Objective To evaluate sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia.Methods Seventy ASA Ⅰ children were randomly divided into two groups,35 children in every group.Children in group S were appliedsevoflurane inhalation[the minimum alveolar concentration(MAC)of sevoflurane was 1.0-1.5],children in group PK were applied ketamine inhalation and total venous anesthesia of propofol[80μg/(kg·min)]with ketamine[20μg/(kg·min)].Compared the time of anesthesia induction,tracheal catheter extubation,anesthesia recovery between the two groups.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_2)during anesthesia were compared.During 2 days after operation,the adverse effects such as nausea and vomit,lower grade of sleep quality were also compared.Results Compared with group PK,the time of anesthesia induction,tracheal catheter extubation and anesthesia recovery in group S were shorter (P<0.05),the incidence of emergence agitation in group S was higher(20.0%,7/35 vs 2.9%,1/35)(P<0.05).But nausea(17.1%,6/35),vomit(31.4%,11/35)and lower grade of sleep quality(54.3%,19/35)were higher in group PK than those in groups(all 2.9%,1/35)at 1 day after operation(P<0.05).The incidence of lower grade of sleep quality at2 days after operation in group PK(14.3%,5/35)was higher than that in group S(0)(P<0.05).Cardiovascular effects of children,such as MAP and heart rate during the period of tracheal catheter extubation in group S was higher than that in group PK.Conclusion Sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia still has some disadvantages,the anesthesia technology is selected by anesthesia method and medicine combination.

The incidence of obesity is increasing in the world yearly, obesity and its complications pose a serious threat to the health of people at the same time. In recent years with the progress of economy, the development of science and technology and the change of concept, surgical robots are increasingly used in metabolic and bariatric surgery. In this review, the application and development trend of minimally invasive surgical robot in metabolic and bariatric surgery are reviewed, the advantages of surgical robot in metabolic and bariatric surgery are discussed, and the future development are prospected.

Objective To investigate the effect of nitric oxide synthase(NOS) inhibitors and L-arginine(L-Arg) on the prognosis of traumatic shock in rats. Methods Traumatic shock models of Sprague-Daulay rats were made and randomly devided into control group (n=24),L-NAME treatment group (n=24),AG treatment group (n=24) and L-Arg treatment group (n=24). Serum nitric oxide(NO) levels and oxygen partial pressure in tissues include skeletal muscles,liver and small intestine were detected at 1h,3h,5h after resuscitation. Meanwhile, hemodynamic data of the rats and their survival rates of 12h and 24h were monitored and recorded. Results Serum NO concentration was statistically lower after resuscitation in L-NAME group than that in control group, while there were no statistical significance of tissues oxygen partial pressure and survival rate in 12、24h between the two groups. AG could decrease serum NO levels only at late stage of traumatic shock,but no effect on the synthesis and relase of NO at early stage of traumati shock.AG could improve tissues oxygen partial pressure of the liver and small intestine, and prolonged the mean survival time. L-Arg could increase serum NO levels, and improve oxygen partial pressure of intestine and significantly increase the survival rate at 12h and 24h in rats with traumatic shock. Conclusions Treatment with AG and L-Arg can improve the prognosis of traumatic shock rats much better than that with L-NAME.

Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.

Objective To analyze the changing rules of schistosomiasis endemic situation before and after reaching the crite-ria of schistosomiasis transmission controlled or transmission interrupted in Zhejiang Province,so as to provide scientific evi-dence for schistosomiasis contro1. Methods Xiuzhou District and Zhuji City were selected and investigated retrospectively to collect schistosomiasis epidemiological information 10 years before they reached the criteria of transmission controlled and the subsequent years until 2008. The database of retrospective investigation was established for analyzing the trends and rules of changes of Oncomelania hupensis snail status and schistosome infection status of cattle and human. Results The snail status and schistosome infection kept a steady declining before reaching the criteria of transmission controlled ,and there were positive correlations between the area of living snails and the infection rates of human and animal in two places(rhuman=0.764,P<0.01, rcatl e=0.709,P<0.01;rhuma=0.775,P<0.01,rcatl e=0.676,P<0.01);No local infection person and animal except residual snails, and found 7 cases of imported infection source were found after reaching the transmission interruption. Conclusion The epi-demic status of schistosomiasis in zhejiang is stable after reaching the criteria of transmission interruption ,and residual snail are easy to re-found and spread under some certain conditions,and some imported cases were found sometimes,which may in-crease the risks for re - emergence of schistosomiasis. The integrated solidification strategy with emphasis on control of residu-al snails and imported cases should be taken in the areas of transmission interruption in the future.

