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Brachial plexus (BP) root injury often results in disability of the upper extremities. Improvements in high-frequency ultrasonography have enabled the visualization of BP nerve roots. This study was aimed at quantifying the diagnostic accuracy of ultrasonography in BP root injury at different stages post-trauma. A consecutive series of 170 patients with BP root injury between 2015 and 2019 were studied retrospectively and divided into three groups on the basis of time between injury and ultrasound examination (≤1 mo, 1-3 mo,3 mo). Diagnosis of complete BP root injury under ultrasound was determined using a pre-defined criterion, including pseudomeningocele, retraction and rupture. Diagnostic accuracy was calculated based on surgical findings and intra-operative electrophysiological tests. Rates of detection of the cervical (C5-C8) and thoracic (T1) nerve roots under ultrasound were 99.4%, 99.4%, 99.4%, 95.9% and 79.4%, respectively. The sensitivity for complete BP root injury was 0.74, and the specificity was 0.91. No significant differences in sensitivity or specificity were observed across time stages. Ultrasound exhibited substantial consistency with surgical findings (κ = 0.70) for complete BP root injury at any stage post-injury. Ultrasound can be an optional method of diagnosis of complete BP root injury at an early stage post-injury.

Introduction: The Medium Energy X-ray telescope (ME) is a collimated X-ray telescope onboard the Insight hard X-ray modulation telescope (Insight-HXMT) satellite. It has 1728 Si-PIN pixels readout using 54 low noise application-specific integrated circuits (ASICs). ME covers the energy range of 5-30 keV and has a total detection area of 952 cm2. The typical energy resolution of ME at the beginning of the mission is 3 keV at 17.8 keV (Full Width at Half Maximum, FWHM) and the time resolution is 255 us. In this study, we present the in-orbit performance of ME in its first 5 years of operation. Methods: The performance of ME was monitored using onboard radioactive sources and astronomical X-ray objects. ME carries six 241Am radioactive sources for onboard calibration, which can continuously illuminate the calibration pixels. The long-term performance evolution of ME can be quantified using the properties of the accumulated spectra of the calibration pixels. In addition, observations of the Crab Nebula and the pulsar were used to check the long-term evolution of the detection efficiency as a function of energy. Conclusion: After 5 years of operation, 742 cm2 of the Si-PIN pixels were still working normally. The peak positions of 241Am emission lines gradually shifted to the high energy region, implying a slow increase in ME gain of 1.43%. A comparison of the ME spectra of the Crab Nebula and the pulsar shows that the E-C relations and the redistribution matrix file are still acceptable for most data analysis works, and there is no detectable variation in the detection efficiency.

IntroductionAphasia affects many stroke survivors; therefore, effective treatments are urgently needed. Preliminary clinical findings have suggested an association between contralateral C7–C7 cross nerve transfer and recovery from chronic aphasia. Randomised controlled trials supporting the efficacy of C7 neurotomy (NC7) are lacking. This study will explore the efficacy of NC7 at the intervertebral foramen for improving chronic poststroke aphasia.Methods and analysisThis study protocol reports a multicentre, randomised, assessor-blinded active-controlled trial. A total of 50 patients with chronic poststroke aphasia for over 1 year and with a aphasia quotient calculated by Western Aphasia Battery Aphasia Quotient (WAB-AQ) score below 93.8 will be recruited. Participants will be randomly assigned to 1 of 2 groups (25 individuals each) to receive NC7 plus intensive speech and language therapy (iSLT), or iSLT alone programme. The primary outcome is the change in Boston Naming Test score from baseline to the first follow-up after NC7 plus 3 weeks of iSLT or iSLT alone. The secondary outcomes include the changes in the WAB-AQ, Communication Activities of Daily Living-3, International Classification of Functioning, Disability and Health (ICF) speech language function, Barthel Index, Stroke Aphasic Depression Questionnaire-hospital version and sensorimotor assessments. The study will also collect functional imaging outcomes of naming and semantic violation tasks through functional MRI and electroencephalogram to evaluate the intervention-induced neuroplasticity.Ethics and disseminationThis study was approved by the institutional review boards of Huashan Hospital, Fudan University, and all participating institutions. The study findings will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberChiCTR2200057180.

