The application of robotic surgery can provide solutions to the many drawbacks of traditional laparoscopic surgery.Robotic surgery is a feasible and safe procedure for patients with gastrointestinal tumor.It can harvest adequate lymph node with low postoperative morbidity.Longer follow-up and further raudomized clinical trials are needed to validate the utility and efficacy of this technology in the field of gastrointestinal surgery.

[Objective]To retrospectively analyze of functional and radiographic outcome of distal calvicle fractures (Neer type II) treated with coracoclavicular screw fixation.[Method]Fifteen patients with Neer type II distal clavicle fracture were treated surgically between March 2001 and March 2004.Operative treatment included open reduction and fixation of the proximal clavicular fragment to the coracoid process using a 6.5-mm cancellous screw and repair of the coracoclavicular ligaments.Perioperative radiographs were performed to ensure that the screw was introduced properly into the coracoid.Following the operation,the arm was placed in a sling for two weeks.After two weeks,the sling was discontinued and the patient was permitted to use the arm for daily activities except for lifting,pulling,and pushing for 6 weeks.The patient is instructed not to perform any heavy lifting,pushing,pulling or participate in contact sports for 3 months.Data were collected to allow scoring according to the American Shoulder and Elbow Surgeons shoulder index 6 months after operation.[Result]All the patients were followed up at an average of 16 months (range:9~26 months).Fracture union occurred at a mean of 7 weeks (range:6~9 weeks)postoperatively without any serious complications such as screw-migration,pseudarthrosis,infection,neurovascular damage,or skin necrosis.All patients returned to the pre-injury level of activity with no residual pain or dysfunction.The mean American Shoulder and Elbow Surgeons shoulder index was 97 points ( range: 90-100 points) 6 months after operation.Two patients showed radiologically ossification of the acromioclavicular joint with no clinical symptoms.[Conclusion]Coracoclavicular screw fixation is a relatively simple,reliable,and safe technique of open reduction and internal fixation of the type II distal clavicle fracture.

Objective To explore the new feature of colorectal carcinoma attack and its clinical significance.Method The clinical data of the 261 cases of colorectal carcinoma were retrospectively analyzed in our hospital examined patients(from 1990 to 1998).Results The morbidity of colorectal carcinoma was rapid increased with time progression ,in the former four years was 28 7% ,but in the latter four years was increased to 71 3%, former four years median of attack age was 54 years,latter four years was 63 years.they had differential histological typing and clinical manifestation.Conclusion The colonoscope technique is helpful to the early differential dignosis of the colorectal carcinoma and colectal inflammatory enteropathy.

Objective To investigate the relationship between the pattern of infarct distribution on diffusion-weight imaging (DWI) and progressive movement deficits (PMD) in patients with infarct in the perforator territory of the middle cerebral artery (MCA). Methods The patients with new infarction in the perforator territory of MCA were analyzed retrospectively. PMD was defined as an increase of at least 2 points on the motor item of the National Institutes of Health Stroke Scale (NIHSS) score persisting for at least 24 hours within 5 days of stroke onset. The demographic characteristics, risk factors, clinical presentation, and distribution characteristics of the infarcts in the PMD and non-PMD groups were compared. Results A total of 64 patients were enrol ed in the study, including 38 females and 26 males, aged 67. 5 ± 10. 8 years. There were 28 patients in the PMD group and 36 in the non-PMD group. The proportion of the infarcts located in the posterior paraventricular region (67. 8% vs. 25. 0%; χ2 =11. 5, P<0. 05) of the PMD group and the mean baseline NIHSS score (6. 9 ± 1. 8 vs. 4. 3 ± 1. 2; t=2. 42, P<0. 05) were significantly higher than those of the non-PMD group. Multiple logistic regression analysis showed that the posterior paraventricular type infarcts had significantly independently correlation with PMD (odds ratio 6. 31, 95% confidence interval 2. 20-18. 0; P<0. 001). Conclusions The posterior paraventricular type infarcts on DWI can be used as a neuroimaging marker for predicting PMD in patients with infarction in the perforator artery territory of MCA.

