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.

Objective To investigate the MRI imaging features, and pathologic basis of the orthotropic transplantation nude mouse model with human pancreatic cancer. Methods Adopting Siemens Magnetom Trio Tim 3.0 Tesla superconductive MRI and breast coil was used to examine 30 orthotropic transplantation nude mouse models of the human pancreatic cancer, these mouse were sampled to acquire TSE-T1 -weighted and T2-weighted transverse axial images. Intraperitoneal injection of Gd DTP A was used to perform continuous dynamic enhancement scanning. Signal intensities of tumors were measured in plain scanning and each phase' s enhancement scanning images, respectively. Intensification rates of tumors were calculated. Pathologic examination of tumors was performed to be compared with the findings of MRI scanning. Results The successful rate of inoculation of 30 nude mice was 100%. The histological findings were comparable with poorly differentiated adenocarcinoma. Compared with signal of adjacent tissues, the MRI findings of the tumors were uniformly slightly hypointensity (90% , 27/30) , or unevenly (10% , 3/30) on TSE-T1WI; uniformly (20% , 6/30) or unevenly (80% , 24/30) hyperintensity with equal or more hyper signal spots on TSE-T2WI. Signal intensities on plain scanning was 228.35 ±11.71, and 1.5,3,6,9, 12 min after enhancement scanning, thesignal intensities were 258.20 ± 11.17, 301.75 ± 17.09, 358.65 ±25.13, 480.05 ± 19.01, 558.35 ± 40.49, which were significantly higher than those in plain scanning (P <0.01). The intensification rate of every phase was 0.13 ±0.04, 0.35 ±0.11, 0.56 ±0.10, 1.10 ±0.10, 1.45 ±0.18, and the difference among these phases was statistically significant (P <0.01). The significantly intensified area was the area where the tumor cells grew actively with rich capillaries; the central area without intensification was the area of necrotic tissue and/or densely packed tumor cells and few capillaries. Conclusions High resolution MRI imaging of implanted tumors can be obtained by intraperitoneal injection of contrast, and it is consistent with pathologic examinations.

Objective To analyze the treatment results of primary nasopharyngeal carcinoma(NPC)treated by four different external beam radiation therapy(EBRT)techniques in Sun Yat-sen University Cancer Center in the beginning of the 21 st century.Methods The data of 1093 hospitalized primary NPC patients treated in Sun Yat-sen University Cancer Center between December 2001 and June 2003 were retrospectively analyzed.The stage distribution(by AJCC/UICC,2002)was 63,439,358 and 233 patients in Stage Ⅰ,Ⅱ,Ⅲ and Ⅳa+Ⅳb.Definitive radiotherapy was given to all patients and the median total dose was 70 Gy.Four different EBRT techniques were used:812 patients with fluoroscopy simulation conventional radiotherapy(CR),155 patients with CT simulation conventional radiotherapy(CT-sim CR),69 patients with three dimensional conformal radiotherapy(3DCRT)and 57 patients with intensity modulated radiotherapv(IMRT). Results The 5-year local failure-free rate(LFFR),nodal failure-free rate(NFFR),and distant metastasis-free rate(DMFR)were 86.8%,95.3%and 83.2%,respectively.The 5-year progressionfree survival(PFS)and overall survival(OS)were 66.9%and 77.9%,respectively.Different EBRT techniques influeneed the OS and the LFFR of patients,the 5-year OS and LFFR of group CR,CT-sim CR,3DCRT and IMRT were 75.9%,83.5%,87.2%,86.6% and 84.5%,96.4%,91.0%,91.7%,respectively(P=0.014 and 0.006).The morbidity and severity of xerostomia and trismus were sigficantly lower in group 3DCRT and IMRT than in group CR and CT-sim CR(P=0.000 and=0.023). Conclusion The CT simulation technique,3DCRT and IMRT can improve the OS,LFFR and life qualitv of patients with primary NPC.

Objective To retrospectively analyze the prognostic factors for locoregionally recurrent early?stage extranodal nasal?type natural killer/T?cell lymphoma ( NKTCL) . Methods A total of 56 patients with early?stage extranodal nasal?type NKTCL, who had locoregional recurrence after initial treatment and then received salvage treatment from 1995 to 2014, were enrolled as subjects. The effects of salvage treatment on the overall survival ( OS) rate were analyzed after initial treatment and recurrence. Univariate and multivariate prognostic analyses were performed on the OS rate after recurrence. Results The median follow?up time was 35. 9 months after initial treatment and 14. 8 months after recurrence. The 3?year OS rate was 73% after initial treatment and 58% after recurrence. Compared with chemotherapy alone, radiotherapy?containing salvage treatment significantly improved the OS rates after initial treatment and recurrence ( P=0. 040, 0. 009 ) , and re?irradiation also significantly improved the OS rates after initial treatment and recurrence (P=0. 018, 0. 019). Most (84%) of the acute and late adverse reactions after re?irradiation were grade 1?2 ones. The univariate and multivariate analyses showed that the Karnofsky Performance Status score, radiotherapy in initial treatment, and radiotherapy in salvage treatment were influencing factors for the OS rate after recurrence. Conclusions Radiotherapy achieves improved survival and tolerable toxicities, making it indispensable in the treatment of locoregionally recurrent extranodal nasal?type NKTCL.