Here we report the spectral-timing results of the black hole X-ray binary 4U 1630–47 during its 2021 outburst using observations from the Hard X-ray Modulation Telescope (Insight-HXMT). Type C quasi-periodic oscillations (QPOs) in ∼1.6–4.2 Hz and quasi-regular modulation (QRM) near 60 mHz are detected during the outburst. The mHz QRM has a fractional rms of ∼10%–16% in the 8–35 keV energy band with a Q factor (frequency/width) of ∼2–4. Benefiting from the broad energy band of Insight-HXMT, we study the energy dependence of the ∼60 mHz QRM in 1–100 keV for the first time. We find that the fractional rms of the mHz QRM increases with photon energy, while the time lags of the mHz QRM are soft and decrease with photon energy. Fast recurrence of the mHz QRM, in a timescale of less than 1 hr, has been observed during the outburst. During this period, the corresponding energy spectra moderately change when the source transitions from the QRM state to the non-QRM state. The QRM phenomenon also shows a dependence with the accretion rate. We suggest that the QRM could be caused by an unknown accretion instability aroused from the corona.

Femoral nerve palsy can cause loss in quadriceps function and knee extension disability, which may lead to severe lower extremity impairment. The obturator nerve trunk transfer in the pelvic, the obturator nerve mortal branches transfer out of the pelvic, along with nerve graft, was introduced years ago to restore femoral nerve function. However, the outcomes of these procedures have never been compared. The aims of this study were to give our experiences in surgical reconstruction for femoral nerve injury and to compare the outcomes of different approaches.Nine patients with complete femoral nerve injury have been enrolled in this study between March 2012 and July 2016. All patients were followed up for at least 2 years after surgical intervention for sural nerve graft (n = 3), obturator trunk transfer in the pelvic (n = 2), or obturator nerve mortal branches transfer out of the pelvic (n = 4).All patients gained satisfactory quadriceps Medical Research Council grade (M3-M4+) after more than 2 years of follow-up. The sural nerve graft led to the earliest recovery on average, followed by obturator nerve mortal branches transfer in the thigh level and then obturator nerve trunk transfer in the pelvic. The functional outcomes, demonstrated by Lower Extremity Functional Scale and Femoral Nerve Motor Function Scale scores, also showed that the sural nerve graft was the best on average, followed by obturator nerve trunk transfer in the pelvic and then obturator nerve mortal branches transfer in the thigh level.Our results indicate that all these 3 procedures are safe and reliable ways to reconstruct femoral nerve function and can be applied to patients with different kinds of injuries. The sural nerve graft should be considered in the first place and the obturator nerve transfer at different level (trunk transfer in the pelvic or mortal branches transfer out of the pelvic) can be performed as the alternative.

The Medium Energy X-ray telescope (ME) is one of the three main telescopes on board the Insight Hard X-ray Modulation Telescope (Insight-HXMT) astronomy satellite. ME contains 1728 pixels of Si-PIN detectors sensitive in 5-30 keV with a total geometrical area of 952 cm2. Application Specific Integrated Circuit (ASIC) chips, VA32TA6, is used to achieve low power consumption and low readout noise. The collimators define three kinds of field of views (FOVs) for the telescope, 1{\deg}{\times}4{\deg}, 4{\deg}{\times}4{\deg}, and blocked ones. Combination of such FOVs can be used to estimate the in-orbit X-ray and particle background components. The energy resolution of ME is ~3 keV at 17.8 keV (FWHM) and the time resolution is 255 {\mu}s. In this paper, we introduce the design and performance of ME., Comment: 18 pages with 36 figures

