With the initiation of laparoscopic techniques in general surgery and a significant expansion of minimally invasive techniques in the last 20 years.However,some of the shortcomings of laparoscopic technology has limited it's surgical application.More recently,the da Vinci robotic surgical system further defined the ability of a roboticassist device to address limitations in laparoscopy.This in cludes a significant improvement in instrument dexterity,dampening of natural hand tremors,three dimensional visualization,ergonomics,and camera stability.As experiencewith robotic technology increased and its applications to advanced laparoscopic procedures have become more understood,more procedures have been performed with robotic assistance.We review the current status of da Vinci robotic technology and its applications in general surgical procedures.

0.05).(2) The volume range of 25 hepatocellular tumors was 395.16～2747.7 ml using diameter measurement and 203.10～1463.19 ml using MSCT 3D measurement before the operation.There was significant difference of the data in these two groups using t-test (t=7.689, P

Objective To explore the relationship between gut mucosal barrier dysfunction and immune response in patients with early severe acute pancreatitis (SAP).Method 46 patients with early SAP were enrolled into this study from January 2010 to December 2012.Results The levels of endotoxin,the lactulose/mannitol (L/M) ratio,the D (-)-lactate concentration,and the proportion of HLA-DR-positive monocytes all decreased from a high level,while the frequency of Tregs increased during the first 14 days.The Th1/Th2 ratio decreased,with a decreased Th1 and an increased Th2 profile in the first week,but it subsequently increased,with an increased Th1 profile.Conclusions The data from this study showed that immunosuppression and immune imbalance happened in patients with early SAP,and showed a positive relationship with gut mucosal barrier dysfunction in patients with early SAP.Thus,early protection of the function of intestinal mucosal barrier is important in the treatment of SAP.

Objective To evaluate the potential of interventional regional arterial infusion for severe acute pancreatitis (SAP). Methods Regional arterial infusion with somatostatin and antibiotic was performed in 20 cases of SAP within 4 hours after diagnosis confirmed,and pressurized infusion lasted for 5 days. Another 28 cases of SAP as control group received drug treatment all over the body. The SAP clinical data such as symptom,mortality,complication rate and stay time in hospital were analysed in two groups. Results There were significant differences in remission,serum amylase,urine amylase and lipase between the regional and total infusion groups. The stay time in hospital,mortality,complication and operation rate were lower in regional infusion group than those of control group(P

Objective To discover regularities behind critical values in an effort to provide scientific evidences for a better critical value report system.Methods Collection, analysis and statistical assessments for critical value items and ranges appropriate for the hospital Results The occurrence rate of critical values is found to be 0.14%.By means of clinical evaluation, statistic analysis and reference to literature and clinical specialists, the clinical labs revised the ranges of PO2, GLU, PT and APTT, and added ALT, MYO, CTnl and K+ , GLU, BILl for newborns, and canceled AMY.All of these changes were put in practice upon approval of the Medical Department of the hospital Conclusion Regular evaluation and continuous improvement of the critical value report system may help with saving lives, improving quality of care of the labs and doctors" diagnosis as well

This experiment aimed to investigate the effect of adrenergic system in the subnucleus commissuriu of nucleus solitrius tractus (CNTS) on renal nerve discharges. Norepinephrine (NE) was microinjected into the CNTS of rabbits and mean arterial blood pressure (MAP) and renal nerve discharges (FRND) were synchronously recorded. The results indicated that (1) microinjection of norepinephine into the CNTS of rabbit could significantly attenuate the frequency of renal nerve discharge, and at the same time decrease markedly the mean arterial pressure. (2) Microinjection of 0.3 nmol yohimbin into CNTS had no significant influence on FRND and MAP, but could attenuate and even reverse the effects of NE on FRND and MAP. These results suggest that microinjection of NE into CNTS may activate the alpha-adrenorecptor located in CNTS and secondarily produce a depressor effect by attenuating the activity of periphenal sympathetic nervous system.
Blood Pressure/drug effects ; Depression, Chemical ; Kidney/*innervation ; Microinjections ; Norepinephrine/*pharmacology ; Solitary Nucleus/*physiology ; Sympathetic Nervous System/drug effects ; Sympathetic Nervous System/*physiopathology ; Vasomotor System/physiopathology

Summary: This experiment aimed to investigate the effect of adrenergic system in the subnucleus commissuriu of nucleus solitrius tractus (CNTS) on renal nerve discharges. Norepinephrine (NE) was microinjected into the CNTS of rabbits and mean arterial blood pressure (MAP) and renal nerve discharges (FRND) were synchronously recorded. The results indicated that (1) microinjection of norepinephine into the CNTS of rabbit could significantly attenuate the frequency of renal nerve discharge, and at the same time decrease markedly the mean arterial pressure. (2) Microinjection of 0.3 nmol yohimbin into CNTS had no significant influence on FRND and MAP, but could attenuate and even reverse the effects of NE on FRND and MAP. These results suggest that microinjection of NE into CNTS may activate the alpha-adrenorecptor located in CNTS and secondarily produce a depressor effect by attenuating the activity of peripheral sympathetic nervous system.

