005)The complete block times were (270?22)min, (204?14)min and (129?12)min respectively, with significant differences among three groups (P

Objective To discuss the role of indoleamine 2, 3-dioxygenas e (IDO) and tryptophanyl-tRNA synthetase (TTS) mediated tryptophan catabolism in immune thrombocytopenia (ITP) patients treated with high doses of dexamethasone through the expressions of IDO and TTS in T cells , and the concentrations of plasma kynurenine and tryptophan. Methods 20 newly diagnosed or relapse ITP patients were treated with 40 mg/d × 4 d dose of dexamethasone. The heparin anticoagulant blood samples were obtained before treatment and the 5th day after treatment. 20 healthy subjects were selected as the control group. The IDO and TTS expressions in CD4+and CD8+ T cells were analyzed by flow cytometry. The concentrations of plasma kynurenine and tryptophan were detected by liquid-mass spectrometry system. Results Compared with healthy controls group, the plasma tryptophan and kynurenine concentration and the ratio of Kyn/Trp were significantly elevated in ITP patients (P <0.05); the IDO expressions of CD4+ and CD8+ T cells in ITP patients were significantly lower than those in healthy controls (P < 0.05), but the TTS expressions were significantly higher (P < 0.05). The concentration of tryptophan in effective group was significantly lower than before treatment (P < 0.05), in contrast, the kynurenine concentration and the ratio of Kyn/Trp were significantly higher than before (P < 0.05). The expression of IDO in effective group were significantly higher than that before treatment (P < 0.05), conversely, the expression of TTS in effective group were significantly decreased (P < 0.05). No significant difference can be found in ineffective group. Conclusion IDO/TTS-mediated tryptophan catabolism pathway could indicate the onset of ITP. The sensitivity of ITP patients with high dose of dexamethasone treatment can be observed through the level of IDO and TTS.

Objective To investigate the outcome of the free double-skin paddle string-type composite fibular flap in the reconstruction of the combined defects of ulna and radium. Methods From June 2005 to July 2009, 5 cases with combined defects of ulna and radium were reconstructed using the free double-skin paddle string-type composite fibular flap. The length of fibular segment for the reconstruction of ulnar defect ranges from 4.5 to 7.5 cm. The length of fibular segment for the reconstruction of radial defect ranges from 5.5 to 7.0 cm. The size of the flap varies from 5.0 cm × 3.0 cm to 8.0 cm × 5.5 cm. At the 12 month follow-up, the function of reconstructed forearm was evaluated based upon Enneking scoring system.Results Ten flaps in the 5 cases all survived. The time for the transplanted fibula healed on the radium and ulna was 4-6 months. The 5 patients were followed up from 14 months to 2 years. The forearm rotation functions were excellent in 2 cases, good in 2 cases and poor in 1 case. The eligible rate was 80%. The average Enneking score was 24.8, which indicated an average of 81.3% recovery of limb function. Conclusion Bone graft with blood supply can ensure the activity of osteocytes, which facilitates the fracture union.Whilst, the procedure can reconstruct multi-location and multi-tissue defects in the forearm. Therefore, the double-skin paddle string-type composite fibular flap is an ideal alternative for the reconstruction of the combined defects of ulna and radium and the skin.

Objective To investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm. Methods From May 2004 to July 2009, the free string-type dorsalis pedis flap and anterior malleolus flap were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases were all survived. Follow-ups were done from 6 months to 2 years after operation. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case.The eligible rate was 81.25%. Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.

