Objective To investigate the correlation between CYP2C19 gene polymorphism and clopidogrel resistance(CR)in patients with ischemic stroke in the north of China.Methods The patients with ischemic stroke were selected as the research object from the First Hospital of Hohhot during September 2015 to No-vember 2016.The polymorphism of CYP2C19 gene was detected by Taqman probe method.Results The clo-pidogrel resistance ratio of the study population is 59%.There is a strong correlation between the CYP2C19* 2 mutant strains with clopidogrel resistance(P=0.006),and we foundd that the increased glutamic oxala-cetic transaminase was associated with clopidogrel resistance.Conclusion Patients with the CYP2C19*2 al-lele were at greater risk of clopidogrel resistance during antithrombotic therapy.

Objective To explore effect of psychological nursing intervention on anxiety and depression of young patients with ischemic cerebral stroke.Methods The Self-rating Depression Scale(SDS)and Self-rating Anxiety Scale (SAS)were applied to investigate and assessed psycho-logical status of 58 young patients with ischemic cerebral stroke.Besides,32 patients were applied systematic intervention and re-evaluation was carried out after two weeks,the data before and af-ter intervention was analyzed.Results After psychological nursing intervention,discharged SAS, SDS scores of 32 patients were lower than that at admission (P <0.05).Conclusion Systematic psychological nursing intervention for young patients with ischemic stroke during hospitalization can significantly reduce psychological stress response,effectively improve the patient’s anxiety and de-pression,and improve quality of life.

Objective To explore effect of psychological nursing intervention on anxiety and depression of young patients with ischemic cerebral stroke.Methods The Self-rating Depression Scale(SDS)and Self-rating Anxiety Scale (SAS)were applied to investigate and assessed psycho-logical status of 58 young patients with ischemic cerebral stroke.Besides,32 patients were applied systematic intervention and re-evaluation was carried out after two weeks,the data before and af-ter intervention was analyzed.Results After psychological nursing intervention,discharged SAS, SDS scores of 32 patients were lower than that at admission (P <0.05).Conclusion Systematic psychological nursing intervention for young patients with ischemic stroke during hospitalization can significantly reduce psychological stress response,effectively improve the patient’s anxiety and de-pression,and improve quality of life.

Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.

Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.

4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.

Laparoscopic radical surgery for rectal can-cer involves total mesorectal excision (TME), D 3 lymphadenectomy, and pelvic autonomic nerve preservation, the goal of which is trying to achieve completely radical cure for cancer and urogenital function preservation. In the actual operation procedure, the understanding of fascial anatomy in abdominal and pelvic cavity will help us to improve the quality of TME surgery for rectal cancer and to preserve the pelvic autonomic nerves. When entering the pelvic cavity, the identification of fascia propria of mesorectum, visceral fascia, pre-hypogastric nerve fascia, presacral fascia, ligament structures around the rectum and the Denonvilliers′ fascia in front of the rectum will help us to protect the pelvic autonomic nerves and avoid surgical injury. So the authors focus on how to identify the pelvic fascia structure clearly in laparoscopic radical resection for rectal cancer, furthermore, to master the concepts of fascia anatomy to realize TME for rectal cancer and to achieve pelvic autonomic nerve preservation.