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.

Objective To investigate cervical spinal upper motor neuron (UMN) dysfunction in patients with frail arm syndrome (FAS) by physical examination,triple stimulation technique (TST) and pectoralis tendon reflex tests.Methods Sixty-seven FAS patients,coming from Peking University Third Hospital from June 2013 to June 2016,underwent physical examination and routine electrophysiological tests.The pyramid signs,the results of pectoralis tendon reflex and TST were collected to estimate the function of cervical spinal UMN.Results On the time of diagnosis,weakness of bilateral proximal upper limbs was found in 61 patients,while weakness of unilateral proximal upper limb was found in six patients.There were 25 patients with tendon hyperreflexia,20 patients with tendon hyporeflexia and 22 patients with tendon areflexia.All the patients were pectoral muscle tendon hyperreflexia except one.UMN score of cervical region was 2.0 ± 0.5.Lower motor neuron score of cervical region was 2.0 ± O.2.The amplitude ratio of TSTtest/TSTcontrol was 78.31％ ± 6.52％.The latency and amplitude of quantitative detection of pectoralis tendon reflex was (7.80 ± 1.22) ms and (1.23 ± 0.14) mV,respectively.In the follow-up study,the tendon reflexes and the UMN score declined,the amplitude ratio of TSTtest/TSTcontrol decreased,while the lower motor neuron score increased and the latency of quantitative detection of pectoralis tendon reflex remained almost unchanged.Conclusion The results showed that there was cervical spinal UMN dysfunction in patients with FAS,and the pyramid signs were often concealed by muscle atrophy with progression of the disease.

Objective To evaluate the clinical effect of acupuncture combined with estazolam for the treatment of primary insomnia with heart and spleen deficiency type. Methods Seventy qualified patients were randomized into treatment group and control group, 35 in each group. Both groups received oral use of estazolam before bed time for 6 continuous weeks, and acupuncture group was additionally given acupuncture for regulating governor vessel and tranquilizing spirit on acupoints of Baihui(GV20), Yintang(GV29), Shenting(GV25), Anmian (EX-HN22), Shenmen(H7), Sanyinjiao(SP6), 3 times a week and lasting for 6 continuous weeks. The sleep state of the patients was estimated according to Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Athens Insomnia Scale(AIS) before treatment, on the third and the sixth week of treatment, and one month after the completion of treatment. Results (1) Five cases in the treatment group and 3 cases in the control group were dropped out for not completing the treatment timely. In the end , 30 cases in the treatment group and 32 cases in the control group finished the trial. (2) The total effective rate in the treatment group was up to 90.0%, and was 71.9% in control group, the difference being significant(P<0.01).(3) Compared to the control group, the scores of PSQI, ESS and AIS were much decreased in treatment group on the third and the sixth week of treatment , and one month after treatment(P<0 . 05 or P<0 . 01). Conclusion Acupuncture for regulating governor vessel and tranquilizing mind combined with oral use of estazolam exerts certain therapeutic effect for the treatment of heart and spleen deficiency type insomnia, and the effect was superior to that of estazolam alone.

The treatments for insomnia after stroke were various in recent years, including acupuncture with its distinguishing feature. It’s reviewed and summarized that experimental researches on Chinese and English databases about acupuncture treatment of insomnia after stroke in recent 10 years. Clinicians had chosen different acupuncture therapies for insomnia after stroke according to yinyang, zangfu, meridians, opening and closing of qi activity. Although those acupuncture therapies had achieved obvious clinical effects, they were deficient in experimental design and methodology.

Objective To observe the clinical effects on prevention of alveolar bone absorption by site preservation after tooth extraction due to periodontitis.Methods The experimental group consisted of 40 patients with 45 extracted teeth due to periodontitis.The fresh sockets were immediately grafted and filled with Bio-oss collagen and Bio-Gide after minimally invasive tooth extraction,while 40 teeth of control group were only treated with cotton balls bitten tightly over the socket for half an hour.Two groups were observed for changes in alveolar bone density by X-ray and cone beam CT (CBCT)after 6 months.Results There were the wound healing and no infection in extraction site of all patients with or without site preservation operation.The gingiva of extraction site was pink and tough in all groups.The alveolar bone loss in regular extraction patients significantly increased in horizontal and vertical aspects by X-ray and CBCT,while site preservation improved the alveolar bone defects (P<0.05).After site preservation for 6 months,CBCT analysis showed that the density of new alveolar bone markedly enhanced compared with regular extraction group.Conclusion The technique of site preservation after tooth extraction due to periodontitis is a method which can prevent and reduce disuse atrophy absorption of the alveolar ridge so that the height and width of the alveolar bone can meet aesthetic requirements.