Objective To investigate the protective effect and its mechanism of prescription Zu Zhong 1 Hao (a traditional Chinese medical prescription, including Astragalus membranaceus, Atractylodes macrocephala, Arisaema cure Bile, Rhizoma pinelliae, the seed of Prunus persiea , Angelica sinensis , Ligusticum Chuanxiong, Paeonia lactiflora , and Pueraria ,etc) pretreatment on focal cerebral ischemia-reperfusion in rats. Methods Sixty SD rats were randomly divided into sham-operation, ischemia-reperfusion, flunarizine and prescription Zu Zhong 1 Hao low-, medium-and high-dose groups (n=10 in each group). A rat model of focal cerebral ischemia-reperfusion was induced by suture method (ischemia for 3 hours followed by reperfusion for 24 hours). Nitric oxide (NO) was measured by the nitrate reductase method; superoxide dismutase (SOD) activity was assessed by the xanthine oxidase method; maiondialde-hyde (MDA) was determined by the thiobarbiturie acid method; and tumor necrosis factor-a(TNF-α) was detected by the enzyme-linked immunosorbent assay (ELISA) method. Results Prescription Zu Zhong 1 Hao significantly improved neurological deficits in focal cerebral ischemia-reperfusion in rats, reduced the content of NO and MDA in brain tissue, increased SOD activity, and down-regulated the expression of TNF-α. Among them, the role of the high-dose group was more significant (P<0. 01). There were also significant differences between the low-and medium-dose groups and the ischemia-reperfusion group (P<0. 05). Conclusions The pretreatment of prescription Zu Zhong 1 Hao has the protective effect on focal cerebral ischemia-reperfusion injury, and its mechanism may be associated with the decreased content of NO and MDA in brain tissue, increased SOD activity, and down-regulated TNF-α expression.

Objective:To study role of IL 10 in acute graft versus host disease(aGVHD)and graft rejection.Methods:20 patients undergoing allogeneic hematopoietic stem cell transplantation (allo HSCT),serum concentrations of IL 10 were measured by using enzymed linked immunosorbent assay(ELISA)during transplantation,IL 10 gene expression in peripheral mononuclear cells were measured by using reverse transcriptase polymerase chain reaction (RT PCR)after transplantation.Results:6 patients developed grade I GVHD.4 patients grade III IV GVHD,3 patients graft rejection. Before transplantation ,the concentrations of IL 10 with the patients who developed severe aGVHD or graft rejection were lower than those without aGVHD.After transplantation, the concentrations of IL 10 with the patients who developed severe aGVHD or graft rejection decreased,and those without aGVHD or graft rejection significantly increased. The result of RT PCR suggested that the expression of IL 10 mRNA decreased in the patients who developed aGVHD.Conclusion:IL 10 plays an important negative role in the development of aGVHD and graft rejection.

Obstructive sleep apnea (OSA)is a high incidence of potentially dangerous disease,characterized by intermittent hypoxia or hypercapnia.It is an independent risk factor for ischemic stroke.Currently a number of studies have confirmed OSA closely associated with oxidative stress.In this paper,the complex mechanisms of oxidative stress in the OSA and the occurrence of stroke will be reviewed,such as promoting atherosclerosis,damaging the mitochondria,ischemia -reperfusion injury,ischemic preconditioning.To investigate the relationship between OSA,oxidative stress and stroke from molecular mechanisms.

Objective To investigate whether Bushen-Huoxue compound adjuvant therapy can be effective on mild cognitive impairment in Parkinson's disease and the influence on plasma phospholipids(PLs) levels. Methods 87 PD patients were recruited and collected for the general information. The patients were evaluated by Unified Parkinson's Disease Rating Scale(UPDRS) Ⅲ and Montreal Cognitive Assessment(MoCA). According to MoCA scores, patients with PD-MCI were divided into a Bushen-Huoxue compound treatment group and a control group(basic L-dopa or dopamine agonist). Reevaluating cognitive function by MoCA and plasma phopholipids levels at posttreatment 12 month and 18 month. Plasma PLs was assayed by measuring its inorganic phosphorus after separation by chromatograph.Results 39 cases in 87 PD patients(44.8%)were with PD-MCI.After 12 months or 18 months treatment period, MoCA scores was significantly higher in Bushen-Huoxue compound treatment group than in controls(P<0.05 or 0.01 respectively). Plasma PLs levels were significantly decreased in Bushen-Huoxue compound treatment group than in controls(P<0.01 or 0.01 respectively). Conclusions Bushen-Huoxue compound could be effective in the adjuvant treatment of PD-MCI, and could delay cognitive rate of decline in patients with PD. Meanwhile, Bushen-Huoxue compound could significantly decrease plasma PLs levels in PD-MCI. The evidence from present study suggested that Bushen-Huoxue compound have neuroprotective effects on patients with PD-MCI.

