With the continuous improvement of the diagnosis rate of benign pancreatic disease and the younger age of disease onset,the demand for minimally invasive pancreatic surgery is increasing,meanwhile,how to keep the normal pancreatic tissue as much as possible to reduce the impact on the patients' life has gained surgeons' thinking.The Da Vinci robotic surgical system,providing a clearer 3D vision and more accurate operation,makes some difficult minimally invasive pancreatic surgery such as pancreaticoduodenectomy can be carried out extensively.Based on clinical experiences and related literatures,this paper will analyze the present situation of Da Vinci robot-assisted pancreatic surgery and give prospects.

KLF9(Kruppel-likefactor9)isthetranscriptionfactorthatcanbindGC-richsitesthrough three C2H2-type zinc fingers and can regulate diverse biological processes,including cell proliferation,apopto-sis and the development of the organ.KLF9 is downregulated in some tumor specimens and tumorous cell lines relative to the normal samples and cell lines and plays an important role in the growth of cancer cells.Similar with the other KLF numbers,KLF9 could affect the development of tumors,especially for the endocrine-related cancers through multiple signaling pathways and interventions with other proteins.

Objective To assess the value of serum creatinine(Scr),serum ?_2-microglobulin(?_2-MG),glomerular filtration rate(GFR),proteinuria index,and Cystatin C(Cys C)to detect impairing of expressing of diease in patients with chronic kidney disease.Methods Peripheral blood was collected from 54 chronic kidney diease:Scr was analyzed using RXL fully automated biochemistry assay instrument,then GFR was calculated;Cys C was measured using particle-enhanced nephelometric immunoassay(PENIA);?_2-MG was measured using chemiluminescent method,proteinuria index was measured by the product of duration and amount of proteinuria,nephropathological progress was measured using the degree of glomerular mesangial proliferation and the dgree of tubulointerstitial fibrosis.Results The level of serum Cys C,Scr,serum ?_2-MG,proteinuria index,and GFR of the CKD patients was correlated with nephropathological progressing.Conclusion In patients with chronic kidney disease serum creatinine,serum ?_2-micro-globulin,glomerular filtration rate,proteinuria index,and Cystatin C are markers of progessing of kidney disease.The sensitivity and correlation of GFR and serum Cys C are higher than others.

Objective: Observing the effect of injecting 5- Fu into the mass of breast hyper-plasia. Methods: We randomly divide the 80 mastopathy patients into two groups ,40 patients ac-cepted the 5- Fu local injection (experiment group),and 40 patients taken orally rubixiaopian and ta-moxifen(control group). The clinical effects of the breast pain and breast lump were observed. Re-sults: The total effect of 5- Fu local injection into the lump of the mastopathy patients was 92.5 % , while control group was 75.0% , its difference was significant(P0.05)in the treatment of mastopathy lump. Conclusion: 5- Fu local injection had obvious effects to breast pain and breast lump of mastopathy.

Objective:To investigate the clinical manifestations and causative factors of adverse drug reactions following cinepazide mahate injection and provide reference for the safe use of drugs.Method:503 cases treated with cine- pazide maleate in our hospital were retrospectively studied and the results were statistically analyzed by SPSS(versionl 1.0).Result:Of 503 patients,27 cases presented some adverse events with an incidence of 5.4%,and adverse drug reac- tions were found in 11 cases with an incidence of 2.2%.The main adverse drug reactions were nervous,gastrointestinal and dermal reactions.The adverse drug reactions had no relation with sex,but with age of patients and combination use of drugs(P

