Objective To analyze the diagnosis and treatme nt of 47femoral fractures in the neonates.Methods The history records of neonatal femo ral fractures during the period from1971to 1998were reviewed.They included of 24boys and 23girls.Thirty-nine fractur es of the femur occurred in Cesarean section and 18during vaginal delive ry.All were unstable fractures,30o blique and 17transverse.All of them were treated conservatively.Results Twenty-nine of the 47cases were foll owed up with the mean period of58months(12to 168months).The average angular and shortening deformity was 39.25?(15?to 80?)and0.69cm(0.5to 1.5cm)respectively.Twenty-five cases we re without leg length discrepancy,4cases had their affected side 1cm longer than t he unaffected side.At final follow u p,ll of the patients could walk with normal gait,and the range of motion o f the hip and knee joint were normal.N o delayed union was found.Conclusion The deformity of the femoral fractur e in neonate is usually severe and dif ficult to get anatomical reduction with closed methods,the f emur of the neonate is of great potent ial of plasticity,and the union period is usually short.The treatment shou ld be simple,and the use of repetitiv ely close or open reduction must be avoided.The popular accepted crite ria of children shortening within 1-2cm,angulations within 25?and torsion within 15?should be enlarged in neonates.

The heterogeneity of exhausted T cells (Tex) is a critical determinant of immune checkpoint blockade therapy efficacy. However, few studies have explored exhausted T cell subpopulations in human cancers. In the present study, we examined samples from two cohorts of 175 patients with head and neck squamous cell cancer (HNSCC) by multiplex immunohistochemistry (mIHC) to investigate two subsets of Tex, CD8⁺PD1⁺TCF1⁺ progenitor exhausted T cells (TCF1⁺Tex^prog) and CD8⁺PD1⁺TCF1^- terminally exhausted T cells (TCF1^-Tex^term). Moreover, fresh tumor samples from 34 patients with HNSCC were examined by flow cytometry and immunohistochemistry to further investigate their properties and cytotoxic capabilities and their correlation with regulatory T cells (Tregs) in the tumor immune microenvironment (TIME). mIHC and flow cytometry analysis showed that TCF1^-Tex^term represented a greater proportion of CD8⁺PD1⁺Tex than TCF1⁺Tex^prog in most patients. TCF1⁺Tex^prog produced abundant TNFα, while TCF1^-Tex^term expressed higher levels of CD103, TIM-3, CTLA-4, and TIGIT. TCF1^-Tex^term exhibited a polyfunctional TNFα⁺GZMB⁺IFNγ⁺ phenotype; and were associated with better overall survival and recurrence-free survival. The results also indicated that larger proportions of TCF1^-Tex^term were accompanied by an increase in the proportion of Tregs. Therefore, it was concluded that TCF1^-Tex^term was the major CD8⁺PD1⁺Tex subset in the HNSCC TIME and that these cells favor patient survival. A high proportion of TCF1^-Tex^term was associated with greater Treg abundance.
CD8-Positive T-Lymphocytes ; Head and Neck Neoplasms/therapy* ; Humans ; Immunotherapy/methods* ; Prognosis ; Programmed Cell Death 1 Receptor ; Squamous Cell Carcinoma of Head and Neck/therapy* ; Tumor Microenvironment ; Tumor Necrosis Factor-alpha