The tumor microenvironment is closely related to the occurrence and development of tumor. Hypoxia is considered to be one of the most important factors in tumor microenvironment.Formation of hypoxic microenvironment can be found in most of malignant tumors,which can inhibit the anti-tumor immune response. Recent studies have indicated that immunosuppressive cells,tumor stem cells and circulating tumor cells in hypoxic tumor microenvironment can mediate immune suppression and immune tolerance,and then promote development of tumor.The new immune therapy will focus on normalizing tumor vasculature,reconstructing the tumor microenvironment,avoiding immune suppression and averting tumor immune tolerance.

Objective To explorethe chest x-ray and MSCT findings and the diagnostic value of pulmonary lymphangioleiomyomatosis (PLAM).Methods Four cases of PLAM proven by pathology were retrospectively analyzed,and the literature was reviewed.Result The clinical manifestations were dyspnoea(4 cases),cough(2 cases),haemoptysis(2 cases),recurrent pneumothorax(2 cases)and chylous effusions (1 case).The chest radiography presented diffused reticular shadows(2 cases),honey-comb changes(1 case),pneumatothorax(2 cases),and pleural effusion(1 case).The characteristic MSCT manifestations of 4 cases with PLAM were multiple different-sized and thin-walled cystoid transparent areas, which were diffusely-distributed throughout both lungs,most cysts were of 3-15 Him in diameter.One case combined with extensive pulmonary interstitial fibrosis,pleural thickening and adhesion.Conclusions PLAM is a kind of exceptional chronic diffuse lung interstitial disease.The chest radiography has been lack of characteristic imagines,but MSCT has characteristics of PLAM,and is more valuable for accurate clinical diagnosis of PLAM.

Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus(HBV)infection in immune tolerant phase.Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study.The age,gender,serum HBV DNA level,hepatic inflammatory activity and fibrosis,hepatic HBsAg and HBcAg expressions were analyzed.The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase(ALT).Data analysis was done by chi-square test. Results In 98 patients,83(84.7%)were＜30 years old and 15(15.3%)were≥30.Patients whose mother was HBsAg positive were 48.0%.High levels of serum HBV DNA were found in all patients, with 78.5% were＞1×107 copy/mL.Only 5 cases(5.1%)were G0 of the inflammatory grade;whereas,64 cases(65.3%)were G1,29(29.6%)were G2.There were 56 patients(57.1%)had no significant liver fibrosis;and 23 cases(23.5%)were S1,14(14.3%)were S2,5(5.1%)were S3;none of patients had cirrhosis.The HBsAg and HBcAg in liver tissues were positive in 79(80.6%)and 80(81.6%)cases,respectively.The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels(X2=8.112 3,P=0.043 7).Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver,some of them have already developed fibrosis.Therefore,liver pathology is recommended for these patients to help understand the patients' conditions and make correct therapeutic decisions.

Objective To analyze the percentage and functional changes of natural killer T (NKT) cells in peripheral blood and bone marrow of severe aplastic anemia (SAA) children before immunosuppressive therapy (IST) comparing to that of healthy children.Methods Ten children with severe aplastic anemia were included in the study and ten healthy children at the same age were selected as the control group. By lfow cytometry, the percentage of CD3+CD1d tetramer+ NKT cell in peripheral blood and bone marrow were detected from March 2014 to December 2014 in our hospital. Immune magnetic bead separation was used to isolate and purify iNKT cells .The puriifed iNKT cells were cultured in the OCH(50 ng/ml,100 ng/ml or 200 ng/ml)+rhIL-2+rhG-CSF culture systems. The ampliifcation of iNKT cells after cultured in different systems were calculated. Elispot method was used to analyze the spotting form cells (SFCs) of IFN-γ or IL-4 expressed by activated iNKT cells.Results The percentage of CD3+CD1d tetramer+ NKT cells in peripheral blood of SAA group(0.72±0.03)% was signiifcantly lower than that of the control group(0.92±0.02)%(P=0.000). The percentage of CD3+CD1d tetramer+ NKT cells in bone marrow of SAA group(0.82±0.02)% was signiifcantly lower than that of the control group(1.05±0.05)%(P=0.000).In vitro iNKT cell ampliif-cation ability of bone marrow in SAA group was signiifcantly lower than the control group, and in medium concentration(50±6) and high concentration OCH group(52±6), the ampliifcation ability was higher than that in low concentration OCH group(30±5) (P<0.05). The secretion of IFN-γ in the iNKT cells of SAA bone marrow was signiifcantly lower in medium concentration(33±3) and high concentration(35±3)OCH group than that of the low concentration(50±3)OCH group(P<0.01). The secretion of IL-4 in the iNKT cells of SAA bone marrow was signiifcantly higher in medium concentration(50±3)and high concentration(75±3) OCH group than that of the low concentration(33±3) OCH group(P<0.01).Conclusions The quantity and function of NKT cells from children with SAA are lower than that of the healthy children.In vitro, they had better ampliifcation ability and could improve IL-4/IFN-γ imbalance in medium concentration and high concentration OCH group than in low concentration OCH group.

Objective To analyze the pathogenic characteristics of sepsis in patients with hepatic failure, and to explore the risk factors for sepsis in patients with liver failure. Methods The data of 221 patients with hepatic failure admitted to Tianjin Second People's Hospital from January 2014 to December 2018 were retrospectively collected. The patients were divided into two groups according to whether they suffered from sepsis or not. The pathogeny results of blood culture in patients with sepsis were observed. The levels of white blood cell (WBC), neutrophil (Neut), platelet (PLT), lactic acid (Lac), C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. The risk factors for sepsis in patients with hepatic failure were analyzed by multivariate Logistic regression analysis. Results Among 221 patients, 27 cases had incomplete data and were excluded. Finally, 194 cases were enrolled in the analysis, including 52 in sepsis group and 142 in non-sepsis group. From 2014 to 2018, there were 11, 12, 11, 11 and 8 positive cases of sepsis in patients with liver failure. The positive rate of Gram-positive (G+) bacteria increased year by year (2, 3, 4, 5 and 4 cases of G+ bacteria from 2014 to 2018). There was no significant difference in demographic and medical history data, such as gender, age and history of diabetes mellitus between the two groups. Compared with non-sepsis group, Neut, Lac, CRP and PCT in sepsis group were significantly increased [Neut:0.81±0.09 vs. 0.74±0.15, Lac (mmol/L): 3.04±0.61 vs. 2.00±0.43, CRP (mg/L): 44.09±8.37 vs. 40.54±8.37, PCT (μg/L): 0.34±0.12 vs. 0.31±0.11], with significant differences (all P < 0.05). But there was no statistical difference in WBC or PLT between the two groups. The multivariate Logistic regression model incorporated the indicators with statistical significance in univariate analysis. The results showed that Lac was an independent factor of sepsis in patients with hepatic failure [odds ratio (OR) = 58.286, 95% confidence interval (95%CI) = 16.633-204.247, P =0.000]. Conclusions For patients with hepatic failure infection, the ratio of G+ bacteria increased year by year. Elevated Lac is an independent risk factor for sepsis in patients with liver failure.