Objective To investigate the risk factor for new-onset diabetes after transplantation (NODAT) and the relationship between NODAT and arterial stiffness. Methods Oral glucose tolerance test (OGTT) was performed on 195 patients with renal transplantation. The degree of arterial stiffness, which was determined by brachial ankle pulse wave velocity (baPWV), anklebrachial blood pressure index (ABPI) and intima-media thickness (IMT) of the carotid artery, was evaluated. Results Twenty-nine patients diagnosed as NODAT had significantly higher fasting plasma glucose before transplantation, blood pressure and incidence of hepatitis C virus (HCV) infection than in patients without NODAT. Multivariate regression analysis revealed that the risk factor of NODAT was fasting plasma glucose pre-transplantation, HCV infection and systolic blood pressure.The independent determinant of the advanced arterial stiffness on NODAT was the statement of hypertension and age. Conclusions High fasting plasma glucose prior to transplantation, HCV infection and high blood pressure are risk factors for NODAT in patients after renal transplantation.Strict control of blood pressure is the key way to prevent the NODAT and atherosclerosis.

A questionnaire survey was conducted in 724 students from three junior high schools in Shanghai Jinshan district.Total 642 students completed the questionnaire with a response rate of 88.7％,among them 75 were overweighted or obese.The positive rate of 6 out 8 unhealthy psycho-behavioral practices related to weight control in overweight or obese students was significantly higher than that of students with normal weight (all P ＜ 0.05).Binary logistic backward stepwise regression analysis showed that overweight or obesity was risk factor for the unhealthy psycho-behavior practices related to weight control in adolescent students.

Objective To evaluate the clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment. Methods Fifty-four patients with posterior malleolar fracture were treated with anatomic reduction and internal fixation from March 2005 to June 2010. The patients groups consisted of 36 males and 18 females. According to CT scan classification,the group was made up of 36 type Ⅰ cases, 10 type Ⅱ and 8 type Ⅲ cases. All patients were evaluated with modified Baird-Jackson scoring system. The relationship between final result and fracture pattern , fixation methods, the time of exercise initiation fitted operation were analyzed respectively. Results The followedup period varied from 6 months to 36 months, with an average of 18 months. The number of patients whose result was excellent, good, fair and poor was respective 29,18 ,5 and 2. The total percent age of good to excellent clinical result was 87. 03%. There were 4 patients who had only slight pain after long time walking ,the remainder patients were completed with no pain. Conclusion Operative treatment may provide satisfactory fracture anatomic reduction and internal fixation for posterior malleolar fracture. Correct fracture pattern estimation and proper internal fixation are important to achieve and improve reduction quality, and to ameliorate better long term results.

Objective To investigate the clinical significance in monitoring the dynamic oxygenated parameters in full-term neonates with acute respiratory distress syndrome (ARDS) and its relationship with the prognosis. Methods Forty-one full-term neonates with ARDS from 3 hospitals were divided into two groups according to the clinical outcomes: the death group (n=17) and the survival group (n=24). The parameters of breathing machine and arterial blood gas analysis in these two groups at 2 h, 12 h, 24 h and 36 h after mechanical ventilation were analyzed retrospectively. PaO_2/FiO_2, A-aDO_2, PaO_2/P_AO_2 and RI were calculated and compared between the two groups and within each group among the values of different period. Results Under the circumstance that parameters of breathing machine in the death group were obviously or gradually higher than those in the survival group, PaO_2 in the death group [(10.38?1.45)kPa] was lower than that in the survival group [(11.42?0.98)kPa] only at 36 h (P0.05). In the death group, PaO_2/FiO_2 at 24 h and 36 h [(15.86?4.92)kPa and (15.99?5.62)kPa] was lower than that in the survival group [(21.18?6.48)kPa and (27.12?8.33)kPa](P0.05) . Conclusions PaO2is not a sensitive indicator on the prognosisof NRDSinits early stage . PaO2/Fi O2, A-aDO2, PaO2/PAO2and RI are better than PaO2to reflectthe degree of lung injury ,oxygen exchange rate and therapeutic efficacy . A-aDO2and PaO2/PAO2arevery sensitive in assessing the therapeutic effect and the dynamic monitoring may be helpful injudgingthe prognosis .