Objective To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA).Methods Two reviewers searched PubMed,MEDLINE,EMBASE,Cochrane Library,Chinese Biomedical Literature Database (CBM),Chinese Scientific Journal Full-text Database (CSJD),and Chinese Journal Full-text Database( CJFD),added with handsearching and other retrievals.The Cochrane Collaboration's RevMan 5.0.18 was used for metaanalyses.Results Pooled data in 9 observational studies describing 2402 people.Meta-analyses showed that EVAR was superior to open repair (OR) as measured by the 30-day all cause mortality [ OR =0.47,95％ CI (0.39,0.57 ),P ＜ 0.01 ] and the primary póstoperative complications [ OR =0.59,95％ CI(0.43,0.81 ),P =0.001 ].Endovascular repair compared with open surgery,in the early postoperative reoperation rate [ OR =0.86,95 ％ CI(0.55,1.33 ),P =0.5 ] and the mid-term all-cause mortality [ OR =1.24,95 ％ CI (0.46,3.37 ),P =0.67 ] was not different statistically.Conclusions Short-term decrease of mortality after endovascular repair for ruptured aneurysms appears promising in selected patients,but the overall benefit is still not clear.Further research is needed to define the indications for REVAR in patients presenfing with RAAA.

Objective To clarify the clinical features of solid pseudo-papillary tumor of pancreas. Methods Clinical data of 38 patients with solid pseudo-papillary tumor of pancreas were analyzed retrospectively. Results The clinical manifestations included a palpable abdominal mass, abdominal pain and discomfort. Tumor occured in 1 case younger than 10 years old, 11 cases between 11 years old and 20 years old, 7 cases between 21 years old and 30 years old, 9 cases between 31 years old and 40 years old, 5 cases between 41 years old and 50 years old and 1 case older than 50 years. Immunohistochemistry staining showed CgA( + ) in 6 cases,Vim( + )in 29 cases,AAT( + ) in 29 cases,Syn( + ) in 21cases,CD10( + ) in 34 cases,CD56( + ) in 37 cases, Ki-67 ( + ) in 36 cases and PR( + ) in 38 cases. Conclusion Solid pseudo-papillary tumor of pancreas is closely associated with gonadal hormone and reproductive system.

OBJECTIVE: To investigate theresearch condition of mechanism of cardiomyocytes differentiation from embryonic stem (ES) cells and the application potency of ES cells at home and abroad.DATA SOURCES: We searched in Medline database from 1997 to 2005 with the key words of "embryonic stem cell,cardiomyocyte/cardiac myocyte,differentiation" in English.STUDY SELECTION: The retrieved data were selected primarily. Inclusive criterion: articles of differentiation into cardiomyocytes from ES cells.Exclusive criterion: the articles of repetitive research were excluded.DATA EXTRACTION: Totally more than 200 articles were researched,and 26 were included.DATA SYNTHESIS: Some articles of differentiation of ES cells into cardiomyocytes from the construction of primarily experimental methods of cardiomyocytes differentiation from ES cells to electrophysiologic study of ES cells-derived cardiomyocytes in monoplast level were collected. Furthermore, many investigators studied the expression of transcription factors that controlled cardio development in the differentiation of ES cells to cardiomyocytes from the angle of transcription factors. Cardiac transcription factors GATA4, MEF2C and NKx2.5 had been reported to control a cardiac gene program and thus to play a crucial role in transcriptional regulation during cardiogenesis. Meanwhile, calcineurin, MAPKs and other signaling pathways were also involved in the adjustment of cardiomyocyte differentiation. In addition, the purity of differentiated ES-derived cardiomyocyte cultures for myocardial infarction was a key issue.CONCLUSION: When ES cells are cultured within Ebs and in the absence of leukemia inhibitory factor (LIF), some of them can differentiate into cardiomyocytes. ES-derived cardiomyocytes express characteristic contractile proteins, such as MHC and myosin light chain (MLC)-2V. Transcription factors, including GATA4, MEF2C and NKx2.5, play a crucial role in the cardioblast differentiation and trigger the expression of specific genes such as α-actin, MHC and MLC2V. However, t he molecular mechanisms of cardiomyocyte differentiation from ES cells remain largely unexplored. The identification of factors that can promote cardiac differentiation is fundament in order to study cardiac differentiation.

