoma (PDAC) and to establish the significance of PVT1 in the development and progression of PDAC.

METHODS

In this study, quantitative real-time polymerase chain reaction was performed to analyze the expression levels of lncRNA PVT1 in paired PDAC and adjacent nontumor tissues. The association of PVT1 expression with clinicopathological features was analyzed. Kaplan-Meier survival analysis was performed to analyze the association of PVT1 expression with overall survival rate of patients with PDAC. Univariate and multivariate Cox regression analyses were carried out to analyze the prognostic significance of PVT1 expression.

RESULTS

The study results showed that the PVT1 expression was significantly increased in PDAC tissues compared to adjacent nontumor tissues. The expression of PVT1 was associated with clinical stage and N-classification (P<0.05). Patients with high PVT1 expression level had shorter overall survival times compared to those with low PVT1 expression level (P<0.05). Univariate and multivariate Cox regression analyses suggested that PVT1 might be an independent prognostic factor for poor overall survival rate in patients with PDAC.

CONCLUSION

The study findings suggested that the increased expression of lncRNA PVT1 in PDAC was correlated with tumor progression, and PVT1 might be a potential molecular biomarker for predicting the prognosis of patients with PDAC.

MicroRNA-30b promotes axon outgrowth of retinal ganglion cells by inhibiting Semaphorin3A expression

Semaphorin3A (Sema3A) is a major inhibitory factor of optic nerve (ON) regeneration post-injury. Many microRNAs (miRNAs) are expressed specifically in the mammalian brain and retina and are dynamically regulated during development, suggesting that this group of miRNAs may be associated with neural development. We found that microRNA-30b (miR-30b) bound to the three prime untranslated region (3' UTR) of Sema3A and inhibited the expression of Sema3A mRNA. The mRNA expression level of miR-30b and the protein expression levels of Sema3A, Neuropilin1 (NRP1), PlexinA1 (PlexA1), phosphorylated p38MAPK (p-p38MAPK), and active caspase-3 were all upregulated in retinas from rats with a damaged ON relative to those with an intact ON. Transfection of cultured retinal ganglion cells (RGCs) with an miR-30b mimic led to decreased levels of Sema3A, NRP1, PlexA1, p-p38MAPK, and active caspase-3 protein expression, as well as axon elongation and reduced levels of apoptosis. These findings provide evidence that miR-30b inhibits Sema3A expression. Decreased Sema3A expression promotes axon outgrowth in RGCs due to reduced levels of Sema3A binding to NRP1 and PlexA1 and simultaneously reduces apoptosis by inhibiting the p38MAPK and caspase-3 pathways. Our findings provide the first evidence that miR-30b-mediated Sema3A downregulation may serve as a new strategy for the clinical treatment of ON injury.

Clinical applications of internal heat source analysis for breast cancer identification

Nondestructive preoperative breast imaging techniques are widely used for breast cancer testing and diagnosis. This study aimed to evaluate the feasibility and efficacy of quantitative diagnosis via the thermal analysis of abnormal metabolism. Nine hundred forty-eight women who underwent breast biopsy from 2009 to 2013 were investigated. Thermal analysis was used to calculate the internal heat source (i.e., tumor) thermal power for each participant. The applicability and effectiveness of our approach were estimated using the chi-square test, kappa statistics (k), and odds ratios (OR). Breast density and tumor size were considered during this estimation. A thermal power q = 0.2 w was determined as the optimal separation threshold between breast cancer and benign disease. Moreover, good agreement (k = 0.837) with the gold-standard assessment (breast biopsy) was confirmed in 93.2% of the patients (N = 884/948), and the sensitivity and specificity were 94.2 and 92.9%, respectively. The results also found no significant differences in methodological accuracy between the fatty and dense breasts (OR = 1.194, P = 0.524). Furthermore, after dividing the cohort into three groups according to tumor size (T1: <2 cm; T2: 2 to 5 cm; T3: >5 cm), the tumor size had no effect on the proposed method (ORs = 1, P = 0.724). Internal heat source analysis can feasibly and efficiently distinguish between breast cancer and benign disease.

Neurofilament M gene in a French-Canadian Population with Parkinson’s Disease

Background:

Recently, a single base pair substitution (G1747A) mutation of the neurofilament M (NF-M) gene was reported in a French-Canadian patient with early onset Parkinson’s disease (PD). Three unaffected siblings were found to be heterozygotes for the NF-M Gly336Ser mutation but, to date, no other affected PD individuals have been found with a similar mutation. No other individuals with Parkinson’s disease and of similar ethnic background have been screened for this mutation.

Methods:

We screened 102 French-Canadian patients with definite PD and 45 French-Canadian controls for this substitution in the NF-M gene using a PCR-restriction enzyme digestion method.

Results:

None of the patients or controls carried this mutation.

Conclusion:

Our results would indicate that this mutation is not common even in a PD population of similar ethnic background and suggest this change represents a rare variant. However, these results do not exclude the possibility that other mutations in this gene could be present.