Objective:To investigate changes in the peripheral interleukin-35 (IL-35) level in patients with alopecia areata, and to assess its modulatory effect on regulatory T (Treg) cell activities.Methods:Totally, 81 patients with alopecia areata (alopecia areata group) and 27 healthy volunteers (control group) were enrolled from Shanxi Provincial People′s Hospital between December 2019 and January 2021. Sera and peripheral blood mononuclear cells (PBMCs) were isolated. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum IL-35 level, real-time fluorescence-based quantitative PCR to determine the mRNA expression of IL-35 subunits EBI3 and IL-12p35, and flow cytometry to determine the proportion of CD4 + CD25 + CD127 dim/- Treg cells. Sorted Treg cells were stimulated by recombinant human IL-35, ELISA was performed to detect levels of perforin and granzyme B in the culture supernatant, and real-time fluorescence-based quantitative PCR to determine the mRNA expression of EBI3, IL-12p35, and immune checkpoint molecules, such as programmed death protein 1 (PD-1) , T cell immunoglobulin and mucin protein-3 (Tim-3) , cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and lymphocyte activation gene-3 (LAG-3) in Treg cells. IL-35-stimulated or unstimulated Treg cells were co-cultured with autologous PBMCs, and cell counting kit-8 (CCK8) assay was conducted to assess cellular proliferative activity. Measurement data were compared between 2 groups by using t test, comparisons among multiple groups were carried out by using one-way analysis of variance, correlation analysis was carried out by using Pearson correlation analysis, and enumeration data were compared by using chi-square test. Results:Compared with the control group, the alopecia areata group showed significantly decreased IL-35 levels (90.10 ± 11.98 ng/L vs. 100.74 ± 28.71 ng/L, t= 2.71, P= 0.008) , mRNA expression of EBI3 and IL-12p35 in PBMCs (EBI3: 1.06 ± 0.15 vs. 1.25 ± 0.11, t= 6.09, P < 0.001; IL-12p35: 1.00 ± 0.15 vs. 1.38 ± 0.22, t= 10.16, P < 0.001) , and proportions of Treg cells (5.91% ± 1.17% vs. 6.85% ± 1.23%, t= 3.54, P= 0.001) . In the alopecia areata group, the proportion of Treg cells was positively correlated with the serum IL-35 level ( r= 0.25, P= 0.026) , and the mRNA expression of EBI3 and IL-12p35 in PBMCs ( r= 0.31, 0.24, P= 0.004, 0.032, respectively) . Compared with the control group, the unstimulated Treg cells from the alopecia areata group showed significantly decreased supernatant levels of perforin and granzyme B, mRNA expression of EBI3, IL-12p35 and immune checkpoint molecules ( P < 0.05 or 0.001) , as well as weakened inhibitory effect on the proliferative activity of PBMCs ( P= 0.013) . There was no significant difference in the level of perforin or granzyme B between the recombinant human IL-35-stimulated and unstimulated Treg cells from the patients with alopecia areata (both P > 0.05) . However, the mRNA expression of EBI3, IL-12p35 and immune checkpoint molecules was significantly higher in the IL-35-stimulated Treg cells than in the unstimulated Treg cells in the alopecia areata group ( P < 0.05 or 0.001) , and the inhibitory effect on the proliferative activity of PBMCs was also significantly enhanced in the IL-35-stimulated Treg cells compared with the unstimulated Treg cells ( P= 0.037) . Conclusion:The peripheral IL-35 level was significantly decreased in the patients with alopecia areata, which was closely associated with reduced activities of Treg cells, and IL-35 may be involved in the occurrence of alopecia areata.

Objective:To investigate changes of natural killer (NK) cell subsets and interleukin-18 (IL-18) level in peripheral blood of patients with alopecia areata, and to assess the regulatory effect of IL-18 on NK cell activity.Methods:A total of 67 patients with alopecia areata (alopecia areata group) and 25 healthy volunteers (control group) were collected from Shanxi Provincial People′s Hospital between December 2019 and January 2021. Peripheral blood mononuclear cells (PBMCs) and plasma were isolated. The percentage of NK cell subsets was investigated by flow cytometry, and plasma IL-18 level was measured by enzyme-linked immunosorbent assay. PBMCs were stimulated with recombinant human IL-18, and co-culture systems of PBMCs with 721.221 cells, K562 cells and P815-Ab cells were established separately. NK cell function was assessed by determining the percentage of CD107a-expressing NK cells and fluorescence intensity of CD16 + NK cells. Comparisons between groups were performed using t test or paired t test. Results:Compared with the control group, the alopecia areata group showed significantly decreased percentage of CD56 +CD16 - NK cells (8.12% ± 3.14% vs. 10.78% ± 4.08%, t = 3.33, P = 0.001) , but significantly increased percentage of CD56 +CD16 + NK cells (46.08% ± 15.21% vs. 32.14% ± 10.45%, t = 4.22, P < 0.001) , and there was no significant difference in the percentage of CD56 -CD16 + NK cells between the alopecia areata group and control group (28.81% ± 8.65% vs. 27.09% ± 7.62%, t = 0.88, P = 0.383) . The plasma IL-18 level was significantly higher in the alopecia areata group than in the control group (112.0 ± 23.72 pg/ml vs. 99.34 ± 15.15 pg/ml, t = 2.48, P = 0.015) . After co-culture with 721.221 cells, K562 cells and P815-Ab cells, the percentage of CD107a-expressing NK cells was significantly higher in NK cells from the alopecia areata group (9.53% ± 1.70%, 5.15% ± 1.35%, 6.50% ± 1.64%, respectively) than in those from the control group (5.00% ± 1.17%, 4.40% ± 1.09%, 5.13% ± 1.36%, respectively, all P < 0.05) . After the stimulation with P815-Ab cells, the alopecia areata group showed significantly decreased fluorescence intensity of CD16 + NK cells (151.10% ± 59.30%) compared with the control group (221.90% ± 93.56%, t = 4.31, P < 0.001) . After IL-18 stimulation, the percentage of CD107a-expressing NK cells significantly increased in the co-culture system of NK cells with 721.221 cells compared with the unstimulated co-culture system (14.47% ± 2.67% vs. 9.93% ± 1.94%, t = 6.00, P < 0.001) , while there was no significant difference between the IL-8-stimulated co-culture system of NK cells with K562 cells or P815-Ab cells and the unstimulated co-culture systems (both P > 0.05) . Conclusion:IL-18 could enhance NK cell activity in patients with alopecia areata, likely by promoting natural cytotoxicity receptor-mediated cytotoxicity.

