OBJECTIVE To explore the diagnostic value of combined detection of microRNA(miRNA)and alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in ascites and serum ex-tracellular vesicles(EVs)for hepatitis B virus(HBV)-related primary hepatocellular carcinoma(HCC).METHODS From Nov.2023 to Nov.2024,41 patients with liver cancer and 26 patients with liver cirrhosis who underwent ascites placement or ascites concentration and reinfusion procedures at the Fifth Medical Center of Chi-nese PLA General Hospital were selected as study subjects.Ascites and serum samples were collected.Real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression levels of miR-21,miR-125a,miR-150 and miR-200a in EVs.Chemiluminescence was used to measure the levels of AFP and PIVKA-Ⅱ in ascites,serum and EVs from ascites and serum.An artificial neural network was utilized to con-struct a combined diagnostic model of serum and ascites markers.RESULTS The area under the curve(AUC)for distinguishing HCC from liver cirrhosis using a combination of serum and other indicators was 0.933.The AUC for distinguishing HCC from liver cirrhosis using a combination of ascites and other indicators was 0.912.By screening all detected indicators using an artificial neural network and incorporating indicators with a relative im-portance＞0.5 into the diagnostic model,the model included four indicators:ascites AFP,ascites EVs miR-21,ascites EVs miR-200a and serum EVs miR-200a.This model had a sensitivity of 80.77％,a specificity of 87.80％and an AUC of 0.960 for distinguishing HCC from liver cirrhosis patients.CONCLUSION The combined diagnos-tic markers of miRNA,AFP and PIVKA-Ⅱ in ascites and serum-derived EVs have good application value in the diagnosis of HCC.

OBJECTIVE To explore the diagnostic value of combined detection of microRNA(miRNA)and alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in ascites and serum ex-tracellular vesicles(EVs)for hepatitis B virus(HBV)-related primary hepatocellular carcinoma(HCC).METHODS From Nov.2023 to Nov.2024,41 patients with liver cancer and 26 patients with liver cirrhosis who underwent ascites placement or ascites concentration and reinfusion procedures at the Fifth Medical Center of Chi-nese PLA General Hospital were selected as study subjects.Ascites and serum samples were collected.Real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression levels of miR-21,miR-125a,miR-150 and miR-200a in EVs.Chemiluminescence was used to measure the levels of AFP and PIVKA-Ⅱ in ascites,serum and EVs from ascites and serum.An artificial neural network was utilized to con-struct a combined diagnostic model of serum and ascites markers.RESULTS The area under the curve(AUC)for distinguishing HCC from liver cirrhosis using a combination of serum and other indicators was 0.933.The AUC for distinguishing HCC from liver cirrhosis using a combination of ascites and other indicators was 0.912.By screening all detected indicators using an artificial neural network and incorporating indicators with a relative im-portance＞0.5 into the diagnostic model,the model included four indicators:ascites AFP,ascites EVs miR-21,ascites EVs miR-200a and serum EVs miR-200a.This model had a sensitivity of 80.77％,a specificity of 87.80％and an AUC of 0.960 for distinguishing HCC from liver cirrhosis patients.CONCLUSION The combined diagnos-tic markers of miRNA,AFP and PIVKA-Ⅱ in ascites and serum-derived EVs have good application value in the diagnosis of HCC.

Objective To evaluate the clinical outcomes of submental island pedicled flap (SIPF) combination with bio-membrane in reconstructing palate defects after maxillofacial or palatal neoplasm resection.Methods There were 12 patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma.The clinical stages of tumours were]] in two patients,Ⅲ in four patients,Ⅳ in six patients(UICC 2002),and one patient with adenoid cystic carcinoma no staged.SIPFs were designed and created,and the tissue sides of the SIPFs were covered with bio-membrane to reconstruct the oral and the nasal sides of the defects respectively.Speech and swallowing functions and opening mouth were evaluated 6 months postoperatively.Results All flaps survived and no serious complications occurred.Ten patients achieved normal speech,two had intelligible speech,and one was with slurred speech;Nine patients resumed a solid diet,three with a soft diet,and one on a liquid diet.Eight patients recovered normal mouth opening,four emerged minor limitation of mouth opening,and one had serious limitation of mouth opening.Conclusions SIPF combined with bio-membrane is a safe,simple,and reliable method for reconstruction of piercing palate defect following neoplasm ablation,with satisfactory oral functions.

Objective To evaluate the effectiveness of the submental island pedicled flap (SIPF) for the repair of oral soft defects following oral cancer ablation.Methods Thirty consecutive patients undergoing resection of oral cancer followed by reconstruction with SIPF from February 2010 to March 2013 were reviewed.The effectiveness complications,oral function recovering and oncologic outcomes after reconstructive operation with SIPF were evaluated.SPSS software was used to analyze the data.Results The dimensions of SIPF ranged from a minimum of 4 cm ×6 cm to a maximum of 6 cm × 15 cm.Of the 30 flaps,28 were survival completely,one had superficial necrosis but healed with treatments,and one failed due to complete necrosis,with a survival rate of 96.7％ (29/30).Operative time ranged from a minimum of 4.5 hours to a maximum of 7.5 hours,mean 6.8 hours,and hospital stay time was 11-18 days,mean 13 days.Thirteen patients (43.3％) received tracheotomy before SIPF operation.Surgical or postoperative complications included temporary marginal mandibular never palsy in one case,neck hematoma in one case,hydrops in the mandibular region in 7 cases,and neck infectionin in 2 cases.Postoperative functional results showed mouth opening was normal in 23 patients,light limitation of mouth opening in 6 cases and obvious limitation of mouth opening in one case.The speech function was re-obtained satisfactorily in 29 patients,but one case with poor speech function.Most patients showed normal swallowing function,of them 26 patients on a full oral diet,3 patients on a soft diet and one patient on a liquid diet only.Postopeative follow-up time was for 6-19 months (median 13 months),and 4 patients had local recurrence and 2 patients had cervical lymph node metastases.Conclusion The SIPF is safe,reliable and simple for the reconstruction of middle-small oral soft defects following resection of early-stage oral cancer.

