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 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.

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 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 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.

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.

Objective To assess the clinical effect of Novonorm on treating type 2 diabetic patients with atherosclerosis. Methods Sixty-five patients of type 2 diabetes with atherosclerosis were randomly divided into 2 groups :36 patients took Novonorm,and the other 29 individuals were treated with Glipizide. The blood glucose and CIMT were compared before and after treatment for 12 months. Results The postprandial blood glucose decreased by(1.99 ± 1.06)mmol/L after the treatment of Novonorm,which was significantly higher than that of(0. 99 ±0. 54)mmol/L after the treatment of Glipizide(P ＜ 0. 05). CIMT significantly decreased from (1.11 ± 0. 07)mm before treatment to(1.02 ± 0. 08)mm after treatment in the Novonorm group(P ＜ 0. 05),whereas CIMT were similar between after and before treatment in the Glipizide group(1.07 ± 0. 06)mm vs.(1.10 ± 0. 08)mm(P ＞ 0. 05).Conclusions Novonorm is a kind of effective and safe regent,which can be used to treat type 2 diabetic patients with atherosclerosis.

Objective] To study the determination of telomerase and CEA in differentiating benign and malignant pleural effusions. [Methods] Telomeric repeat amplification ELISA method(TRAP- PCR-ELISA) and enzyme immunoassay(EIA) were measured in 40 patients with malignant pleural effusion and 38 cases of benign pleural effusion telomeres activity and CEA levels. [Results] The telomerase activity in pleural effusions and CEA positive rate in malignant pleural effusion group were 80.0%(32/40) and 85%(34/40), benign pleural effusion group was 7.9%(3/40) and 0%(0/38), malignant pleural effusion of telomerase and CEA-positive rate was significantly higher than benign pleural effusion group, the difference was significant(χ2=40.96,57.26, P<0.001).Determination of telomerase activity in malignant pleural effusion diagnostic sensitivity and specificity of CEA rather, the difference was not statistical y significant(χ2=0.35, P>0.05). Two combined detection of tumor markers in terms of a positive diagnosis of malignant pleural effusion as the standard, the combined detection sensitivity was 97.5%(39/40), significantly higher than the telomerase and CEA single detection sensitivity 80% and 85%, the differences were statistical y significant(χ2=6.13,3.91,P<0.01). [Conclusion] Detection of the TA and CEA in pleural effusion is of a definite value in differentiating benign from malignant pleural effusion, and the detection of TA is more sensitive and specific than detection of CEA. Combining detection of both markers may raise the accuracy of the diagnosis.

Objective To analyze the causes of clinical misdiagnosis of solid pseudopapillary tumor of pancreas (SPTP),and recommend the countermeasures with a combination of pertinent literature.Methods The clinical data of 10 cases of SPTP with misdiagnosis were retrospectively analyzed.There were 9 women and 1 man,and the average age was 29.3 years old.The clinical symptoms were nonspecific.Results All patients received surgical treatment,and the correct diagnosis was made according to the pathology after surgery.All patients were followed up,and no recurrence or metastasis was found.Conclusions SPTP is a rare disease in clinic.Sufficient understanding in the clinical features and imaging characteristics can improve the rate of diagnosis before operation.