Background: Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge. The contralateral C7 (CC7) nerve transfer has been used in treating brachial plexus avulsion injury (BPAI) since 1986. However, the effectiveness of the procedure remains a subject of controversy. The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer. Methods: Chinese or English (i.e., "contralateral c-7" , "contralateral c7" , "c7 nerve root" , and "seventh cervical nerve root" ) keywords were used for a literature search for articles related to CC7 nerve transfer in several databases (i.e., PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang Data). Clinical research articles were screened, and animal studies as well as duplicate publications were excluded. Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3, respectively. Results: The overall ipsilateral recipient nerve recovery rates were as follows: the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 (95% confidence interval [CI]: 0.48- 0.66) and for sensory recovery was 0.52 (95% CI: 0.46–0.58). When the recipient nerve was the median nerve, the efficiency rate for muscle strength recovery was 0.50 (95% CI: 0.39- 0.61) and for sensory was 0.56 (95% CI: 0.50–0.63). When the recipient nerve was the musculocutaneous nerve and the radial nerve, the efficiency rate for muscle strength recovery was 0.74 (95% CI: 0.65- 0.82) and 0.50 (95% CI: 0.31- 0.70), respectively. Conclusions: Transfer of CC7 nerves to musculocutaneous nerves leads to the best results. CC7 is a reliable donor nerve, which can be safely used for upper limb function reconstruction, especially for entirely BPAI. When modifying procedures, musculocutaneous nerves and median nerve can be combined as recipient nerves. Key words: Contralateral C7; Functional Recovery ; Meta-analysis; Nerve Transfer

In this paper we present the enhanced X-ray Timing and Polarimetry mission - eXTP. eXTP is a space science mission designed to study fundamental physics under extreme conditions of density, gravity and magnetism. The mission aims at determining the equation of state of matter at supra-nuclear density, measuring effects of QED, and understanding the dynamics of matter in strong-field gravity. In addition to investigating fundamental physics, eXTP will be a very powerful observatory for astrophysics that will provide observations of unprecedented quality on a variety of galactic and extragalactic objects. In particular, its wide field monitoring capabilities will be highly instrumental to detect the electro-magnetic counterparts of gravitational wave sources. The paper provides a detailed description of: (1) the technological and technical aspects, and the expected performance of the instruments of the scientific payload; (2) the elements and functions of the mission, from the spacecraft to the ground segment., Accepted for publication on Sci. China Phys. Mech. Astron. (2019)

A central issue underlying end-to-side neurorrhaphy technique is whether injury to the donor nerve fibers is necessary for successful reinnervation of the recipient nerve. To address this question, the authors developed a novel atraumatic end-to-side neurorrhaphy model that uses the preexisting anatomical structure of the median nerve as the Y-chamber to study the mechanism of collateral sprouting.In this rat forelimb model, the authors transected the musculocutaneous nerve and the lateral head of the median nerve, and coapted their distal stumps together. In this model, the authors use the medial head of the median nerve as the donor nerve, and the lateral head of the median nerve (distal stump) as a Y-shaped chamber, which provided structural connection to the recipient musculocutaneous nerve in end-to-side fashion.Three months after surgery, converging histologic, electrophysiologic, and behavioral observations confirmed the successful reinnervation of the recipient nerve. Retrograde labeling indicated that sensory fibers exhibited greater collateral sprouting than observed for motor fibers. Interestingly, fluorescence of these collateral sprouting fibers was present only when the median nerve lateral head was attached to the musculocutaneous nerve of the biceps, indicating that factors derived from the denervated tissue likely induced the collateral sprouting in this model.The authors' findings provide strong evidence that collateral sprouting can be robustly initiated independent of donor nerve fiber injury. The authors' model can accelerate the understanding of the mechanism underlying end-to-side neurorrhaphy and the optimization of its clinical use.