Objective To determine the clinical value of cytological diagnosis of the impressed specimens in the radical gastrectomy for patients with gastric cancer. Methods During radical gastrectomies for 52 patients with gastric cancer, 232 impressed specimens were taken from the tumor tissues,paratumor tissues, proximal and distal incision margin,and partial lymph nodes respectively, to detect if there was tumor cells by cytological examination and compared with the pathology. Results In the tumor tissues,there were no pseudo positive specimen,and the pseudo negative specimen occurred in 1.In the incision margin,there was no pseudo negative specimen,while 12 pseudo positive specimens were found.In the paratumor tissues,there were 3 pseudo negative and 10 pseudo positive specimens.In all specimens,the sensibility was 92.8%; specificity was 85.8%; accuracy rate was 87.9%. Conclusions Cytological examination of the impressed specimens in radical gastrectomy is helpful in detecting residue tumor tissue in the incision margin, especially in hospitals without rapid pathologic examination.If cytological examination is combined with rapid pathological examination,the results will be better.

Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects.Methods The clinical,imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up.Results Of 74 tunors,67 were resected with Simpson Ⅱ grade,7 with Simpson Ⅲ,none of them with Simpson Ⅰ.Superior sagittal sinus and the vein of central suleus and feeders of cortex were reserved well.Severe brain injury was not occurred in 66 cases with tumors debulking(Simpson Ⅱ 61 cases,Simpson Ⅲ 5 cases),the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively.Tumors of 8 cases were "turned over" and resected by piecemeal (Simpson Ⅱ 6 cases,Simpson Ⅲ 2 cases),weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery.Followed-up ranged from 6 months to 4 years and 2 months,4 cases were lost to follow-up.Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month.Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ 6 months later,no recurrence and death.Conclusion The measures,including piecemeal tumor reseeted mierosugically,good protection of the vein of central sulcus,excellent management of superior sagittal sinus,and avoiding damage to functional cerebral cortex during operations,are best ways for raising the tumor resection rate and nearo-function reserved.

Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.

Objective:To compare the three effects of lidocaine in the prevention of general anesthesia in elderly patients.Methods:A total of 120 elderly patients (65-85 years old) underwent anesthesia with general anesthesia (ASA) Ⅰ ～ Ⅱ were randomly divided into thyrocricocentesis group (group H),throat surface anesthesia group (Group Y),intravenous injection group (group J) and control group (group D).Group H was injected with lidocaine for surface anesthesia;group Y used laryngeal spray for laryngeal sprayed lidocaine for surface anesthesia;group J was anesthetized induction of intravenous lidocaine to prevent intubation reaction;group D the control group was not treated with lidocaine.(SBP) and heart rate (HR) were measured before and after induction (T0),tracheal intubation (T1) and 1 (T2),3 (T3) and 5 min (T4),the changes of hemodynamics related indexes were compared.Results:Compared with the same group of T0,the SBP and HR of four groups of T1 moments were significantly decreased (P ＜0.05);In the other three groups,SBP was significantly increased at T2 and T3 (P ＜0.05),HR ofT2 was significantly increased (P ＜0.05);Compared with group D,SBP and HR in group H,Y and J were significantly different at T2,T3 and T4,he difference was statistically significant (P ＜0.05);but there was no statistically significant difference between the three groups (P＞ 0.05).Conclusion:The three ways of lidocaine can be used to prevent the general anesthesia reaction in elderly patients,the effect of three ways is parallel.However,cricothyroid membrane puncture increased the patient's pain,throat spray method increased the cumbersome operation and enhanced the cost of the patient,and intravenous injection method is simple and worthy of popularization and application in clinic.

Vitamin D plays an important role in cellular differentiation and Calcium phosphate metabolism.At the same time,the role of Vitamin D in glycolipid metabolism had attracted a lot of attention.Bariatric surgery is an effective treatment to achieve therapeutic endpoints for comorbidities associated with obesity,but vitamin D status is always insufficient before and after surgery.In this review,the author aim to (1) discuss the deficiency of vitamin D in bariatric patients,(2) to summarize the impact of vitamin D on glycolipid metabolism and the outcome of bariatric surgery,(3) to discuss the supplementation for the deficiency of vitamin D.