The rapid development of second-generation sequencing technology and bioinformatics has enabled us to find out more about the components of the microbiome throughout the respiratory tract,including bacteria,fungi and viruses.A growing number of studies have shown that there is a close relationship between respiratory microorganisms and various respiratory diseases,which provides new areas of research relating to asthma,cystic fibrosis (CF),chronic obstructive pulmonary disease (COPD),lung cancer and influenza.In this paper,research progress in respiratory microbiome (bacteria, fungi and viruses)and related diseases is reviewed.

ObjectiveTo evaluate the efficacy and safety of Sirolimus (SRL) in immunosuppression following liver transplantation. Methods SRL was applied in 21 patients totally.Indication for adoption was Tac-related nephrotoxicity (4/21), suspiciously Tac-related hepatoxicity (8/21), Tac overdose (3/21), renal insufficiency pre-operation (2/21), or cancer (4/21). Median follow-up was 25. 4 months. Results SRL provided an adequate prophylaxis against rejection in all study patients, with one case of acute rejection. Sirolimus was Withdrawn in 2 cases due to its sideeffect. Tat-induced hepatoxicity in 6 cases and nephrotoxicity in 3 cases were relieved significantly.Conclusions SRL given alone appears to be an effective primary immunosuppressant regimen fororthotopic liver transplantation patients. Early conversion contributes to significant improvement of Tac-related hepatoxicity and nephrotoxicity.

Objective To investigate the expression of MTSS1 in cholangiocarcinoma tissue and its relationship with the prognosis of patients.Methods The specimens of bile duct of 49 patients with hilar cholangiocarcinoma who received surgical excision at the Eastern Hepatobiliary Surgery Hospital from January 2003 to December 2005 were collected.Tissue microarrays of the 49 samples of hilar cholangiocarcinomas and the 10samples of adjancent normal bile duct epithelial tissue were constructed.The expression of MTSS1 was detected by the immunohistochemical staining.The pcDNA3.1-MTSS1 was transferred into the RBE cells and the abilities of proliferation of REB cells were measured by MTT assay.The patients were followed up via out-patient examination and telephone till May 2012.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test,the survival curve was drawn by the Kaplan-Meier method,the survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results The results of immunohistochemical staining showed that the expression rate of MTSS1 was 10/10 in the adjacent normal epithelial tissue of bile duct,while 59.2％ (29/49) in the cholangiocarcinoma tissues.The proliferative rate of cholangiocarcinoma cells transfected with MTSS1 was 1.55 ±0.05,which was significantly lower than 2.32 ±0.08 of cholangiocarcinoma cells without transfection of MTSS1 (t =4.454,P ＜ 0.05).Gender,age,TNM stage,T stage,differentiation,neural invasion and diameter of tumor did not influence the expression of MTSS1 (x2=0.211,3.471,0.507,0.507,0.368,0.882,0.660,P ＜ 0.05),while lymph node metastasis influenced the expression of MTSS1 (x2=10.436,P ＜ 0.05).All the patients were followed up for 1-59 months,and the median time for follow-up was 16 months.The median tumor-free survival time was 17.9 months in patients with positive expression of MTSSI,and 11.3 months of patients with negative expression of MTSS1,with no significant difference (Log-rank value =3.707,P ＞ 0.05).The median survival time was 34.9 months in patients with positive expression of MTSS1,which was significantly longer than 18.7 months of patients with negative expression of MTSS1 (Log-rank value =5.671,P ＜0.05).Multivariate analysis showed that MTSS1 was not the independent risk factor influencing the prognosis of patients (x2 =0.406,P ＞ 0.05).Conclusions The expression of MTSS1 is decreased in cholangiocarcinoma tissue,which negatively correlates with lymph node metastasis.MTSS1 could be used as a biomarker in predicting the prognosis of patients with cholangiocarcinoma.

Currently,there is a worldwide increase in the incidence and mortality of intrahepatic cholangiocarcinoma (ICC),but the etiology of ICC remains unclear.Recent efforts suggest an etiological role of hepatitis B virus (HBV)infection in ICC,and this article reviews the relationship between chronic HBV infection and the risk and prognosis of ICC.

