The tumor microenvironment is a special environment including tumor cells,stromal cells and extracellular matrix.The notion that the tumor microenvironment is a necessary functional unit to support cancer progression,metastasis and recurrence has been accepted by more and more scholars.Studies have shown that exosomes may play a pivotal role in tumor progression that involved in cell-cell communication in the tumor microenvironment.Here,we summarize the recent publications on the characteristics of exosomes,its biological effects and the potential roles as an important part of the tumor microenvironment during tumor progression.

OBJECTIVE: To design an electronically controlled hydraulic damper cylinder as a key part of the computer-controlled intelligent knee joint.METHODS: According to the characteristics of hydraulic fluids and processing technology, new type of micro-structure of the digital throttle and unique structure of the two-cylinder piston had been applied to the damper. It could control extension and flexion of the knee joint in two-way automatically, which improved the gait symmetry of artificial limb. Finally, a special self-made testing device was used to evaluate the performance of the hydraulic damper. The damping force adjustment was simulated in test by controlling the two needle valves with micro-computer. The kinematics speed was detected under different state of simulating the driving moment of hip joint and the damping moment of knee joint. The testing results indirectly built the dynamics relationship among the inertial force, damping force and the swing speed of the knee joint. RESULTS: When the position value X of the needle valve was reduced by the step motor driving, the resistance of the hydraulic cylinder was increased which resulted in faster speed of the cylinder rod. The sensitivity of the speed to the driving force decreased with the opening of needle valve increasing. When the stepping motor controlled the needle valve closer, the damping moment increased which led to a faster swing speed.CONCLUSION: The design of hydraulic damper cylinder meets the requirements of prosthetic knee dynamics control.

Objective To evaluate the clinical efficacy of thoracoscopic surgery combined with chemorad-iotherapy in patients with N2 stage ⅢA non-small cell lung cancer (NSCLC). Methods 40 patients (study group) received thoracoscopic surgery and another 40 patients (control group) received traditional thoracotomy. Combination therapy with navelbine and cisplatin were postoperatively administered for four cycles and one cycle lasted for 3 weeks. 7 to 14 days after chemotherapy , sequential conformal radiotherapy were delivered. The one-year survival and two-year survival rates , duration of tatal treatment , and adverse reactions were compared between the two groups. Results In the study group, duration of total treatment time and time to postoperative chemotherapy were significantly shorter (χ2=9.45,P=0.002 andχ2=41.324, P=0.000), and the KPS score was significantly higher (χ2 = 15.118,P = 0.002). No significant differences were found between the two groups in bone marrow suppression,gastrointestinal reactions,and one- or two-year survival rate. Conclusions As compared with conventional surgery,post-thoracoscopic surgery sequential chemoradiotherapy for patients with N2 stage ⅢA NSCLC could achieve a better efficacy with less surgical trauma , shorter hospital stay , faster recovery , and shorter time to postoperative chemotherapy and total treatment duration;it is worth further researching and popularizing.

Objective To investigate the effect of auxiliary heterotopic partial liver transplantation in treating acute ischemic liver failure. Methods Auxiliary heterotopic partial liver transplantation was performed on pigs.The pigs were divided into two groups.Group I: The host′ liver was preserved in situ, liver artery was ligated, portal vein was constricted,and donor patial right liver was transplanted under the right lobe of the liver of the host.Portal venous blood supply was constructed only, and arterial blood supply was not constructed .Group B:Except both arterial blood supply and portal venous blood supply of the donor liver were constructed, and the other operative procedures were as the same as in Group A. The living condition, liver function, blood supply, pathology and bile secretion of the donor liver were observed. Results The survival rates in Group B before and after operation were higher than that in Group A .Serum bilirubin(SB) after the operation was higher than that before the operation in Group A, but showed no change in Group B.After the operation, SB in Group A was higher than that in Group B. In Group A, the donor liver didn't secret bile,and hepatocytes were necrosis.In Group B, the bile secretion and blood supply of donor liver were good,and hepatocyte of the donor liver were alive and proliferating actively.The hosts' liver was necrosis obviously in both groups. Conclusions Hosts' liver artery ligation and portal vein constriction can result in acute ischemic liver failure.Auxiliary heterotopic partial liver transplantation is effective in correcting liver failure.The good arterial blood supply must be constructed in the donor liver to get good donor liver quality.