Introduction: End-to-side neurotization is currently used to treat brachial plexus injury, but it is not clear which donor nerve yields the best outcome. We performed experiments to determine the optimal donor nerve. Methods: A total of 66 male Sprague-Dawley rats were assigned to 1 of 3 groups. Group A was the control group. In Group B, the phrenic nerve was used as the donor, while the ipsilateral C7 nerve root served as the donor in Group C. The epineurial window was used in end-to-side neurorrhaphy. Behavioral observations, histology, electrophysiology, and fluorescence retrotracing were performed postoperatively. Results: Fluorescence retrotracing confirmed nerve regeneration in both Groups B and C upon end-to-side neurotization. The outcome of Group B was superior to that of Group C. Conclusions: Use of the phrenic nerve as the donor nerve yielded a better outcome than use of the ipsilateral C7 nerve root. Muscle Nerve 50: 67–72, 2014

Total scalp avulsion is a rare but challenging surgical trauma to manage. This study reports 8 cases of total scalp avulsion between 2001 and 2008. In all these cases, the patients were subjected to vascular replantation of the scalp. Microvascular technique after the debridement was used for scalp replantation in all these patients. Study outcome was that between 2001 and 2004, only 1 case had shown major scalp revival and scalp survival whereas in 3 other cases, the scalp survival failed. This may be attributed to the poor microscopic anastomosis. However, between 2005 and 2008, scalp survival was reported in all the cases, which was chiefly due the advanced microsurgical method adopted. In this advanced microsurgical technique, the subcutaneous tissue was suspended by the tight suture of scalp tissue around the anastomotic stoma, which resulted in scalp survival in all the cases. Microsurgical scalp replantation is an effective treatment for scalp avulsion. The key to the successful scalp replantation is high-quality vascular anastomosis involving subcutaneous tissue suspension via the tight suture of scalp tissue around the anastomotic stoma careful debridement.

Objective Peripheral nerve injury can induce immediate and long-standing remodelling of the brain cortex, which may affect outcomes of nerve repair. This study examined changes of corresponding cortical representations in patients with brachial plexus injuries. Methods Resting-state fMRI was acquired for 13 adult patients with total brachial plexus root avulsion, three of whom underwent second scans 7 or 8 months later. The time of examination ranged from 1 to 16 months after injuries. Nine healthy adults were enrolled as control. Seed-based functional connectivity was performed for all subjects. Results For nine patients whose first fMRI was performed from 1 to 4 months after brachial plexus injuries, images showed that their cortical maps of sensorimotor areas corresponding to the hand and arm in the hemisphere contralateral to the injured side had much weaker correlation with the supplementary motor area (SMA) than those ipsilateral to the injured side. Symmetrical maps of bilateral cortical sensorimotor areas corresponding to the hand and arm were observed in other four cases with fMRI tested from 7 to 16 months after injuries. For three of the nine patients with asymmetrical cortical representations, second scans indicated symmetric results or even stronger correlation with SMA in the cerebral cortex contralateral to the injured side. Conclusions Total brachial plexus root avulsion causes cortical representations of the brachial plexus to undergo a change from an inactive to an active state. This implies that peripheral deafferentation after brachial plexus injuries will induce corresponding cortical representations to be occupied by adjacent non-deafferented cortical territories.

ZnO tetrapods were synthesized by a typical thermal vapor-solid deposition method in a horizontal tube furnace. Structural characterization was carried out by transmission electron microscopy (TEM) and select-area electron diffraction (SAED), which shows the presence of zinc blende nucleus in the center of tetrapods while the four branches taking hexagonal wurtzite structure. The electrical transport property of ZnO tetrapods was investigated through an in-situ nanoprobe system. The three branches of a tetrapod serve as source, drain, and “gate”, respectively; while the fourth branch pointing upward works as the force trigger by vertically applying external force downward. The conductivity of each branch of ZnO-tetrapods increases 3–4 times under pressure. In such situation, the electrical current through the branches of ZnO tetrapods can be tuned by external force, and therefore a simple force sensor based on ZnO tetrapods has been demonstrated for the first time.

The electrical transport characteristic of a ZnO tetrapod has been measured by in situ nanoprobes. By contacting the three legs of a tetrapod as the ‘gate’, source and drain, some control and tunability have been achieved in the output voltage/current, in analogous to the operation of a field effect transistor. A simple logic circuit has also been demonstrated.