Objective To provide theoretical reference for clinical therapy of pulmonary adenocarcinoma by evaluating the effects of polysaccharides and pioglitazone on mouse model of pulmonary adenocarcinoma and to explore the relationship between inflammation and pulmonary adenocarcinoma. Methods One hundred mice were averagely divided into five groups, including control group, model group, polysaccharides group, pioglitazone group, polysaccharides and pioglitazone group (unite group). Polysaccharides solution (500 mg/kg) was given to polysaccharides group, pioglitazone solution (15 mg/kg) was given to pioglitazone group, polysaccharides solution (500 mg/kg) and pioglitazone solution (15 mg/kg) were given to unite group;and the equal volume of saline (10 mL/kg) was given to control and model group (1 t/d, 5 d/w, continuously 20 w ). The pulmonary adenocarcinoma induced by urethane was evaluated in each group at different time points. The levels of NF-κB, TNF-α, IL-1β and IL-6 were measured in each group at the 12th week and the 20th week respectively. Results The body weights were increased in the control group, which were decreased in other groups during urethane-injection, but increased continuously after the injection. At the 20th week, nodules were found in lung surfaces in all mice except mice of control group. The lung index was higher in all mice except mice of control group. The levels of NF-κB, TNF-α, IL-1βand IL-6 were significantly higher at 12th week and 20th in model group, polysaccharides group, pioglitazone group, polysaccha?rides and pioglitazone group than those of control group. The levels of NF-κB, TNF-α, IL-1βand IL-6 were significantly lower in polysaccharides group, pioglitazone group, polysaccharides and pioglitazone group than those of model group. Con?clusion Sustained inflammatory response is one of the risk factors for the development of lung adenocarcinoma. Polysaccha?rides and pioglitazone can reduce the level of inflammation in mouse lung adenocarcinoma, suggesting that both of them can be used as potential adjuvant in the clinical treatment of lung adenocarcinoma.

Objective To evaluate the predictive effect of preoperative CTP score,MELD score and MELD-Na score on short-term prognosis (≤ 3 months) after liver transplantation,to analyze factors which correlated with survival,and to seek indicators that accurately predicted short-term outcomes.Methods The clinical data of 73 consecutive patients with end-stage liver diseases who underwent liver transplantation in a single center were retrospectively analyzed.The area under the ROC curve (AUC) was used to determine the predictive power.Correlated factors were analyzed by multivariate logistic regression.The statistical processing package used was SAS 9.1.3 software.Results 11 (15.1％) of 73 patients died within 3 months after liver transplantation.The areas under the ROC curve of the preoperative CTP score,MELD score and MELD-Na score for predicting short-term survival were 0.817,0.839 and 0.860 respectively.There was no significant difference among these 3 scoring systems.On univariate analysis,indicators significantly correlated with early mortality were preoperative serum sodium,serum urea,PT-INR,CTP score,MELD score and MELD-Na score.On logistic multiple regression,only MELD-Na score remained as a significant indicator (P =0.001,β =-2.496,OR =0.085,95％ CI:0.019 ～ 0.370).Conclusions The MELD-Na scoring system showed superior predictability of early mortality in patients who underwent liver transplantation.The preoperative MELD-Na score was an independent risk factor of short-term survival.The higher the MELD-Na score,the higher was the early mortality.

ObjectiveTo compare planning quality,treatment efficiency and delivery accuracy for initial treated nasopharyngeal carcinoma (NPC) with step & shoot intensity modulated radiation therapy (ssIMRT) and volumetric modulated arc therapy (VMAT).These results will help make a clinic choice of the therapeutical technique.MethodsTwenty-six NPC cases were planned with the same dose prescription and objective constrains by means of 9-field ss-IMRT and VMAT respectively.Compare:( 1 ) plan dosimetric distribution,conformity index and homogeneity index of the targets,the average dose,maximum dose and interested dose-volume histograms of organs at risk (OAR) et al;(2) delivery times of the therapy plans ;(3) the accuracy of treatment plans dose verification.ResultsBoth therapeutical plans can achieve the clinic dosimetric demands.Compared to ss-IMRT,VMAT had less inferior target coverage.The CI and HI of the PGTV was 0.57 and 0.08 ( ss-IMRT),0.48 and 0.12 (VMAT) respectively ( t =-4.52,- 8.33,P =0.000,0.000).Except of brain stem,VMAT had higher mean dose and maximum dose of OARs than ss-IMRT (t=-9.57 - -3.71,P=0.000 -0.001).The spinal cord D1cc and parotids D50％ were increased by 11.9％ and 6.5％ averagely.The treatment times of ss-IMRT and VMAT were 803.7 s and 389.3 s respectively (t =24.12,P =0.000),while V MAT decreasing by 51.6％.The pass ratios of γ (3mm,3％ ) from the dose verification were 99.4％ (ss-IMRT) and 98.0％ (VMAT) respectively ( t =5.19,P =0.000).ConclusionsThe dose distribution of VMAT for initial treated nasopharyngeal carcinoma can achieve the clinic demands,but slightly worse than 9-field ss-IMRT.VMAT has the advantage of high efficiency and dosimetric accuracy.

