Objective To investigate the role of neutrophils and their IgA Fc receptor CD89 in the occurrence of Henoch-Sch（o）nlein purpura (HSP),to evaluate their effects on vascular endothelial cell apoptosis,and to explore their mechanisms.Methods Peripheral blood neutrophils were isolated from 30 children with acute HSP and 9 age-matched healthy controls separately.After isolation of serum IgA by Jacalin affinity chromatography,IgA was purified by polypropylene dextran gel chromatography.Real-time fluorescence-based quantitative PCR (qPCR) and Western blot analysis were performed to determine the mRNA and protein expression of CD89 on neutrophils respectively,and flow cytometry was conducted to measure the expression of neutrophil activation marker CD11b.Human umbilical vein endothelial cells (HUVEC) were co-cultured with neutrophils isolated from patients with HSP (HSP group) and healthy controls (healthy control group) separately.Moreover,the HSP group were divided into 3 subgroups to be treated with serum IgA isolated from the HSP patients (HSP IgA group),monomeric IgA (mIgA group) and phosphate-buffered saline (blank control group) respectively.Then,flow cytometry was conducted to detect apoptosis of co-cultured HUVEC,and enzyme-linked immunosorbent assay (ELISA)to measure levels of interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) in the supernatant of co-cultured cells.Results There was no significant difference in the mRNA expression of CD89 on neutrophils between the patients with HSP and healthy controls (P =0.98),but the protein expression of CD89 was significantly lower in the patients with HSP than in the healthy controls (0.60 ± 0.16 vs.0.83 ± 0.24,P =0.03).The expression of CD1 1b on neutrophils was significantly higher in the patients with HSP than in the healthy controls (1 880.25 ± 388.29 vs.1 109.25 ± 364.25,P ＜ 0.01).The apoptosis rate of co-cultured HUVEC was also significantly higher in the HSP group than in the healthy control group (37.44％ ± 5.49％ vs.17.14％ ± 4.45％,P ＜ 0.01).In addition,the H SP IgA group showed significantly higher apoptosis rate of cocultured HUVEC and levels of IL-8 and TNF-cα in the supematant compared with the mIgA group (all P ＜0.01) and blank control group (P ＜ 0.01,=0.01,=0.02,respectively).Conclusions Peripheral blood neutrophils in patients with HSP are activated,which can induce the apoptosis of vascular endothelial cells.HSP IgA can promote the neutrophil-mediated apoptosis of vascular endothelial cells and secretion of IL-8 and TNF-α,while mIgA may show a certain inhibitory effects.

Objective: To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation. Methods: A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision. Results: All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results. Conclusions The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.