Objective To observe the effects of different antithrombotic interventions on the changes of plasma lysophosphatidic acid (LPA) level in patients with nonvalvular atrial fibrillation (NVAF) and to provide the basis for clinical antithrombotic therapy. Methods A total of 235 patients with NVAF who did not receive antithrombotic therapy diagnosed by clinical and auxiliary examinations were randomly allocated to receive aspirin (100 mg/d) plus dipyridamole (100 mg/d) (n =76), aspirin (100 mg/d) plus fixed-dose warfarin (1.25 mg/d) (n =79), and dose-adjusted warfarin (international normalized ratio (INR) range of 1.5 to 2. 1) (n =80). They gore redivided into <60, 60-75, and ≥76 year-old groups according to their age. The plasma LPA levels were measured and compared before treatment and 2 and 6 weeks after treatment. Results 1he plasma LPA levels were decreased more significantly in the aspirin plus fixed-dose group than those in the aspirin plus dipyridamole and dose-adjusted warfarin groups (all P < 0.01). Two and 6 weeks after treatment with aspirin plus dipyridamole in the < 60 year-old group, the plasma LPA levels were significantly lower than those before treatment (all P<0. 01). Two and6 weeks after treatment with aspirin plus fixed-dose warfarin in the < 60 year-old group, the plasma LPA levels were significantly lower than those before treatment (all P <0. 01). Two and 6 weeks after treatment with aspirin plus fixed-dose warfarin in the 60-75 year-old group, the plasma LPA levels were significantly lover than those before treatment (all P <0.01). Two and 6 weeks after the treatment with dose-adjusted warfarin (INR 1.5-2. 1) in patients in each age group, the plasma LPA levels were significantly lower than those before treatment. Conclusions 1he different antithromhotic therapeutic modalities have different effects on platelet activation in patients with NVAF in different age groups. The patients in the < 60 year-old group can receive aspirin plus dipyridamole, the patients in the < 75 year-old group can receive aspirin plus fix-dose warfarin, and the patients > 75 year-old, dose-adjusted warfarin (INR 1. 5-2. 1) should he recommend.

Objective To investigate the changes of plasma lysephosphatidic acid (LPA) or acidic phospholipids (AP) levels in patients with nonvalvular atrial fibrillation(NVAF) or NVAF associated with silent brain infarction (SBI) and to provide biochemistry evidence to antithrombotic therapy. Methods Plasma LPA/AP levels was examined in blood freshly sampled in 235 cases of NVAF who were not receiving any antithrombotic therapy, 116 cases SBI who were not with NVAF and 120 cases healthy volunteers as control enrolled in the LPA and stroke prevention study. Plasma LPA was assayed by measuring its inorganic phosphorus after separation by chromatograph. Meanwhile, the platelet activation in NVAF or (and) SBI were observed. Results SBI was found in 31.5% of the participants with NVAF, and in 37.6% of the elderly NVAF subjects (age60 years old). LPA/AP levels were significantly increased in NVAF with SBI group((3.78±0.61) μmol/L) compared with controls ((2.66±0.49) μmol/L, 95% CI 3.47-4.21,P = 0.000), NVAF without SBI group ((3.29±0.57) μmol/L, 95 % CI 3.01-3.76, P = 0.008), SBI without NVAF group((3.17±0.54) μmol/L, P=0.004). The platelet activation was significantly higherin NVAF with SBI group, the odds ratio (95% CI) was 21.39(10.17 to 45.02),than those in NVAF without SBI group (P<0.01). Conclusion The plasma LPA/AP levels were significantly elevated in NVAF or NVAF with SBI, NVAF contributes to the risk of SBI. Platelet activation may play an important role in the pathogenesis of thromboembolism in NVAF and the measurement of LPA reflects activation of platelets in vivo and may be a useful marker for the diagnosis of thrombosis or prothrombotic states.Consideration of the role of antiplatelet therapy should be given when choosing antithrombotic therapy to NVAF-associated ischemic stroke.