Objective To investigate the short and longterm effect of the treatment on acute coronary syndrome(ACS) with percutaneous coronary angioplasty and stenting.Methods 65 patients suffering from ACS were treated with angiography to illuminate the features of lesions and proceeded with percutaneous coronary angioplasty and stenting when the angina was not completed controlled with internal medicine.All patients were treated with a new anti-thrombotic regimen,including aspirin,ticlopidine or clopidogrel, and low-molecular-weight heparin.Results The rates of success for patients and lesions were 96.9% and 82.7% respectively.One patient died without myocardial infarction or emergency bypass surgery.56 patients had no symptom of angina after procedure,and 5 patients had non-typical chest pain which disappeared within 2~3 days.During the 3~54 month follow-up,one patient died,one patient developed myocardial infarction and 4 patients underwent target vessel revascularization(repeated angioplasty 2 and bypass surgery 2).Conclusions With the widespread use of aspirin-ticlopidine-low molecular heparin regimen,ACS patients can undergo PTCA and stenting with high success rate,excellent immediate efficacy and long-term efficacy.

Objective To evaluate the feasibility and efficiency of transthoracic echocardiography(TTE) combined with real-time three dimensional echocardiography(RT-3DE)in guiding transcatheter closure of atrial septal defect(TCASD)without X-ray.Methods Eleven patients with atrial septal defects(ASD)underwent the procedure of TCASD guided by TTE combined with RT-3DE.The position of the catheter and transporting sheath,the location and deploying of ASD occluder(ASO)were monitored by muhisection echoscan.especially in RT-3DE.The results were compared with those guided by conventional method(TTE and X-ray).Results All the operations were held successfully.The complications of cardiac tamponade,shedding of occluder,residual shunt,atrioventricular valve regurgitation,embolism and arrhythmia were not observed.Compared with the conventional procedure of the control group,the operation time was significantly prolonged[(65.76±14.15)min versus(45.50±20.88)min,P＜0.000)].Conclusions TCASD was tested to be safe and efficient guided by TTE combined RT-3DE without X-ray,especially for children and pregnant women.It may be expected used widely in the future independently from X-ray.

Objective To evaluate the response rate and survival rates of refractory or relapsed Hodgkin lymphoma (HL) and grey zone lymphoma patients treated with autologous peripheral blood stem cell transplantation (APBSCT).Methods From January 2004 to August 2012,30 HL and grey zone lymphoma patients were retrospectively analyzed.Statistical analysis was done to explore the long term outcome and prognostic factors of patients treated with APBSCT.Among all patients,the median age at transplantion was 30 (13-55) years old.Patients were major with nodular sclerosis HL and in stage Ⅲ/Ⅳ.Results Every patient had a successful collection.The median MNC cell dose infused was 6.8×108/kg [range (1.0-13.8)×108/kg] and median CD34+ cell dose infused was 6.3×106/kg [range (0.6-20.6)×106/kg].Median time to neutrophil engraftment was 9 days (range 8-12 days).28 patients were evaluable after transplantation with a median follow-up of 18.5 months (range 2.5-95.0 months).The overall response rate was 89.3 ％ [CR 64.3 ％ (18/28),PR 25.0 ％ (7/28)].The overall survival (OS) rate and progression free survival (PFS) rate at 5 year would be 78 ％ and 58 ％ for all patients.3 in 7 patients with no remission after salvage chemotherapy with rituximab plus chemotherapy before APBSCT got CR and 2 got PR.Univariate analysis showed that disease status and the number of replacement types of chemotherapy prior to transplantation affected OS,the history of radiotherapy prior to transplantation affected PFS.Conclusion APBSCT can increase CR rate,prolong survival time in patients with refractory or relapsed HL and grey zone lymphoma.Rituximab plus chemotherapy as a salvage therapy could raise CR rate before APBSCT.Chemosensitivity before transplantation affect outcome with APBSCT.Changing many types of chemotherapy is adverse for APBSCT.Salvage radiotherapy before APBSCT is not recommended.

