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Objective:To investigate the detecting method and clinical characteristics of anti-nodal/paranodal antibodies in chronic inflammatory demyelinating polyradiculopathy.Methods:Serum samples were collected from 212 patients with chronic inflammatory demyelinating polyradiculopathy who were admitted to Huashan Hospital of Fudan University or from other clinical centers from January 2018 to July 2021. Autoantibodies (anti-NF155, anti-NF186, anti-CNTN1) and IgG subtypes were detected with cell-based assay. According to the test results, patients were divided into anti-NF155 positive group, anti-NF186 positive group and anti-CNTN1 positive group, clinical characteristics of patients in each group, including limb weakness, superficial sensation and proprioception, tremor, cerebrospinal fluid protein level, brachial plexus magnetic resonance (MRI) were retrospectively analyzed and compared.Results:A total of 23 patients (10.8%,23/212) were positive for anti-NF155 antibody, 12 (5.7%,12/212) for anti-NF186 antibody, and 4 (1.9%,4/212) for anti-CNTN1 antibody. IgG 4 was the predominant subtype in anti-NF155 and anti-CNTN1 groups. In the anti-NF186 group, all cases were IgG positive and antibody subtypes could be detected in 4 cases (4/12). In anti-NF155 group, 23 patients (100%,23/23) had limb weakness and deep sensory disturbance, 19 patients (82.6%,19/23) had superficial sensory disturbance, 22 patients (95.7%,22/23) were symmetrically involved, 18 patients (78.3%,18/23) showed tremor, 19 patients (19/19) showed abnormal in brachial plexus MRI. In anti-NF186 group, 12 patients had limb weakness (12/12), 9 patients (9/12) and 6 patients (6/12) had superficial sensory disturbance and deep sensory disturbance respectively, 8 patients (8/12) were asymmetrically involved, and only 1 patient (1/12) showed tremor, 1 (1/7) showed abnormal brachial plexus MRI. In anti-CNTN1 group, 4 cases showed symmetrical limb weakness and sensory disturbance, 3 patients had tremor, and four patients showed brachial plexus MRI abnormality. There were statistically significant differences in onset age, proprioception, tremor and MRI abnormalities of brachial plexus among the 3 groups ( P<0.01). Conclusions:The clinical characteristics of CIDP patients with anti-NF155, anti-NF186 and anti-CNTN1 antibodies are different. Screening anti-nodal/paranodal antibodies is of great significance for accurate diagnosis and treatment of patients with peripheral neuropathy.
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Localized peripheral neuropathy amyloidosis is a rare disease that mainly occurred in elder people who present with focal neurological symptoms. AL is the main type of amyloid protein. Biopsy is the golden standard for diagnosis. Mass spectrometry and immunohistochemical analysis help to confirm the type of amyloid protein. This paper retrospectively analyzes the clinical and imaging data, auxiliary examinations, histological, and immunohistochemical markers. The patient, a 34-year-old woman, presented with a right neck mass and weakness of the right arm. Brachial plexus magnetic resonance imaging (MRI) showed a tumor-like lesion in the nerve root at C5 and C6 and in upper trunk. Electrophysiological studies revealed damage in the upper trunk of the brachial plexus. Positive staining with Congo red was found in brachial plexus biopsy. Mass spectrometry showed that the type of amyloid protein was AHL(G-λ). The patient underwent nerve graft for treatment. Meanwhile, literature review revealed that the average onset age of localized spinal nerve amyloidosis was 62.4 years old.The radial nerve was the most susceptible, followed by the lumbosacral plexus. Fifty percent of the type of amyloid protein is AL.Until now, no consolidated treatment is available. Here, we summarize the clinical characteristics of localized peripheral neuropathy amyloidosis in order to raise the awareness of the disease.
