The primary causative factors of liver failure include direct damage and immune -mediated liver injury.Increasing evidence sug-gests that immune -mediated injury plays a pivotal role in the pathogenesis of liver failure.The new concepts concerning the mechanisms of immune -mediated liver injury in liver failure are reviewed with relevant basic and clinical studies in both humans and animals.The innate and adaptive immunity,particularly the interaction of various immune cells and molecules,as well as apoptosis -related molecules,are dis-cussed in detail.

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects.Methods Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, in which 11 cases male; 7 cases were female, age from 5 to 73 years.Average age was 45.9 years.Repair parts: 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which 8 cases of bone exposure wounds, tendons exposed in 3 cases.Surgical repair of soft tissue defect size of about 6 cm×4 cm-22 cm × 10 cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases.Results All the flaps were survived completely without any complications.The appearance and functional results were satisfactory with following up for 3 to 36 months.18 cases of flap were survived completely, primary healing, without any complications such as vein congestion or engorgement.The 4 cases which remains the cutaneous nerve in site had an average recovery time about 13 days of the donor site.The innervated region of the cutaneous nerve had no acroesthesia or dysesthesia.Conclusion This modified operation methods of flap, enhanced the blood support of the flap, impmved the survive rates and also preserved the sensory function of the patients' donor site.This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.

Objective To explore the effect of the island flap application on repairing large scale defects on the face.Methods Based on the defect size,shape and location,preauricula narrow stem side geny-neck flap,submental island flap,angular artery flap,eyelid musculus orbicularis flap and nasolabial groove island flap were used to repair the large scale defects of the face in a one-stage operation.Results All flaps survived well without any obvious complications.35 patients were followed up for 1 to 36 months.Repaired tissues were well matched with the surrounding tissue.Resulting facial contour and appearance were good,and cosmetic results overall were satisfactory.Conclusion The application of island flaps to repair the large scale defects on the face in a one-stage operation is a better method that can achieve good contour and satisfactory cosmetic results.

BACKGROUND:Keloids are the result of abnormal post-traumatic skin restoration, which are characterized with overgrowth and progressive enlargement, invasion of adjacent normal skin tissue, extension beyond the scope of the original wound. Given the high recurrence, treatment with surgery alone is meaningless and, therefore, comprehensive treatment of surgery and other approaches is required. OBJECTIVE:To explore the clinical curative effect of local injection after timely removal of auricle keloid core. METHODS:Twenty patients with auricle keloid were enroled. After keloid core excision, the time interval within the incision scar tissue injection of fluorouracil or triamcinolone acetonide add lidocaine or monotherapy was gradualy lengthened, and if necessary the proper amount of compound betamethasone was added according to scar conditions. The injection dose was adjusted timely based on the regression of scar. The treatment effect was observed for 12 to 24 months. RESULTS AND CONCLUSION: Of 36 auricle keloids from 20 patients, the comprehensive treatment was effective in 1 keloid, and other 35 keloids were cured. The effective rate was 100%, the completely cured rate was 97.2% and the excelent rate was 2.8%. These findings indicate that minimaly invasive excision of keloid core and the epithelial flap coverage combined with 5-fluorouracil and corticosteroid injection is a safe and effective method to treat auricle keloids.

Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n=855) and sentinel polyps group (n 108).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was (49.7 ± 9.4) years,and the majority of the patients were male (n=610,63.3％).A total of 785 patients (81.5％) had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients (8.1 ％) were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis (2.2％,21/963).The positive rate of tumor marker of sentinel polyps group was higher (69.4％,75/ 108) than that of pure polyps group (6.8％,58/855; x2 =316.285,P＜0.01).The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm (61.1％ (66/108) vs 46.9％ (401/855)),multi polyps (n＞5,38.9％ (42/108) vs 11.8％ (101/855)) and adenomatous polyp (83.3％ (90/108) vs 35.6％(304/855),x2=7.752,55.595 and 90.544,all P＜ 0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma which was account for 75.9％ (82/108).Some were mucinous carcinoma and signet ring cell carcinoma.Most of the proximal colon carcinoma with rectal polys did not penetrate the serosa layer (Duk A-+Duk B,59.3％,64/108) and with little distant metastasis (Duke D,17.6％,19/ 108).Ninty-five point six percent (817/855) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.Forty-one point seven percent (45/108) of patients of sentinel polyps group accepted the radical operation and 19.4％ (21/108) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be awared.If the endoscope is difficult to go further or the patient can not tolerate the whole colon examination,the patient should be followed up in short-term and complete the whole colon examination.

Objective To discuss the change of elasticity of common carotid artery(CCA) with velocity vector imaging(VVI) technique in perimenopausal women.Methods 68 women in perimenopausal period were divided into two groups:estrogen drop group(42 women) and normal control group(26 women) according to the level of estrogen in serum.All women were examined with color Doppler ultrasound,and the maximum time to peak of the velocity(VTTP),maximum velocity(Vmax),maximum radial strain (Smax),maximum strain rate(SRmax) and the change rate of area(ΔS) were measured and assessed in common carotid artery(CCA) including 6 segments:anterior wall,posterior wall,anterolateral wall,anterior internal wall,posterolateral wall and posterointernal wall.Results There were signicantly differences of the elastic parameters between two groups inculding VTTP,Smax and ΔS (P ＜0.01),and there were no statistical difference on the Vmax and SRmax in both two groups(P ＞0.05).Conclusions The change of elasticity in CCA can be observed susceptibly with VVI in perimenopausal women,and VVI is an effective and sensitive technique for detecting CCA elastic characteristics.