Theexisting literature reports progress in observing the phenom-enon of plasticity and in measuring the elastic modulus ofsingle NWs or NW arrays. In this Communication, we reportusing a manipulation probe and an atomic force microscope(AFM) tip in scanning electron microscopy (SEM) toinvestigate the mechanical behavior of a single SiNW underbuckling and bending conditions. Some of the mechanicalproperties of SiNWs have been quantified. Our study hasdemonstrated the tough and robust behavior of SiNWs.The SiNWs used for our experiments were fabricated bychemical vapor deposition by the vapor–liquid–solid (VLS)growth process.

Using a two-end bonded ZnO piezoelectric-fine-wire (PFW) (nanowire, microwire) on a flexible polymer substrate, the strain-induced change in I-V transport characteristic from symmetric to diode-type has been observed. This phenomenon is attributed to the asymmetric change in Schottky-barrier heights at both source and drain electrodes as caused by the strain-induced piezoelectric potential-drop along the PFW, which have been quantified using the thermionic emission-diffusion theory. A new piezotronic switch device with an "on" and "off" ratio of approximately 120 has been demonstrated. This work demonstrates a novel approach for fabricating diodes and switches that rely on a strain governed piezoelectric-semiconductor coupling process.

We demonstrate a mechanical-electrical trigger using a ZnO piezoelectric fine-wire (PFW) (microwire, nanowire). Once subjected to mechanical impact, a bent PFW creates a voltage drop across its width, with the tensile and compressive surfaces showing positive and negative voltages, respectively. The voltage and current created by the piezoelectric effect could trigger an external electronic system, thus, the impact force/pressure can be detected. The response time of the trigger/sensor is approximately 10 ms. The piezoelectric potential across the PFW has a lifetime of approximately 100 s, which is long enough for effectively "gating" the transport current along the wire; thus a piezoelectric field effect transistor is possible based on the piezotronic effect.

Objective To sum up the treatment of brachial plexus root avulsion and the progress in functional reconstruction and rehabilitation following brachial plexus root avulsion. Data sources A search of Medline was performed to select functional reconstruction and rehabilitation following brachial plexus injury-related English articles published between January 1990 and July 2006, with key words of “brachial plexus injury, reconstruction and rehabilitation”. Meanwhile, a computer-based search of CBM was carried out to select the similar Chinese articles published between January 1998 and July 2006, with key words of “brachial plexus injury, reconstruction and rehabilitation”. Study selection The materials were checked primarily, and the literatures of functional reconstruction and rehabilitation of brachial plexus injury were selected and the full texts were retrieved. Inclusive criteria: Functional reconstruction following brachial plexus injury. Rehabilitation method of brachial plexus injury. Exclusive criteria: Reviews, repetitive study, and Meta analytical papers. Data extraction Forty-six literatures about functional reconstruction following brachial plexus injury were collected, and 36 of them met the inclusive criteria. Data synthesis Brachial plexus injury causes the complete or incomplete palsy of muscle of upper extremity. The treatment of brachial plexus is to displace not very important nerves to the distal end of very important nerve, called nerve transfer, which is an important method to treat brachial plexus injury. Postoperative rehabilitations consist of sensory training and motor functional training. It is very important to keep the initiativeness of exercise. Besides recovering peripheral nerve continuity by operation, combined treatment and accelerating neural regeneration, active motors of cerebral cortex is also the important factor to reconstruct peripheral nerve function. Conclusion Consciously and actively strengthening functional exercise after operation is helpful to form cerebral plasticity and produce voluntary movements, can re-educate re-dominated muscle, obviously improves postoperative therapeutic effect and promote functional reconstruction.

Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root (associated with upper-limb chronic neuropathic pain) were given electroacupuncture stimulation at bilateral Quchi (LI11), Hegu (LI04), Zusanli (ST36) and Yanglingquan (GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats' upper limbs was significantly attenuated. Immunofluorescence staining showed that the expression of β-endorphins in the arcuate nucleus was significantly increased after therapy. Thus, experimental findings indicate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulating β-endorphin expression.