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Objective:To investigate the clinical value of early gastroscopy for patients with hypopharyngeal cancer.Methods:A total of 231 cases of hypopharyngeal cancer diagnosed and treated in the First Affiliated Hospital of Xiamen University from January 2010 to December 2014 were included in the retrospective analysis. The 5-year survival rate of hypopharyngeal cancer and patients accompanied with synchronous esophageal cancer (including early and advanced esophageal cancer), as well as the detection rate of synchronous esophageal cancer by gastroscopy and systemic PET-CT examination were statistically analyzed.Results:The 5-year survival rate of hypopharyngeal cancer was 38.96% (90/231). The 5-year survival rates of 62 patients accompanied with synchronous esophageal cancer and 169 patients without were 27.42% (17/62) and 43.20% (73/169), respectively, with statistic difference ( χ2=4.747, P=0.029). The 5-year survival rate of 49 patients accompanied with synchronous early esophageal cancer was 30.69% (17/49). Among the 13 patients with synchronous progressive esophageal cancer, none had a survival period of 5 years, which was significantly different compared with the patients with synchronous early esophageal cancer ( P=0.013). The detection rates of synchronous esophageal carcinoma by gastroscopy and by systemic PET-CT were 26.84% (62/231) and 14.29% (33/231), respectively, with statistic difference ( χ2=11.14, P<0.01). The detection rates of synchronous early esophageal carcinoma by gastroscopy and by systemic PET-CT were 21.21% (49/231) and 8.66% (20/231), respectively, and the difference was also statistically significant ( χ2=14.328, P<0.01). Conclusion:Hypopharyngeal cancer accompanied with synchronous esophageal cancer is of high risk, which affects the survival rate of patients. Early gastroscopy in hypopharyngeal cancer patients can significantly improve the detection rate of synchronous esophageal cancer, which helps to design individualized regimen to improve the survival rate of patients.
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Objective:To study the efficacy of dental floss traction-assisted endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions.Methods:Data of 127 patients with gastric angle mucosal lesions admitted to the endoscopic center of the First Affiliated Hospital of Xiamen University from January 2015 to December 2018 were retrospectively analyzed. According to the surgical methods, patients were divided into the dental floss traction-assisted ESD group (the traction group, n=51) and the traditional ESD group (the traditional group, n=76). The 41 fibrosis cases were further divided into the traction group (n=23) and the traditional group (n=18). The operation time, en block resection rate, curative resection rate and the incidence of adverse events such as bleeding, muscle layer injury and perforation were compared between the two groups.Results:There was no significant difference in age, sex, lesion size or morphology between the traction group and the traditional group ( P > 0.05). The operation time of the traction group was significantly shorter than that of the traditional group (65.4±36.5 min VS 103.5±43.2 min, P=0.012). The en block resection rate was higher in the traction group [100.00% (51/51) VS 90.79% (69/76), P=0.026], and the curative resection rate was higher too [94.12% (48/51) VS 81.58% (62/76), P=0.042]. The incidences of muscular layer damage [5.88% (3/51) VS 25.00% (19/76), P=0.010] and intraoperative bleeding [47.06% (24/51)VS 82.89% (63/76), P=0.010] were lower in the traction group. Perforation occurred in two patients (2.63%) of fibrosis in the traditional group; no perforation occurred in the traction group. There was no significant difference in the perforation incidence ( P=0.243). In the cases of fibrosis, the operation time of the traction group was significantly shorter compared with that of the traditional group (81.4±29.3 min VS 119.3±37.6 min, P=0.010). The en block resection rate and curative resection rate were also higher in the traction group [100.00% (23/23) VS 72.22% (13/18), P=0.007; 95.65% (22/23) VS 72.22% (13/18), P=0.035]. The incidences of muscular layer damage [8.70% (2/23) VS 72.22% (13/18), P=0.001] and intraoperative bleeding [78.26% (18/23) VS 100.00% (18/18), P=0.035] were lower in the traction group. Conclusion:The dental floss traction-assisted ESD is safe and effective for gastric angle mucosal lesions and fibrotic lesions, with shorter operation time, higher curative resection rate and lower incidence of adverse events.
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Objective To investigate the feasibility and efifcacy of endoscopic submucosal dissection (ESD) for gastrointestinal neuroendocrine neoplasms (GI-NENs).Methods 52 patients with conifrmed histological diagnosis of GI-NENs performed ESD from January 2011 to December 2015 were included. The endoscopic morphology of tumor was summarized. Complete resection rate, complications, clinicopathological characteristics, and follow-up results were evaluated.Results There were 16 cases of stomach, 9 cases of colon and rectum 27 cases. Most of the lesions were submucosal uplift. A few of lesions looked like polyps. All the lesions were one-time whole diseased. 44 lesions were NET-G1, 8 lesions were NET-G2. Complete resection rate was 94.23%. 2 cases of rectal lesions infringemented intrinsic muscle layer, and got additional surgery. 1 case of rectal perforation, which was managed by endoscopic treatment and conservative treatment. All cases did not appear haemorrhage. During a mean follow-up period of 22.6 months, local recurrences occurred in 1 case of stomach, and treated with second line ESD. No cases lymph node and distant metastasis were found.Conclusion ESD appears to be a feasible, safe and effective treatment for GI-NENs with strict endoscopic treatment indications.