Objective To explore the condition of cortistatin (CST)expression in human renal tissue and the changes in the level of CST in IgA nephropathy (IgAN)of different degrees.Methods Ten tumor adjacent normal renal tissue samples were collected.The mRNA and protein expressions of CST in human renal tissue were detected by reverse transcription-polymerase chain reaction (RT-PCR)and Western blotting,respectively.Immunohistochemisty (IHC)was performed to locate the expression of CST in renal tissue.According to the grading system of Lee et al,IgAN was divided into three groups:grade Ⅰ -Ⅱ (group A),grade Ⅲ -Ⅳ (group B),and grade Ⅴ (group C),and ten renal biopsy tissue samples were collected for each group.IHC was performed to detect the change in the level of CST in normal and IgAN renal tissue of different degrees.The effect of clinical indices on the level of CST in IgAN renal tissue was assessed by multiple linear regression analysis.Results RT-PCR and Western blotting showed that CST was expressed in renal tissue and IHC showed that CST was expressed on renal tubular epithelial cells.In IgAN,the higher the pathological grade was, the higher the expression of CST in renal tubules was.Multiple linear regression analysis showed that the pathological grade was associated with the expression of CST in renal tissue (r =0.875,P <0.01).Conclusion CST may participate in the inflammatory reaction of IgAN pathological injury and exert anti-inflammation effects.

ObjectiveTo identify the association of HLA-DQA1*0302 and DQB1*0303 alleles with vitiligo in Uygur nationality in Xinjiang Uygur Autonomous Region. MethodsPolymerase chain reaction with sequence-specific primers(PCR-SSP) was performed to analyze the distribution of HLA-DQA1*0302 and HLA-DQB1*0303 alleles among 300 patients with vitiligo and 300 normal human controls of Uygur nationality in Xinjiang region. ResultsA significant increase was observed in the frequency of HLA-DQA1*0302 and -DQB1*0303 alleles in patients with vitiligo compared with the controls(20.5％ vs. 13.83％, 30.17％ vs. 13.33％, both P ＜ 0.01 ). Increased frequency of HLA-DQA1*0302 and -DQB1*0303 alleles was also seen in patients with adult vitiligo (onset age ＞ 12 years) and those with childhood vitiligo (onset age ≤≤ 12 years) ascompared with the normal controls(both P ＜ 0.01). The frequency of DQB1*0303 allele was higher in both patients with and without family history of vitiligo than in the normal controls(both P ＜ 0.01), while that of DQA 1*0302 was higher in only patients without family history (P ＜ 0.01 ). No significant difference was observed in the frequency of HLA-DQA 1*0302 or HLA-DQB1*0303 between patients with adult vitiligo and those with childhood vitiligo or between patients with and without family history(all P ＞ 0.05). Conclusions HLADQA 1*0302 and DQB 1*0303 alleles may be associated with vitiligo in Uygur nationality in Xinjiang region,and there seems to be genetic heterogeneity between patients with adult and childhood vitiligo and between vitiligo patients with and without family history.

The role of interleukin-17 (IL-17) in autoimmune hepatitis (AIH) was investigated. A mouse model of experimental autoimmune hepatitis was established, and the syngeneic S-100 antigen emulsified in complete Freud's adjuvant was injected intraperitoneally into adult male C57BL/6 mice. The IL-17 expression in serum and the livers of the mice models was detected by using ELISA and immunohistochemistry, respectively. IL-17 neutralizing antibody was used to study the biological effect of IL-17 in the experimental AIH. IL-17 neutralizing antibody in vivo administration alleviated the hepatic inflammation and ALT level in the AIH model. IL-17 in the peripheral blood mononuclear cells (PBMC) of AIH patients was measured by using real-time PCR method. The results showed that IL-17 level was significantly up-regulated in AIH patients and mice models. It was concluded that IL-17 contributed to the development of AIH and might be a potential therapeutic target of AIH.

CD4(+)CD25(+)CD127(dim/-) regulatory T cells (Tregs) have been implicated in suppressing T cell immune responses to hepatitis B virus (HBV), but the inhibition mechanism has not being clear yet. This study investigated the effects of soluble FGL2 (sFGL2) secreted by Tregs on immune suppression in chronic HBV-infected patients. We verified that sFGL2 protein and mRNA were highly expressed in Tregs. The separated Tregs by using magnetic beads from peripheral blood mononuclear cells (PBMCs) in 20 patients with chronic hepatitis B were co-cultured with PBMCs at a ratio of 1:3 with anti-CD3 stimulating antibody or FGL2 blocking antibody. The proliferation index of CD8(+)T cells after blocking FGL2 was higher than that in blank group (3.58±0.18 vs. 3.28±0.17, P=0.034) in 18 of 20 samples, and lower than that in CD3 stimulation group (3.82±0.19, P=0.026) in 16 of 20 samples. The IFN-γ secreted in the mixed culture in the absence of Tregs was higher than that in the culture in the presence of Tregs, but it could be abolished by FGL2 blocking antibody. These results suggest that sFGL2 protein secreted by Tregs suppresses the proliferation and function of CD8(+) T cells in chronic hepatitis B.