Objective To study the clinical features, laboratory findings and therapy of patients with bullous pemphigoid. Methods Clinical data of 89 cases of bullous pemphigoid were retrospectively analyzed. Results The male female ratio was 1.07∶1. The mean age of first onset was 58 years old. Patients presented erythema multiforme and dermatitis herpetiformis like lesions besides typical bullae and erythema. Oral mucosal lesions occurred in 33.7% of patients, and oral bullae and erosions were the inital symptoms in 6.7% of patients. Nikolsky′s sign was present in 18% of patients. Direct and indirect immunoflorescence were positive in 95% and 74.4% of patients, respectively. The patients were mainly treated with corticosteroids or the combination of corticosteroids with immunosuppressive agents. The mean dose of coricosteroid needed to control lesions was 65.5 mg (equivalent of prednisone), except patients treated with pulse therapy of corticosteroids. Conclusions Histopathological and immunofluorescent findings are the most important evidence for the diagnosis of bullous pemphigoid. The maximum doses needed to control lesions vary greatly in different individuals.

OBJECTIVE:To approach the information of stem cell transplantation in treating myocardial infarction.DATA SOURCES: An online search of Medline database was undertaken to identify articles about stem cell transplantation in treating myocardial infarction published in English from January 1980 to December 2005 using the keywords of "stem cells, myocerdial infarction, cell transplantation".STUDY SELECTION: The literatures were checked primarily, and articles about the stem cell transplantation in treating myocardial infarction were selected, and the repetitive studies and reviews were excluded.DATA EXTRACTION: Totally 106 relevant articles were collected, finally 30 of them were involved and the other 76 were excluded.DATA SYNTHESIS: Myocardial infarction occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The transplantation of exogenous cells into damaged myocardium, a procedure known as cellular cardiomyoplasty (CCM), can be used to ameliorate the remodeling process by the regeneration of cardiomyocytes and replenishment of the vascular supply. Advances in stem cell therapy now provide wide cell sources for the treatment of cardiovascular disease by CCM such as skeletal myoblasts (satellite cells),embryonic stem cells (ESCs) and bone marrow-derived mesenchymal stem cells (MSCs). Although there are many problems to be resolved, recent in vitro and in vivo animal studies as well as clinical trials have suggested the promising potential of the transplantation of stem cells for the treatment of myocardial infarction.CONCLUSION:Stem cell transplantation acts as a more potential treatment measure for myocardial infarction. There are still some fundamental issues to be addressed for the clinical application in future.

Combined with the features of clinical practice teaching of cardiothoracic surgery ,we discuss how to improve the quality of clinical practice teaching of cardiothoracic surgery and strengthen the cultivation of medicos'capability and diathesis,thus correctly guiding medicos to finish their interim study commendably and change their roles from students to doctors.

[Objective] To determine the relationship between the adjacent segment degeneration(ASD)and the clinical outcome after lumbar spine fusion.[Methods]Totally 436 patients undergoing posterolateral lumbar fusion were followed up for 58.13 months(26~114 months).The patients were divided into 3 groups according to the number of the fusion segments:1 segment,2 segments and 3 or more segments.UCLA grading scale was used to evaluate the degeneration of the adjacent segments.Cinical outcome was evaluated according to the criteria established by Hou SH.[Results]Adjacent segment degeneration(ASD)occurred in 58 patients,including 14 in group A,27 in group B and 17 in group C.Forty-nine patients had their ASD above the fusion level and 9 below the fusion level.For all the 14 patients in group A,the degenerative grade increased by 1 grade.Of the 27 patients in group B,16 increased by 1 grade,7 by 2 grades,and 4 by 3 grades.Of the 17 patients in group C,4 increased by 1 grade,8 by 2 grades and 5 by 3 grades.For the clinical outcome,7 patients in group A increased by 1 grade.In group B,13 patients increased by 2 grade and 5 patients increased by 3 grades.For the clinical effect degrees,7 cases decreased by 1 degree in group A.In group B,13 cases decreased by 1 degree and 6 decreased by 2 degrees.[Conclusion]No significant relationship was found between the adjacent segment degeneration and the clinical outcome.Careful attention is needed for avoidance of multi-segmental fusion.

The differentiation of neural stem cells/neural precursors (NSCs/NPs) is a hot spot in neurobiological research. It used to identify their differentiation degree only by morphologic appearances. The functional characteristics, such as electrical properties of cellular membrane and ion channel activities, are drawing more and more attention with the development of patch clamp technique. It was summarized the recent progress in the study of NSCs/NPs functional differentiation using patch clamp, some existing problems and research perspectives were suggested.