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Objective To correct the high supratarsal fold after cosmetic upper blepharoplasty is a challenge because of the shortage of both upper eyelid skin and fat.Levator shortening has been a procedure of choice selected by the surgeons to correct this condition.Methods Under local anesthesia, the desired crease was marked according to the characteristics of eyelid anatomy and aesthetic consideration for Asian women.The incision was made through the marked new skin crease and the old incision with surrounding scar tissue was incised.The adhesion between the skin and the levator aponeurosis was completely released.The levator aponeurosis was then divided above the tarsal plate.It could be shortened and then reattached to the tarsal plate depending on the amount of the upper eyelid skin and the degree of the ptosis.The skin incision was then closed to form new but lowered fold.Results Between 2003 to 2015, a total of 34 Chinese women underwent bilateral levator shortening for correction of high supratarsal fold after previous unsatisfactory upper blepharoplasty by other surgeons.There were no surgical complications postoperatively in this series and 32 patients (94.1%) were satisfactory for the outcome of the proper height of the supratarsal fold with at least 1 month follow-up.Only one patient (2.9%) required surgical revision for asymmetry of supratarsal folds and one patient (2.9%) for correction of deepened supratarsal fold.Conclusions The levator shortening can be an effective procedure to correct high supratarsal fold after unsatisfactory upper blepharoplasty in Asian women.It is especially useful to correct such a condition where there is shortage of the eyelid skin combined with the eyelid ptosis.
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Objective To investigate the therapeutic effects of botulinum toxin type A injection and acupuncture on periorbital wrinkles.Methods From May to September in 2015,24 patents were randomly divided into experimental and control group according to random number table:the patients in experimental group were treated with disposable acupuncture needles,20 min for each treatment,once a day,five times each course for courses,2 days interval between the two courses;the patients in control group were treated with 20 units of hotulinum toxin type A injection.The therapeutic results were observed 2 weeks after the treatment by the third-party doctor according to skin wrinkles grading.Results The periorbital wrinkles in both groups improved remarkably,and the wrinkle grading in control group was significantly lower than that in the experimental group (0.67±0.67 vs 1.33±0.61,P＜0.05).The skin quality and facial expression sensation in the experimental group improved significantly when compared with those in the control group.Conclusions Acupuncture can be used as a complementary treatment of periorbital wrinkles,and it improves the skin quality in terms of elasticity and color and keeps the natural facial expression sensation.
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<p><b>OBJECTIVE</b>To investigate the application and therapeutic effect of advanced orbicularis oculi muscle (OOM ) flap for eyelid defect.</p><p><b>METHODS</b>Uni-pedicle or bi-pedicle advanced OOM flaps were designed according to the location, depth and size of the eyelid defects. The resulted wounds in the donor sites were closed directly. The flap size ranged from 1.5 cm x 0.5 cm - 6.0 cm x 3.5 cm.</p><p><b>RESULTS</b>120 cases were treated. All the flaps survived except for 3 flaps with epidermis necrosis at the end of flaps, which healed after dressing. The patients were followed up for 3 -36 months with inconspicious scar in donor sites. The flap color, texture had a good match with surrounding skin.</p><p><b>CONCLUSIONS</b>The OOM flap is ideal for eyelid defect with reliable blood supply, satisfied color and texture. The wound at donor site can be closed directly with less morbidity.</p>
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Humans , Blepharoplasty , Methods , Cicatrix , Eyelids , General Surgery , Facial Muscles , Transplantation , Surgical Flaps , Transplantation , Transplant Donor Site , General SurgeryABSTRACT
Objective To investigate the application of numerical simulation technique in supraorbital and frontal osseous defect.Methods The data of the patients with complex supraorbital and frontal osseous defects were obtained by helix CT scan.Numerical model based on the data was built up by computer.And the true model was produced by Rapid Prototyping.Being stimulated before this operation.the model was directly used in the operation.Results All of these 12 patients(one of defect of brow,four fracture of brow and zygoma,seven of old fracture of brow and zygoma)in this study were satisfied and their brows were symmetry after operation.All of them were satisfied after 1 or 2 years,without implantation exposure and transfiguration except one with infection.Conclusion Based on numerical technique difficulties of repairing,complex supraorbital and frontal osseous defect could be resolved by such process as collecting the bone data,stimulating operation by true models,and producing implantation before the operation.The accuracy of these operations can be improved.
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Objective To study the pathologenesis and to evaluate an operative method of blepharochalasis. Methods A double eyelid-fold incision was made. The lacrimal glands were found and repositioned into lacrimal glands fossa behind superolateral orbital rim. Then redundant skin and muscles as well as hernia septal fat were removed. Results Twenty-three patients were successfully treated by the mentioned methods from 1998 to 2002. A good clinical results in both function and appearance were achieved. Conclusion It is convenient and effective to treat blepharochalasis through a double eyelid fold incision.