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Objective To explore the morphological characteristics of intraepidermal nerve fibers in healthy Chinese by skin biopsy,to provide reference basis for the early diagnosis of peripheral neuropathy.Methods Skin biopsies samples were obtained from 192 healthy volunteers (half male and half female,collected in our hospital from June 2009 to August 2013),and these samples were divided into 6 groups according to different anatomic sites (far-end of the upper arm,far-end of the forearm,opisthenar,near-end of thigh,far-end of crus and acrotarsium) and 4 groups according to age (patients of younger than 20,patients of 21-40 years old,patients of 41-60 years old and patients of older than 61).Morphological observation of the intraepidermal nerve fibers was performed by skin biopsy and immunohistochemical technique.Results Various branch models emerged at each location:non-branching,branching at the epidermis-dermis junction,branching near the epidermis-dermis junction,branching at faraway side of epidermis-dermis junction,and branching near the cuticle.Branch models showed no significant diferences among patients of different ages.The above branch models appeared in far-end of the upper arm,far-end of the forearm,opisthenar,near-end of thigh,far-end of crus and acrotarsium,and as body based site famess,skin nerve fibers usually had more branches,and more axon expansion and varicose.Conclusions The age and lanatomic sites do not affect the branching pattems of intraepidermal nerve fibers.The closer to the extremities,the more branches of the intraepidermal nerve fiber.
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Objective To establish the quantitative standard of intraepidermal nerve fibers in healthy Chinese and provide reference basis for the early diagnosis of peripheral neuropathy through the large sample system of quantitative research by skin biopsy.Methods Adult skin samples of different anatomical locations,age and gender were obtained from 192 healthy volunteers who performed skin biopsies in our hospital from May 2009 to July 2013;they were divided into 6 groups according to different anatomic sites (distal upper arm,distal forearm,opisthenar,proximal thigh,distal crus and acrotarsium) and 4 groups according to the ages (patients under 20 years old,patients of 21-40 years old,patients of 41-60 years old and patients older than 61 years).Quantitative observation of the intraepidermal nerve fibers was performed by skin biopsy and immunohistochemical technique.Half males and half females were chosen.Results The comparison of intra epidermal nerve fiber density (IENFD) among thigh,leg,dorsum of foot and the comparison among upper arm,forearm,dorsum of hand showed statistical significance (P＜0.05).Along with the limbs part from proximal to distal,the IENFD in the upper and lower limbs both manifested a degressive tendency by degrees (normal reference value ranges of each anatomic site:upper arm＞320.00 fibers/mm2,forearm＞190.57 fibers/mm2,opisthenar＞184.37 fibers/mm2,thigh＞418.36 fibers/mm2,crus＞157.35 fibers/mm2,and acrotarsium＞ 140.00 fibers/mm2).The IENFD among patients under 20 years old,patients of 21-40 years old,patients of 41-60 years old and patients older than 61 years did not show statistically significant differences (P＞0.05).The IENFD between patients under 20 years old and patients older than 61 years showed statistical significance (P＜0.05).The IENFD in male and female adults did not show statistical significance (P＞0.05).Conclusions A significant difference of IENFD is observed among different anatomic sites.Ages has small effect on IENFD,and gender has no effect on IENFD.
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Objective To investigate the changes of the electrocardiograms (ECG) and the cardiac markers in patients with acute insular infarction,and analyze the relationship between them and the prognosis.Methods A total of 202 patients with acute middle cerebral artery territory infarction (patients group) and 150 control subjects (control group) was selected in this study.Patients included insular infarction (insular infarction group,136 cases),non-insular infarction (non-insular infarction group,66 cases),left-side insular infarction(71 cases) and right-side insular infarction(65 cases).ECG recordings and plasma cardiac troponin I (cTnI),creatine kinase-MB (CK-MB) were measured and compared.Death in 6 months was followed-up.Results There was significant difference in the incidence of abnormal changes of ECG and plasma cTnI,CK-MB increasing between patients group and control group (P ＜0.01).The incidence of abnormal changes of ECG and fatality rate were higher in insular infarction group than those in non-insular infarction group [80.88％(110/136) vs.46.97％(31/66) and 11.76％ (16/136) vs.3.03％ (2/66),P ＜ 0.05 or ＜ 0.01].The incidences of ectopy and prolonged QT were higher in right-side insular infarction patients than those in left-side insular infarction patients [44.62％(29/65) vs.11.27％ (8/71),P ＜0.01 ; 55.38％ (36/65) vs.35.21％ (25/71),P ＜ 0.05].The incidences of sinus bradycardia and ST segment deviation were higher in left-side insular infarction patients than those in right-side insular infarction patients [22.54％(16/71) vs.7.69％(5/65),P ＜ 0.05 ;47.89％(34/71) vs.13.85％ (9/65),P ＜ 0.05].The increased rates plasma cTnI and CK-MB level were mainly seen in insular infarction [insular infarction group:47.79％ (65/136),34.56％ (47/136); non-insular infarction group:4.55％ (3/66),1.52％ (1/66),P ＜ 0.01].The incidence of plasma cTnI increasing in right-side insular infarction patients was higher than that in left-side insular infarction patients [67.69％(44/65) vs.29.58％(21/71),P＜ 0.05].There was no significant difference in the incidence of plasma CK-MB increasing between left-side insular infarction patients and right-side insular infarction patients(P ＞ 0.05).The fatality rates in plasma cTnI,CK-MB increasing patients were higher than those in normal plasma cTnI,CK-MB patients [16.18％ (11/68) vs.5.22％ (7/134),P ＜0.05;29.17％ (14/48) vs.2.60％ (4/154),P ＜0.01].Conclusions The effects of acute hemispheric cerebral infarction on heart are mainly associated with destruction of insula.Patients with insular infarction have more abnormal changes of cardiac markers and ECG,which is correlated with poor prognosis.
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Objectives To complete quantitive analysis of intraepidermal nerve fibers(IENFs) by skin biopsy, evaluate epidermal innervation according to age and anatomical site and establish a reference range for IENFs at the distal leg. Methods Seventy skin biopsy specimens involving 70 patients were analyzed. Specimens were fixed routinely in formalin and thereafter embedded in paraffin. Nerve fibers of 10 μm thick sections were revealed using immunoperoxidase staining with panaxonal antibody PGP9. 5. Examine the morphology of IENFs, determine intrsepidermal nerve fibers density (IENFD) and perform the statistical analysis finally. Results Epidermal innervation of different age groups which came from distal leg and wrist did not chang with age. A trend displaying age-associated decreased epidermal innervation was found, although it was not statistically significant. The number of IENFD (fibers/mm2) in upper arm (91.8±21.1) and subterminal thigh (89. 2±21.4) were significantly higher than their number in wrist (64. 5 ± 22. 5) and distal leg (62. 9 ± 15.3). The reference range for IENFD of distal leg in normal humans is 40. 6 fibers/mm2. Condnsions Morphology of IENFs can be dearly displayed by skin biopsy, and this technology is easy to complete the quantitative study of IENFs. It provides a reliable platform for the diagnose and study of peripheral neuropathy.