Objective:To compare of the efficacy of Steinman pin-assisted and manual reduction for the treatment of distal femoral fracture with anterograde intramedullary nail.Methods:From January 2014 to August 2018, data of 54 patients with distal femoral fracture were retrospectively analyzed. According to the fracture reduction methods, patients were divided into two groups: bare-handed reduction group and Steinman pin-assisted reduction group (referred to Steinman pin group). There were 16 males and 10 females in bare-handed reduction group, with age of 37.5±9.2 years (range, 21-59 years). According to AO/OTA classification, 16 cases were type 32-A, 7 type 32-B, 3 type 32-C. There were 19 males and 9 females in Steinman pin reduction group, with age of 36.4±9.8 years (range, 18-55 years). According to AO/OTA classification, 19 cases were type 32-A, 7 type 32-B, 2 type 32-C. The reduction time, fluoroscopy times, intraoperative blood loss, fracture healing time, and knee joint function score of American hospital for special surgery (HSS) were compared between the two groups.Results:The amount of blood loss during operation was 142.78±29.76 ml in the bare-handed group, and 94.81±17.71 ml in the Steinman pin group. The reduction time of fracture was 14.19±2.50 min in the bare-handed group and 5.02±1.69 min in the Steinman pin group. The times of fluoroscopy during reduction was 12.56 ±2.01 in the bare-handed group and 5.01±1.51 in the Steinman pin group. There were significant differences in the above indexes ( t=12.19, 4.02, 5.47; all P < 0.05). All 54 patients were followed up for 12-51 months, with an average of 23.4 months. All the fractures healed, and there was no delayed union or nonunion. The healing time was 7.01±1.15 months in the bare-handed group and 5.99±0.97 months in the Steinman pin group. There were no significant difference. The HSS score of knee joint function was 23.7±4.1 before operation, 61.3±4.5 at 1 month after operation, 70.2±4.2 at 2 months after operation, 78.9±5.9 at 3 months after operation, 87.9±4.6 at 6 months after operation, and 93.1±5.8 at 12 months after operation, in the bare-handed group. Meanwhile, in the Steinman pin group, 22.5±3.8 before operation, 62.2±5.1 at 1 month after operation, 69.1±4.7 at 2 months after operation, 79.2±4.3 at 3 months after operation, 88.6±5.3 at 6 months after operation, and 92.3±6.1 at 12 months after operation. There were no significant difference between the two groups ( t=1.113, 0.689, 0.908, 0.212, 0.519, 0.494, P > 0.05). There were significant differences between the two groups at each time point before and after operation ( F=716.42, 815.52, P < 0.001). There were no complications such as injection point infection, vascular and nerve injury, failure of internal fixation and so on. Conclusion:Both groups had good functional recovery after operation. However, compared with bare-handed reduction, Steinman pin groupreduction has less intraoperative blood loss, shorter reduction time and less fluoroscopy times, which is a safer reduction method.

Objective:To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods:From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results:Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc. After electronic laryngoscopy, the first case was diagnosed with laryngeal softening （severe, type Ⅱ）, and the angular incision was performed. While cases 2, 3 diagnosed with case 2 and 3 were diagnosed with laryngeal cyst and underwent laryngeal cyst resection. All three cases underwent low-temperature plasma surgery under visual laryngoscope, and the symptoms were relieved after operation. Case 4 was laryngeal wheezing and dyspnea after extubation under general anesthesia. The electronic laryngoscopy showeded early stage of globetic stenosis, and endoscopic pseudomembrane clamping was performed, and the postoperative symptoms were relieved. Conclusion:Infants and young children with laryngeal airway diseases should pay attention to the early symptoms and be diagnosed by electronic laryngoscopy as soon as possible. With good curative effect and few complications, low-temperature plasma surgery under visual laryngoscope is recommended. The formation of pseudomembrane under the gluteal caused by tracheal intubation causes rapid onset and rapid development. The pseudomembrane extraction by clamping is convenient and fast, with good curative effect.
Infant ; Child ; Humans ; Child, Preschool ; Respiratory Sounds/etiology* ; Larynx ; Laryngeal Diseases/surgery* ; Laryngoscopy ; Intubation, Intratracheal/adverse effects* ; Dyspnea/surgery* ; Cysts/surgery*