Percutaneous myocardial revascularization (PMR)，building on the succeeds of transmyocardial laser revascularization (TMR)，has developed that allows TMR-like channels to be cradated via a percutaneous approach.This catheter based approach avoids the morbidity associated with general anesthesia and thoractomy or thoracoscopy.It also avoids transmural treatment of the myocardium by the laser.Although its mechanism remains unclear,many patients with intractable angina and non-bypassable coronary artery disease have benefited from the new system.It is hoped that PMR will mimic the clinical benefit of TMR，and will gradually become a main method in treating end-staged coronary artery disease.

Chemotherapy and endocrine therapy are two kinds of important treatment modalities of breast cancer with hormone receptor-positive. Adjuvant chemotherapy whether can be proposed to the individual patient or not according to tumor burden factors, multi-gene prognostic signatures detection and molecular subtype classification for breast cancer. There are four different endocrine strategies, and each of them has its own advantage over others and cannot be replaced by others. Individualized therapy should be performed to Luminal A and Luminal B breast cancers.

Epidermal stem cells (ESCs) play a critical role in homeostasis and wound repair of skin tissue. Since ESCs are rare (fewer than 10% in total basal cells population) and lack specific markers,it is difficult to isolate and identify them from keratinocytes. Currently ,isolation of ESCs was achieved mainly by fast adhesion of ESCs to extracelluar matrix or flow cytometry. Several specific markers have been found in recent years for the identification of ESCs.

Objective To explore the effect of enalapril combined with folate acid on endothelial function and urine microalbumin(UMA) in patients with hypertension.Methods 120 patients with hypertension were randomly divided into two groups:control group (n =60) was given enalapril 10.0mg/d,observation group (n =60) received enalapril 10.0mg + folic acid 0.4mg/d.The total treatment period was 8 weeks.Blood pressure,plasma homocysteine (Hcy),flow mediated dilation (FMD) and UMA were examined.Results The efficacy of pressure releasinghad no significant difference between two groups.Hcy[(10.2 ± 5.8) μmol/L vs (16.6 ±-8.1) μmol/L,t =3.641],FMD[(14.8 ±5.4)％ vs (8.2±3.5)％,t =7.325] and UMA[(14.8 ±5.4)mg/L vs (31.6 ±9.5)mg/L,t =8.221] of two groups were significantly different after treatment.Conclusion Combination therapy of enalapril and folate acid can decrease plasma Hey and UMA,restore vascular endothelium function in patients with hypertension.

Objective To evaluate the efficacy and influence factors of peginterferon combined with ribavirin for the treatment of elderly patients with chronic hepatitis C (CHC).Methods 34 CHC patients aged over 60 years were enrolled in this retrospective study.Virological responses,relapse rate and discontinuation rate were evaluated,and the predictive factors associated with these outcomes were analyzed.Results The proportions of rapid virological response (RVR),early virological response (EVR),end of treatment virological response(ETR),sustained virologic response (SVR) were 26.5％,41.2％,52.9％ and 35.3％,respectively in patients after peginterferon plus ribavirin theraphy,and the relapse rate was 33.3％.The relapse rate was higher in patients with the interferon treatment history than in patients with initial interferon treatment (P＜0.05).The rates of ETR and SVR were lower in CHC patients with diabetes than without diabetes (P＜0.05 or 0.01).The ratio of dose adjustment of peginterferon and ribavirin alone and in combination were 26.5％ (9/ 34),61.8％ (21/34) and 8.8％ (3/34),respectively.The discontinuation rate was 20.6％ (7/34).Multivariate Logistic regression analysis showed that SVR rate was lower in CHC patients with diabetes than in those without diabetes (P＜ 0.05).Conclusions Peginterferon plus ribavirin therapy has a better virological response,but a poor tolerance in CHC patients.Diabetes may be an important risk factor for sustained virologic response in CHC patients.