Background: Skeletal muscle atrophy induced by denervation is associated with apoptosis. This study was undertaken to determine the role of apoptosis and the expression of apoptosis-associated genes in rat skeletal muscle made atrophic by brachial plexus injury, and to study the apoptotic signal transduction pathway. Methods: An animal model of skeletal muscle atrophy was established in rats by severing the brachial plexus of one forelimb. Apoptosis of muscle cells was investigated with terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate end labeling, flow cytometry, deoxyribonucleic acid (DNA) electrophoresis, and electron microscopy. The apoptosis-associated genes Fas, FADD, Caspase 8, c-myc, p53, and Bcl-2 were detected by immunohistochemistry and Northern blot. Results: By terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate end labeling and flow cytometry we found that the percentage of apoptotic muscle cells was higher in atrophic than in healthy skeletal muscle (p < 0.05). DNA laddering could be seen in gel electrophoresis of DNA from atrophic muscle. By electron microscopy, we observed morphologic change of early apoptosis, such as aggregation of chromosomes, expansion of nucleic cistern, and contraction of the nucleus. Using immunohistochemistry, we determined that in atrophic muscle Fas, FADD, and Caspase-8 genes were highly expressed, whereas Bcl-2 was poorly expressed (p < 0.01). However, we did not detect a change in the expression of p53 or c-myc genes. Northern blots indicated that Fas messenger ribonucleic acid was higher and Bcl-2 messenger ribonucleic acid was lower in atrophic than in healthy muscle (p < 0.01). Conclusion: There are many more apoptotic cells in muscle atrophied as a result of brachial plexus injury than in healthy muscle, and apoptosis plays an important role in the pathogenesis of atrophy. The apoptotic signal may be transmitted from Fas to FADD to Caspase-8, with a decrease in Bcl-2 expression aggravating the process.

Mallet's test was used to evaluate shoulder and elbow functional results following conservative treatment, neurolysis, and nerve transfer and grafting in 31 patients with obstetrical brachial plexus palsy, who had no recovery of biceps contraction by 3 months of age. Twelve of them had been treated conservatively for 3 to 4 years. Nine patients with upper trunk conducting neuromas underwent neurolysis at the age of 4 to 6 months. Nerve transfer and grafting were performed in 10 patients at the age of 3 to 6 months. Upper trunk conducting neuromas were found in six of them. The follow-up period was, on average, 44.3 and 51.5 months in the nerve transfer and grafting group and in the neurolysis group, respectively. Excellent and good results in shoulder abduction, external rotation, and elbow flexion were found in 70 percent of patients in the nerve transfer and grafting group. However, none of the conservative treatment and neurolysis groups had a good result. The authors conclude that when there is no recovery of biceps contraction by 3 months of age, surgical intervention is indicated. Neuroma should be managed by nerve transfer and grafting, even though intraoperative electrophysiologic studies show that the neuroma is a conducting one.

The authors evaluated the reliability of a rat-tail replantation model Eleven male adult Sprague-Dawley rats were involved. The tails were completely amputated 3 to 6 cm distal to the base. They were then replanted in the following order: fixation of the coccygeal vertebrae; suturing of tendons; anastomosis of the artery; anastomosis of the two dominant veins (or one of them); and skin closure. Tails were inspected daily for 14 postoperative days for color, capillary refill, skin consistency and wound condition. Subsequently, ultrasound Doppler inspection and angiography were carried out to observe the patency of the vessels. All replanted tails were pink, viable, and had normal capillary refill and appearance. Complete survival was achieved. Doppler flow imaging and angiography demonstrated patency of the vessels. This rat-tail replantation is a reliable and reproducible experimental model of microvascular anastomosis. Crucial steps in the procedure are presented.

a b s t r a c t Rapid photon response is demonstrated for devices made using individual single-crystalline selenium nanobelts. The temperature dependence of the photocurrent has been studied between — 70 to 100 C. The best performance is at temperatures below 40 C. The response time to fluorescent light is as quick as 30 ms once tunes on, and the recovery time is as short as 50 ms when the light is off. This study demonstrates the potential application of Se nanobelts for building fast photon detectors.