Objective:To investigate the feasibility and safety of endovascular repair for traumatic thoracic aortic pseudoaneurysm.Methods:From Oct 2015 to Oct 2018, the clinical and followup data of 7 patients diagnosed as traumatic thoracic aortic pseudoaneurysm in Fuwai Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively.Results:The patients average age was (51.2±11.0) years old. All patients underwent surgery in the hybrid operating room under general anesthesia. Two did thoracic endovascular aortic repair (TEVAR), three did TEVAR combined with chimney technique to reconstruct the left subclavian artery, and 1 had TEVAR combined with fenestration to reconstruct the left subclavian artery. One did TEVAR with left common carotid artery and left subclavian artery bypass. The mean operative time was (90.1±27.4) min, the mean postoperative hospital stay was (8.9±3.7) d, and the mean postoperative follow-up time was 42.4 months. All the patients received CTA reexamination of the aorta after 1, 6, 12 months and yearly thereafter. TypeⅠendoleak was found in one patient with chimney technique to reconstruct of left subclavian artery after operation. CT showed that the type Ⅰ endoleak disappeared 6 months after operation. There was no death, paraplegia or stroke during the perioperative period and follow-up period, and there was no aortic related reintervention.Conclusion:TEVAR is a safe and effective method for the treatment of traumatic pseudoaneurysm of thoracic aorta, and the early and mid-term results were satisfactory.

Objective:To evaluate the safety and feasibility of the in-situ needle fenestration combined with the in vitro physician modified fenestration technique to reconstruct supra-aortic branches during thoracic endovascular aortic repair (TEVAR) for aortic arch lesions requiring landing at Z0 and Z1.Methods:From Nov 2017 to Dec 2019, eighteen patients who underwent both the in-situ needle fenestration and the in vitro physician modified fenestration techniques to extend the proximal landing zone to Z0 and Z1 during TEVAR were included in our study.Results:Sixteen patients underwent in vitro physician modified fenestration ,two patients underwent in vitro physician modified fenestration to reconstruct both the left common carotid artery and the innominate artery. All eighteen patients received in-situ needle fenestration to preserve the left subclavian artery. Supra aortic branches were preserved in all patients (38/38, 100%). There was no Type Ⅰ endoleak. Type Ⅱ endoleak was found in four paitnets (4/18). Type Ⅲ endoleak occurred in one patient (1/18). Type Ⅳ endoleak in four patients (4/18). Type Ⅲ endoleak needed open aortic arch repair 6 months later. The median follow-up time was 12 months. One (1/18) died in 12 months and the other patients were doing well.Conclusions:The joint application of the in-situ needle fenestration and the in vitro physician modified fenestration to reconstruct supra-aortic branches during TEVAR for aortic arch pathologies requiring landing at Z0 and Z1 was satisfactory.

Objective To demonstrate the imaging characteristics of pancreatic neuroendocrine neoplasm (P-NEN).Methods The CT and MRI findings of 43 cases of P-NEN confirmed by pathology were analyzed,and compared with pathological results.Results Mean size of 43 lesions in 43 P-NEN patients were (25.00± 1.82)mm.Necrosis cystic degeneration were found in 26 lesions.In CT plain scan,15 lesions were isodense,28 lesions were hypodense.All of 43 lesions were hypointensity signal on T1WI;27 lesions were hypointensity signal,16 cases were isointensity signal on T2WI.Twenty-seven lesions showed envelope;30 lesions showed clear outline.In enhancement images,24 lesions were marked enhancement since arterial phase;8 lesions showed delayed enhancement;5 lesions showed centrality enhancement;6 lesions showed wild enhancement.Conclusion P-NEN has some characteristics on CT and MRI scanning,imaging can play an important role in diagnosis for P-NEN.

Objective To investigate the level of caregivers′burden and the coping style among parents of cancer children. Methods Totally, 229 parents of cancer children participated in the investigation by Chinese version of zarit burden interview (ZBI), Chinese version of coping health inventory for parents (CHIP) and self-designed general information questionnaire. The associations between caregivers′burden and coping styles were tested by Spearman correlation analysis. Results The caregiver′s burden on the parents was in the middle level with a total score of (30.50 ± 12.24). The coping style the parents took most frequently was to unite the family and keep a positive attitude and regard it as most effective. The caregiver′s burden was negatively associated with the positive coping style . Conclusion The parents of cancerous children suffer from middle level of burden . Nurses should assess the caregiver′s burden, provide targeted interventions to relieve it, help the to establish effective coping style and change their psychological and mental state and ultimately improve their quality of life.

Stakeholder theory and game theory were applied to analyze the stakeholders,role definition,participation,interest,power,position and the shift of positions under different conditions in the negotiation.Use SPSS 17.0 to analyze the database of NCMS in 2009～2010 in three counties of Hubei province,and then employ Linear programming method to do a case study of price negotiation.It is difficult to meet all stakeholders' expectations under the current condition of catastrophic disease insurance pooled at municipal-level.Medical cost differences in tertiary hospitals at provincial level are small for different regions,which constitute a basis for price negotiation at provincial level.Besides,the negotiation at province level can effectively address the conflicts of interest,and promote the negotiations.Negotiation at provincial level for such diseases,and formulating unified pricing standards for multi-wins.

Objective:This paper designs to analyze the status of catastrophic disease medical assistance in A and B regions, and put forward feasible suggestions to improve the medical assistance level and financial effects. Methods:We selected A city at Hubei province and B county at Guizhou province as sample areas, and obtained 872 copies of questionnaires in the field survey. Then, out-of-pocket health expenditure per year, the incidence, and rel-ative gap of catastrophic health expenditure before and after the financial aid were calculated. Results: Catastrophic disease medical assistance plays a limited role in relieving patients' economic burden. Low financial aid rate, narrow range, high deductibles and low ceiling level are responsible for much lower effective financial aid rate. Conclusion:Raise financial aid rate and widen the scope of medical assistance gradually;Establish effective link-up between cata-strophic disease medical assistance and catastrophic disease insurance / basic medical insurance;Put outpatient OOP into the scope of catastrophic disease medical assistance.