Objective: To observe the histological changes of lamina extema cranii at both the graft and donor areas after having been grafted in animal experiment. Methods; 4 mini pigs aged from 8 to 12 months were selected. Part of the outer table of skull (2.5 cm × 1.0 cm) was decorticated and was divided equally. Both were implanted on each side of the snouts of animals. 2 pigs were selected randomly and were killed 12 weeks postoperation. Each 1, 0 cm ×0. 5 cm specimen was harvested and histological study was performed. The other 2 animals were killed 24 weeks after operation. Gross inspection of the donor site was performed and histological study was done. Results; In the graft area; bone absorption was obvious 12 weeks postoperation, but bone matrix increased obviously at 24 weeks postoperation. Results of scanning electron microscope showed that interface between bone graft and recipient site was discernment and collagen type I was malaligned 12 weeks postoperation. Collagen fibers were in good order and good mineralization was found 24 weeks postoperation. In the donor area; small amounts of new bone formation could be seen and alignment of cemental line was chaotic 12 weeks postoperation. At 24 weeks, bone formation was obvious and alignment of haversian canal was regular. Scanning electron microscopy showed that structure of the tissue was uneven and disorder at 12 weeks postoperation. Collagen fibers were in good order and good mineralization was found 24 weeks postoperation. On gross view, raw surface of the donor site got complete healing, os-teanagenesis was incomplete and introcession could be observed in the local area. Conclusion; Histological remodeling of lamina exter-na cranii is complete at 24 weeks after having been grafted. The donor site can regenerate but morphologic introcession could be observed.

OBJECTIVE To strengthen and explore the effect of target monitoring in ICU.METHODS To put out prospectively the target monitoring of the nosocomial infection in ICU from Jan 2006 to Dec 2007.RESULTS A total of 3917 patients were monitored and 217 of them suffered from infection.The day infection rate was 11.7‰,and the infection rater per thousand day were 13.4‰,10.0‰ in 2006 and 2007,respectively.The infection rate related to urinary catheter,central venous catheter and ventilator were 1.2‰,0.9‰,4.1‰,2.8‰,14.2‰,6.0‰ in the past two years,respectively.It decrease 0.3‰,1.3‰,8.2‰,respectively.Ventilator-associated infection was the main infection part of hospital infection,and the patients after liver transplantation ICU had the highest infectionrate.CONCLUSIONS Prospective target monitoring is a scientific monitoring method that plays an important role in controlling and preventing hospital-acquired infection.It deserves recommendation.

0.05). Results The median survival of patients with splenectomy and without (splenectomy) was (507.4?318.6) days and (849.4?672.9) days,respectively.The patients without splenectomy survived (significantly) longer than those with splenectomy(P=0.046).The 1-year,3-year and 5-year survival rates of patients with splenectomy and without splenectomy were 61.18%, 8.23%, (0%) and (81.56%), 48.28%, 30.62%, respectively. Multivariate Cox regression analysis indicated that (only ) (splenectomy) was an independent prognostic factor (P=0.007). Conclusions The rates of postoperative complications and tumors recurrence were not influenced by splenectomy. Splenectomy did not prolong the survival time of patients with proximal gastric carcinoma who underwent radical total gastrectomy. Preservation of the spleen can prolong postoperative survival time and improve the survival rate in these patients.Splenectomy might only be (appropriate) for patients with direct invasion of the spleen.

Objective To evaluate recurrent laryngeal nerves exposure during thyroid resection. Methods Nineteen case-control clinical trials were collected from relevant studies published in different Chinese databases, and 9269 cases were collected for analysis OR (odds ratios). 95% confidence intervals using the Mantel-Haenszel method for a fixed-effects model, and the Mantel-Haenszel method for a random-effects model were summarized. Both fixed effect model and random effect model were applied to analyze the results and heterogeneity. Results The injury rate of the recurrent laryngeal nerves was significantly lower in exposure group ( OR 0.29, 95% CI 0.16～0.54, P

Objective To compare the sensitivity of HE,immunohistochemistry (IHC) and RT-PCR in detection of breast cancer metastases in axillary lymph nodes.Methods Twenty female patients with newly diagnosed and clinically node-negative breast cancers underwent modified radical mastectomy, including a complete axillary lymph node dissection. The ages of the patients ranged from 31 years to 65 years, and the diagnosis of breast cancer was approved by pathological finding. Two hundred and thirty-nine axillary lymph nodes were found in these 20 patients. Metastases in axillary lymph nodes were explored by HE, cytokeratin 19 IHC and RT-PCR for cytokeratin 19 respectively. Results Seven(2.9%) lymph nodes were found to have metastatic cancers by HE in 3 patients,all nodes were found in level Ⅰ. Metastatic cancers were found in 13 (5.4%) nodes by IHC in 7 patients,11 nodes in level Ⅰ and 2 nodes in level Ⅱ; and 52(21.8%) nodes were found to contain tumor cells by RT-PCR in 14 patients,30 nodes in level Ⅰ and 22 nodes in level Ⅱ. All of 7 histologically(HE) positive nodes were found to contain tumor cells by IHC and RT-PCR. Among 232 histologically(HE) negative nodes,6(2.6%) nodes were found to contain tumor cells by IHC,and 45(19.4%) nodes were found to contain tumor cells by RT-PCR, all 6 IHC positive nodes showed the expected 460-base pair products on gel electrophoresis ( P