Objective To introduce a new way to solve the problem of field-field junction in the traditional radiotherapy of the nasopharyngeal carcinoma better.Methods Using the 3-dimentional planning system,the dose distribution of traditional radiotherapy and the electronic beam irradiation technology of L shape field for nasopharyngeal carcinoma in 2D-or 3D-CRT could be gotten.Results The dose coverage of V95 of the gross tumor volume(GTV)satisfied the clinical requirements.The highest dose in the electronic beam irradiation of L shape field was 7200 cGy,while it was 8900 cGy in the traditional way.The volume of dose that over 6500 cGy of throat was 19.64 ％ in the former,the latter was 31.95 ％.Conclusion The electronic beam irradiation technology of L shape field is better than the traditional radiotherapy in field-field junction and in dose distribution.Since that,the electronic beam irradiation technology of L shape field is worth of application for the treatment of nasopharyngeal carcinoma.

Objective To develop a network management system for tumor radiotherapy information that integrates process management and quality assurance functions, and to investigate its clinical value. Methods Based on the requirements of radiotherapy process quality assurance and control, the client-server ( C-S) pattern, along with SQL SERVER 2008 database structure, international standard DICOM 3.0, DICOM RT, and HL7 protocols, and system hardware and self-developed software in local area network, was adopted to establish the network management system for radiotherapy information, and clinical tests were performed to evaluate the operation performance of this platform.Results ( 1 ) The interactive integrated management platform and client-side functional modules with a uniform interface were developed.( 2) The safe and reliable standardized data interface was developed, which could be connected to accelerators, treatment planning systems, and hospital information systems developed by mainstream manufacturers.( 3) The modules for radiotherapy process management and quality assurance and management were designed and developed.( 4) The platform passed all the tests before operation and had been used in clinical departments for almost 3 years, which confirmed that the system was safe and stable during operation and that all functions designed were realized.Conclusions The integrated management platform meets the requirements for application and management of radiotherapy information and data, improves the overall work efficiency in radiotherapy department and the level of quality assurance and control, and holds promise for clinical application as a good tool for tumor radiotherapy departments.

Objective To retrospectively study the high risk factors for biliary complication (BC) and the application of the Clavien system to classify BC in a large cohorts of subjects undergoing liver transplantations (LT).Methods The clinical data of 181 patients who received LT from Jan.2004 to Dec.2008 were studied.BC was classified using the Clavien system.The risk factors of biliary complication were evaluated by using a binary forward stepwise logistic regression analysis.Results 14.4％ (26/181) recipients developed BC (BC group).In 84.6％ (22/26) patients the BC was above the Clavien Ⅲ b.Regression analysis of BC revealed that the placement of a T tube (P =0.0090,OR=31.177),RIld (P=0.0094,OR＜0.001).RI1w (P=0.0013,OR＞999.999) were significantly associated with the development of BC.Regression analysis of BC above Clavien Ⅲ b revealed that RIld (P=0.0065,OR＜0.001,RI1w (P=0.0022,OR＞999.999) were significantly associated with the development of BC above Clavien Ⅲ b.Conclusions The Clavien classification system was useful to classify BC.The placement of a T tube was an independent risk factor to predict BC,it was not a factor for BC above Clavien Ⅲ b.Hepatic arterial insufficiency (HAI) was an independent risk factor for BC and BC above Clavien Ⅲ b.