ABSTRACT:Objective To investigate the effects of berberine on matrix metalloproteinases/tissue inhibitors of matrix metalloproteinases (MMPs/TIMPs) in rat periodontitis .Methods Adult male Sprague‐Dawley rats were subjected to thread ligation and porphyromonas gingivalis ( P . gingivalis ) inoculation resulting in periodontitis . Berberine [150 mg/(kg · d)] or vehicle was administered by oral gavage for 4 weeks .Alveolar bone loss and soft‐tissue destruction were determined by micro‐computed tomography (μ‐CT) and HE staining .The contents of tumor necrosis factor‐α(TNF‐α) and interleukin‐1β(IL‐1β) of gingival tissue were examined by ELISA .The expressions of MMP‐2 ,MMP‐9 and TIMP‐2 as well as the phosphorylation of P38 MAPK and NF‐κB were determined by Western blot .Results Significant increases were observed in alveolar bone loss and periodontal soft‐tissue destruction with higher levels of TNF‐α, IL‐1β and MMP‐2/9 expressions and the activities of P38 MAPK and NF‐κB in the experiment periodontitis group .Berberine of [150 mg/(kg · d)] not only improved the periodontal tissue and decreased alveolar bone loss ,but also reduced the contents of TNF‐α,IL‐1βand MMP‐2/9 and increased TIMP‐2 .In addition ,berberine inhibited the phosphorylation of P38 MAPK/NF‐κB .Conclusion Berberine protects against periodontal tissue damage via decreasing MMP‐2 and MMP‐9 expressions but increasing TIMP‐2 expression , which may be induced by inhibition of P38 MAPK/NF‐κB and the anti‐inflammatory effect on rat periodontitis .

Objective To study the risk factors of lymph node metastasis in the central neck compartment of thyroid carcinoma,and to explore the reasonable range of lymph node dissection in central neck dissection for clinically node-negative papillary thyroid microcarcinoma patients.Methods From Dec.2015 to Dec.2016,a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups according to the registration number:unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery,Fujian Medical University Union Hospital.The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed.Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were ≥0.7 cm in diameter and older than 45 years in age and gender in male.Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm.The positive rate was 22％.The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18,P=0.035,respectively.The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75,P=0,022 respectively.Conclusion In patients with tumor diameter ≥0.5 cm,bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.

Objective To observe the clinical features and cardiac magnetic resonance (CMR)imaging characteristics in patients with cardiac amyloidosis. Methods A total of 5 patients (4 males and 1 female) with the diagnosis of cardiac amyloidosis (3 were proven by heart transplantation, 2 by endomyocardial biopsy) were evaluated by electrocardiogram, echocardiogram, chest X-ray and CMR with delayed Gadolinium enhancement. Results Echocardiograms were abnormal in all five patients; chest X-ray showed pulmonary hemorrhage ( 3 ), cardiomegaly (5), pleural effusion (3); echocardiogram showed atrial enlargement, left ventricular wall thickening, limited ventricular wall motion, etc. CMR exhibited increased thickness of the left ventricular wall, mild to moderate depression of systolic function ( mean ejection fraction: 32.5% ± 15.0% ) and bilateral atrial enlargement with restriction of diastolic ventricular filling. In all patients, there were widespread enhancement of the thickened myocardium on delayed postcontrast studies. In 4 patients, global subendocardial delayed gadolinium enhancement was found, in papillary muscles, and interventricular septa with" zebra-like" sign in 3 patients. Left ventricular transmural delayed gadolinium enhancement was found in 1 patient. Conclusions CMR shows a characteristic pattern of global subendocardial delayed gadolinium enhancement in cardiac amyloidosis. The findings may be valuable in the diagnosis of cardiac amyloidosis.

Objective To describe the clinical spectrum,especially sleep disorder in three patients diagnosed with Morvan syndrome.Methods Three consecutive patients were identified with Morvan syndrome in the Department of Neurology, Peking Union Medical College Hospital between December 2014 and March 2016.The character in three cases has been studied from several aspects such as clinical presentation, imaging, polysomnography (PSG), cerebrospinal fluid and serum.Results Serum test showed serum contactin-associated protein 2 (CASPR2)antibodies strongly positive (+++) and leucine-rich glioma inactivated protein 1 antibodies positive (+) in three patients.Neuropsychiatric features, neuromyotonia, neuropathic pain, dysautonomia, agrypnia excitata presented in all three patients.The agrypnia excitata was characterized by severe insomnia, excessive motor activity during the night.Agrypnia excitata was diagnosed in three patients according to their history.PSG was finished in case 2 and case 3.PSG in one patient (case 2) documented severe insomnia (sleep efficiency was 59%), lack of cyclic sleep organization with a predominance of stage 1 non-rapid eye movement sleep episodes intermixed with brief rapid eye movement, and a marked reduction of spindles and delta sleep;PSG in another patient (case 3) revealed complete absence of recognizable sleep.Sleep disorders and other symptoms resolved completely or almost completely in two patients (case 1,case 2) who received immunotherapy.Case 3 died from sudden cardiac death before immunotherapy.Conclusions Morvan syndrome usually is associated with high-titer CASPR2 antibodies in serum.Agrypnia excitata is cardinal manifestation of Morvan syndrome in association with a spectrum of neurologic presentations.Early immunotherapy could provide a favorable outcome.