BACKGROUND: Reactive oxygen species (ROS), including superoxide anion (O2) and hydrogen peroxide (H2O2), have been recognized as specific second messengers in signaling cascades involved in the growth and differentiation of cells.The generation of excessive ROS initiates cardiomyocyte apoptosis. This paper is aimed to corroborate the hypothesis that excessive amounts of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) 4-dependent ROS can suppress cardiomyocyte differentiation from embryonic stem (ES) cells by induction of apoptosis.OBJECTIVE: To investigate the role of NOX4 ROS on cardiomyocyte differentiation.DESIGN: Randomized and controlled trial observation.SETTING: Beijing Institute of Geriatrics, Beijing Hospital, Key Laboratory of Geriatrics, Ministry of Health.MATERIALS: ES cells were preserved by the laboratory of Beijing Institute of Geriatrics, Beijing Hospital, Key Laboratory of Geriatrics, Ministry of Health, while other reagents were purchased from Sigma Company without specific notification.METHODS: The experiment was carried out in the Beijing Institute of Geriatrics, Beijing Hospital, Key Laboratory of Geriatrics, Ministry of Health from October 2003 to August 2005. ①Mouse ES cells were differentiated into embryoid bodies (Ebs). At day 4, Ebs were managed for one hour with different concentrations (1, 10, 100, 1 000 nmol/L) of H2O2, and generation of cardiomyocytes was observed at day 8 to analyze the effect of ROS on cardiomyocyte differentiation.② CGB8 cells transfected with pcDNA3.1 and pcDNA3.1-NOX4 respectively were adopted, while those untransfected CGB8 cells were taken as controls. A quantitative NBT (nitro blue tetrazolium) test was used to measure NOX4 ROS generation. The levels of NOX4 mRNA and MLC2v protein were assayed by RT-PCR and western blotting, respectively.③ROS scavenger N-acetylcysteine (5 mmol/L) and catalase (200 U/mL) managed for 2 hours before transcription were taken as controls to observe the apoptosis of CGB8 cell after NOX4 overexpressed and the expressions of p21, p53 and Bcl-2 of NOX4-transfected CGB8 cells simultaneously. And the apoptosis of ES cells was detected by Hoechst staining, TUNEL assay and DNA fragmentation.MAIN OUTCOME MEASURES: ①the role of ROS on cardiomyocyte differentiation.②the expression of NOX in ES cells.③ the production of ROS, differentiation of cardiomyocyte and apoptosis of ES cells after NOX4 overexpressed.④the feasibility that p53, p21 and Bcl-2 are involved in the apoptosis induced by the overexpression of NOX4.RESULTS: ①Different concentrations of ROS play different roles on cardiomyocyte differentiation. The exposure of Ebs to 1-100 nmol/L H2O2 for 2 hours at day 4 of culture leaded to an enhanced beating activity (P ＜ 0.01 or 0.001), whereas 1 μmol/L H2O2 depressed cardiomyocyte differentiation as compared with control conditions (P ＜ 0.001). ②NOX4 was highly expressed in ES cells, while NOX1 and NOX2 were absent and only a weak band of NOX3 was detected. The results from RT-PCR revealed that NOX4 overexpressed in CGR8 transfected with pcDNA3.1-NOX4 as compared to the control.③NBT result proved that highly-expressed NOX4 produced the excessive amounts of ROS (P ＜ 0.05). The beating activity was remarkably reduced in NOX4-overexpressing Ebs as compared to wild-type or mock-transfected Ebs (P ＜0.01). Moreover, a severe reduction of MLC2v protein in NOX4-overexpressing Ebs was also observed by western blot analysis.④p21 and p53 may be responsible for the NOX4-induced apoptosis. P53-/- cells R72D27 transfected by NOX4 did not induce apoptosis. NOX4 overexpression induced ES cell apoptosis could be prevented by overexpression of Bcl-2.CONCLUSION: The findings of this paper highlight the role of NADPH oxidase NOX4 in cardiomyocyte differentiation from ES cells. P53, p21 and Bcl-2 could be involved in the apoptotic pathway.

A numerical model is developed in this paper to calculate the bending moments of flexural members through integration in 3D solid finite element analyses according to the nonlinear constitutive model of concrete and the elastoplastic constitutive model of steel, utilizing the stress condition of the cross-section, considering the destruction characteristic of reinforced concrete members, and based on the plane cross-section assumption. The results of this model give good agreement with those of the classical method. Consequently, we can also deduce the corresponding numerical expression for eccentrically loaded members according to the analysis method.