Objective To investigate IL-17 as adjuvant effect on the humoral and cellular immune responses to HIV DNA vaccine by immunizing mice with HIV DNA vaccine plus IL-17. Methods We immunized the BALB/c mice with pGX-Env alone, or with pcDNA3-IL-17 by intramuscular injection. The immunization was performed on week 0, 2. The concentration of the anti-Env IgG, the stimulated index of T lymphocyte proliferation, and the expression of IFN-γ, IL-4 and IL-17 in CD4~+T cell and IFN-γ in CD8~+ T cell, specific in vivo cytotoxic T lymphocyte (CTL) activity were detected at week 4. Results We show here that IL-17 as a molecular adjuvant with the HIV DNA vaccine, pGX-Env, can enhance immune responses. Interestingly, IL-17 has no adjuvant effect on the responses for T cell proliferation, antibody production and expressions of IFN-γ, IL-4 and IL-17 in CD4~+ T cells, but rather on the up-regulation of IFN-γ in CD8~+ T cells and CTL in vivo significantly(P<0.05). Conclusion The data suggest that IL-17 as the molecular adjuvant may not effect the development and differentiation of CD4~+ Th cells, but directly affect on the CD8~+ T cell functions. The novel functionality of IL-17 on adaptive immunity may lead to develop effecfive HIV DNA vaccination targeted to potentiate the CD8~+ T cell functions.

OBJECTIVETo discuss features of onset of chronic severe viral hepatitis (CSH).

METHODSThe patterns of onset of 520 cases of CSH were analyzed by SPASS and STATA software.

RESULTS1. Within less than 10 days, less than 2 weeks, 2 to 4 weeks, 4 weeks to 6 months, 10.4%, 18.1%, 17.1% and 64.8% of 520 cases deteriorated into severe hepatitis respectively. 2. There were no definite predisposing factors in more than 40% cases. There were 1 to 3 or more predisposing factors in more than 30% cases. The incidence of concurrent infection was the highest (P<0.01). 3. The pathogenic basis in more than 50% cases was cirrhosis. 4. Hepatic encephalopathy did not occur in more than 50% of the cases. Ascites occurred in more than 75% of cases. Hepatic encephalopathy first occurred in less than 5% cases and ascites in more than 10% of cases. 5. The latest time for occurrence of hepatic encephalopathy was later than the time of deteriorating into severe hepatitis.

CONCLUSIONS1. Gradual deterioration into CSH was found in all the 520 cases. 2. The predisposing factors, pathogenic bases, incidence and occurring time of hepatic encephalopathy, firstly occurring complication and so on in CSH are not the same as those in acute and subacute severe hepatitis. Therefore, CSH should be independently named and the study of CSH should be strengthened.

Adolescent ; Adult ; Aged ; Ascites ; etiology ; Child ; Female ; Hepatic Encephalopathy ; etiology ; Hepatitis, Chronic ; complications ; Hepatitis, Viral, Human ; complications ; Humans ; Liver Cirrhosis ; etiology ; Male ; Middle Aged ; Prospective Studies

OBJECTIVETo further understand chronic severe hepatitis (CSH) and to improve the level of diagnosis and treatment and to explore the methods to reduce the fatality rate of CSH through analysing the factors related to prognosis of CSH.

METHODSThe factors related to prognosis from 520 cases with CSH were analyzed by SPASS and STATA software.

RESULTS1. The fatality rate in cases with age > or = 40 years was higher than that in cases with age <40 years (P<0.001), there was no significant difference (P>0.05) in sex and pathogenic basis of CSH; 2. The fatality rate rose in cases with WBC > or = 10.0 x 10(9) per liter or platelet <100 x 10(9) per liter; 3. The fatality rate increased gradually with the ratio of aspartic aminotransferase to alanine aminotransferase (AST/ALT) and serum total bilirubin (TBil), appearance of deviation of TBil and ALT, decrease in prothrombin activity (PTA), total cholesterol (TC), cholinesterase and albumin (Alb) (P<0.001). 4. The fatality rate increased with appearance of complications such as ascites, electrolyte disturbance, spontaneous peritonitis and so on (P<0.001).

CONCLUSIONSThe important factors related to prognosis were age, > or = 40 years, WBC 10.0 x 10(9) per liter or platelet <100 x 10(9) per liter; the ratio of AST/ALT, TBil, Tc, cholinesterase, Alb and complication, to monitor dynamically laboratory indexes such as TBil, PTA, Tc, cholinesterase and so on and to prevent and cure various complications are important measures to reduce the fatality rate of CSH.

Adolescent ; Adult ; Aged ; Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Bilirubin ; blood ; Child ; Cholinesterases ; blood ; D-Alanine Transaminase ; Factor Analysis, Statistical ; Female ; Hepatitis, Chronic ; blood ; complications ; mortality ; Humans ; Male ; Middle Aged ; Prognosis ; Serum Albumin ; analysis ; Thrombin ; analysis