[Mechanism and clinical significance of HBV reactivation after anti-HCV therapy]

Direct-acting antivirals (DAAs) can strongly inhibit the replication of hepatitis C virus (HCV) and effectively clear the infection, but it may cause hepatitis B virus (HBV) reactivation, leading to severe liver damage and fulminate hepatitis in patients with HCV/HBV coinfection. In this review, we summarized the different replication process of HCV and HBV in infected hepatocytes and consequent innate immune response, and then discussed the molecular mechanism and clinical significance of HBV reactivation, and put forward the clinical precaution.

[Treatment of parotid hemangioma in children]

Objective:To summarize the treatment and effect of children with parotid hemangioma. Method:Thirty-three children with parotid hemangioma were treated with drug in 22 cases, 9 of which received propranolol orally, accounting for 27%; 13 cases underwent B-ultrasound guided bleomycin injection, accounting for 40%; another 11 cases were used. The treatment of surgical removal of hemangioma, accounting for 33%. Result:In 22 children with drug therapy, the evaluation criteria were evaluated by Achauer et al. 12 cases of grade Ⅳ, accounting for 54.5%; 7 cases of grade Ⅲ, accounting for 31.8%; 2 cases of grade Ⅱ, accounting for 9%. For example, accounted for 4.5%; 2 of them（1 in gradeⅠand Ⅱ） were treated with drug therapy for 6 months after surgical resection of hemangioma. Eleven children underwent surgical resection of hemangioma, and 8 patients underwent complete resection of the tumor, accounting for 73%. Among them, 3 patients had residual hemangiomas during operation, and the residual tumor was treated with bleomycin. This group of medications showed that children aged<12 months, after oral propranolol, the tumors were reduced to varying degrees, the most significant change within 1 week after administration, and then the tumor was further reduced until the end of treatment. Conclusion:B-ultrasoun lower bleomycin injection in children with parotid hemangioma is effective, and the incidence of adverse reactions is low, but multiple courses of treatment are required. For patients with poor drug treatment, recurrence or limited range, surgical resection of blood vessels can be selected. Tumor surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars. There are many different treatments for infantile hemangioma, but there is still no treatment for all children. The drug treatment of this group showed that after oral propranolol, the tumors were all reduced to varying degrees, the color became lighter, the texture became softer, and the change was most significant within 1 week after administration, and then the tumor was further reduced until the end of treatment. B-ultrasound guided bleomycin injection in children with parotid hemangioma is effective. After 1-2 courses of treatment, the tumor shrinks significantly and the incidence of adverse reactions is low. Drug treatment of parotid hemangioma in children is simple. A safe and effective method. For children with poor drug treatment, recurrence or limited range, surgical treatment of hemangioma can be selected. Surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars.

Mechanism of Hepatocyte Apoptosis

Hepatocyte apoptosis plays important roles in both the removal of external microorganisms and the occurrence and development of liver diseases. Different conditions, such as virus infection, fatty liver disease, hepatic ischemia reperfusion, and drug-induced liver injury, are accompanied by hepatocyte apoptosis. This review summarizes recent research on the mechanism of hepatocyte apoptosis involving the classical extrinsic and intrinsic apoptotic pathways, endoplasmic reticulum stress, and oxidative stress-induced apoptosis. We emphasized the major causes of apoptosis according to the characteristics of different liver diseases. Several concerns regarding future research and clinical application are also raised.

General/epidural anesthesia in combination preserves NK cell activity and affects cytokine response in cervical carcinoma patients undergoing radical resection: a cohort prospective study

OBJECTIVE

Emerging evidence has shown that epidural anesthesia may help to preserve the body's defenses against tumor progression in comparison with general anesthesia in malignant patients receiving operation. This study aims to evaluate the effect of epidural anesthesia on postoperative immune suppression in cervical carcinoma patients undergoing radical resection.

MATERIALS AND METHODS

Eighty five cervical carcinoma patients receiving radical resection were randomized to combined general/epidural anesthesia (study group) or general anesthesia alone (control group). Natural killer (NK) cell activity and serum concentrations of protumorigenic cytokines (IL-1β, IL-6, and 1L-8) and antitumorigenic cytokines (IL-2 and IFN-γ) were measured before anesthesia (T1), four hours after skin incision (T2), and 24 hours after skin incision (T3) in both groups.

RESULTS

No difference was observed in basal NK cell activity and cytokine concen- trations between study and control groups. The study group exhibited less suppression of NK cell activity, higher levels of IL-2 and IFN-γ, and lower levels of IL-1β, IL-6, and IL-8 at T2 and T3 compared with the control group.

CONCLUSIONS

Combined general/epidural anesthesia seems to be helpful to maintain the body's perioperative immune function compared to general anesthesia alone in cervical carcinoma patients receiving operation.

Pathological characteristics, PCNA labeling index and DNA index in prognostic evaluation of patients with moderately differentiated hepatocellular carcinoma

AIM: To study the relationship between prognosis and pathological characteristics, proliferating cell nuclear antigen labeling index (PCNA-LI) and DNA index (DI) in patients with moderately differentiated hepatocellular carcinoma(HCC).

METHODS: 51 cases of moderately differentiated HCC were analyzed with respect to the relation between their clinical follow-up data and pathological characteristics. Meanwhile, PCNA-LI of HCC cells was detected by immunohistochemistry assay and DI was measured by Feulgen staining and automatic image analysis technique.

RESULTS: Patients with a single tumor nodule, less than 5 cm in diameter, no tumor emboli, no daughter nodules and necrosis had relatively better prognosis; patients with euploidy HCC had better prognosis than those with aneuploidy; among the aneuploidy patients those with DI < 1.5 had better prognosis than the cases with DI > 1.5; The higher the PCNA-LI, the worse would be the prognosis. The increase in DI was correlated with the increase in PCNA-LI, and both of them were correlated with the pathological changes of the tumor.

CONCLUSION: A composite analysis of the pathological characteristics of tumor tissue, DI and PCNA-LI might be useful in predicting the prognosis of HCC patients.

Cytomegalovirus infection in pregnancy

OBJECTIVES

To investigate the effects of intrauterine human cytomegalovirus (HCMV) infection on pregnancy outcomes and infant development.

METHODS

The study group consisted of the HCMV-IgM-positive offspring of 75 pregnant women, and a control group of the non-infected offspring of 73 pregnant women. Chorionic villi, amnionic fluid, and umbilical blood were obtained to detect HCMV-late mRNA with a reverse transcriptase-polymerase chain reaction (RT-PCR) assay. The pregnancy outcomes were followed up. For all offspring, neurological development was evaluated with neurosonography, audiologic development with the brainstem auditory evoked potential (BAEP), and psychomotor development with the Beyley Scale of Infant Development (BSID).

RESULTS

In the study group the positive rate of late mRNA was 50% in the chorionic villi and 67.65% in the amnionic fluid and the umbilical blood; the incidence of abnormal pregnancy outcomes (abortion, preterm delivery, stillbirth, etc.) was much higher than in the control group (40% vs. 6.57%; chi(2)=24.06; P=0.001); the abnormal rate of neurosonography results at birth and 3 months after birth was higher in the study group than in the control group (P<0.05), as were BAEP values 4 months after birth (chi(2)=8.960; P=0.003). Scores for the Infant Mental Development Index (MDI) were apparently lower than in the control group. When congenitally infected children were tested at the age of 5.5-6.5 years with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), their rate of mental retardation was still found to be approximately 20%.

CONCLUSIONS

Intrauterine HCMV infection is closely related to abnormal pregnancy outcomes, infant neurological damage, mental retardation, and hearing loss.