Objective To explore the incidence and risk factors of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 72 cases allo-HSCT from Oct 2004 to Dec 2008 were analyzed. Thirteen factors possibly correlated with the development of aGVHD were analyzed. Results aGVHD was developed in 32 cases (44.4 %), in which grades Ⅰ aGVHD was 11.1%, gradesⅡaGVHD was 18.1%, and grades Ⅲ-Ⅳ aGVHD was 15.3 %. The univariate analysis showed that diagnosis, the status of disease, use ATG, conditioning regimen, donor type,ABO blood group disparity between donor and recipient, CD34+ cell number, early engraftment and neutropenic infection, HLA locus were associated with the occurence of aGVHD (P ＜0.1). On the COX regression mode, an increased risk of aGVHD was associated with HLA mismatch (HR =2.58, P ＜0.005), GVHD prophylaxis without ATG (HR =2.94, P ＜ 0.001), and unrelated donor (HR =1.97, P ＜0.01). Conclusion aGVHD is a common complication after allo-HSCT, and HLA mismatch and unrelated donor are independent risk factors for aGVHD.

Objective To apply the optical coherence tomography(OCT) to detect the characteristics of coronary artery plaque and to investigate its correlation with levels of serum matrix metalloproteinase 7(MMP 7),MMP9 and MMP12.Methods The patients undergoing coronary arterial angiography for diagnosing coronary arterial lesions in the cardiology department of our hospital from October 2014 to March 2016 were collected and included into the research subjects.The subjects were divided into the stable plaque group and unstable plaque group based on the results of OCT scanning.The neovascularization characteristics such as the fibrous cap thickness of plaque,angle of lipid pool,macrophage infiltration and plaque cracks were detected by using OCT.ELISA was used to measure serum MMP7,MMP9 and MMP12 levels.Results (1) The fibrous cap thickness in the stable plaque group was more than that in the unstable plaque group(P＜0.01);the lipid pool angle,microphage infiltration,intima erosion and plaque cracks in the unstable plaque group were more than those in the stable plaque group(P＜0.05).(2) The MMP7 and MMP9 levels in the unstable plaque group were higher than those in the stable plaque group and control group(P＜0.05).(3) The fibrous cap thickness had significantly negative correlation with serum MMP9 level(r=-0.336,P=0.034);the MMP7 and MMP9 levels in the microphage infiltration group were higher than those in the non-microphage infiltration group(P＜0.05);the MMP9 level in the intima erosion group was higher than that in the non-intima erosion group(P＜0.01).Conclusion OCT can detect and find unstable plaque and the serum levels of MMP7 and MMP9 are significantly elevated in the patients with unstable plaque,which can be used as an important basis for predicting unstable plaque and guiding the treatment decisions.

Objective To evaluate the efficiency of transcatheter closure of PDA using domestic occluder device.Methods Thirteen two patients(male 11,female 21) with PDA were treated by transcatheter closure of PDA with domestic occluder device. The mean age of patients was 14.4?9.8 years (ranged from 1.8 to 39 years old). PDA were shown by transethroracic echocardiography (TTE) before interventions. Each case was treated with domestic occluder device through the percutaneous procedure under fluoroscopy and TTE. After the procedure,TTE were performed immediately to find whether there any residual shunt remained. Transthoracic echocardiography (TTE) and X-ray examination were done 24-hour, 1-month, 3-month and 6-month after the procedure to evaluate the efficiency.Results The success rate of placement of domestic occluder was 100%. Thoracic angiography showed that 18 patients had complete immediate closure and one had a small residual shunt after the operation. Residual shunt was found in four case after the operation. X-ray examination and TTE showed that both pulmonary vascularity and heart size were improved.Conclusions Transcatheter closure of PDA using domestic occluder device is an efficient nonsurgical method for patients of any age group. The operation is simple and safe with a high success rate of placement and a good occlusion effect. The long-term follow-up remains to be studied.