Objective:To study the level of non-protein-bound iron (NPBI) and oxidative stress status in cord blood of small for gestational age (SGA) infants.Methods:From March 2021 to December 2021, late preterm and term infants born in department of obstetrics at our hospital with umbilical arterial bood (UAB) sampled were enrolled in this retrospective study. SGA infants were assigned into SGA group and appropriate for gestational age (AGA) group was matched in a 1∶1 ratio to SGA group selecting from all the AGA infants. The levels of NPBI, 8-isoprostagladin F2α (8-iso-PGF2α) and malondialdehyde (MDA) in UAB were compared between the two groups. The correlations of NPBI and other indicators were analyzed.Results:A total of 68 infants were enrolled, including 34 in SGA group and 34 in AGA group. SGA group had significantly higher levels of NPBI [3.9(2.6,5.1) nmol/ml vs. 0.8(0.2,1.4) nmol/ml], 8-iso-PGF2α[ (119.6±30.2) pg/ml vs. (66.5±22.7) pg/ml) ] and MDA [4.6(4.1, 5.1) nmol/ml vs. 3.4(2.9,3.8) nmol/ml] than AGA group ( P<0.05). The levels of 8-iso-PGF2α and MDA were positively correlated with NPBI in SGA group ( r=0.582, P=0.001; r=0.371, P=0.031). In AGA group, NPBI was positively correlated with MDA level ( r=0.492, P=0.003), but not with 8-iso-PGF2α ( r=0.032, P=0.859). Conclusions:Oxidative stress exists in SGA and NPBI may induce oxidative stress in SGA through lipid peroxidation.

Objective:To evaluate the relationship between the preoperative sleep quality and postoperative delirium (POD) in elderly patients.Methods:Three hundred and eighty-nine patients of either sex, aged 65-90 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent elective knee/hip arthroplasty under combined spinal-epidural anesthesia in Qingdao Municipal Hospital from May 2022 to October 2023, were selected. The Pittsburgh Sleep Quality Index scale was applied at 1 day before surgery to assess the sleep quality within 1 month before surgery. The cerebrospinal fluid (CSF) specimens 2 ml were withdrawn from the subarachnoid space before anesthesia for determination of the concentrations of biomarkers (β-amyloid), total tau protein [t-tau], and phosphorylated tau protein [p-tau]) by enzyme-linked immunosorbent assay. Patients were divided into POD group and non-POD group based on whether delirium occurred within 7 days after surgery. Logistic regression was used to identify the risk factors for POD, and the sensitivity analysis was used to test the stability of the regression models. The mediation model was used to examine whether CSF biomarkers mediated the link between sleep quality and POD. The accuracy of preoperative sleep quality and CSF biomarker concentrations in predicting the occurrence of POD was evaluated by plotting the receiver operating characteristic curve and calculating the area under the curve.Results:Two hundred and seventy-nine patients were finally included, with 33 patients in POD group and 246 patients in non-POD group. The results of logistic regression analysis showed that shorter sleep duration, use of hypnotics, daytime dysfunction within 1 month before surgery, elevated t-tau concentrations in CSF, and elevated p-tau concentrations in CSF were risk factors for POD after adjusting for multiple confounding factors such as age, sex, body mass index, years of education, Mini-Mental State Examination score, and VAS score. The results of mediating effect showed that the effect of use of hypnotics and daytime dysfunction within 1 month before surgery on POD was partially mediated by p-tau concentrations in CSF (>10%). The area under the curve of combination of daytime dysfunction, sleep duration, use of hypnotics within 1 month before surgery, and CSF biomarker concentrations in predicting POD was 0.979.Conclusions:Shortened sleep duration, use of hypnotic, and daytime dysfunction with 1 month before surgery are risk factors for POD in elderly patients, and the association between use of hypnotics and daytime dysfunction and POD is partially mediated by p-tau in CSF.

Objective To investigate a new strategy of bone marrow transplantation (BMT) for donor-specific tolerance induction after heart transplantation. Methods Donor bone marrow cells (BMCs)were harvested simultaneously with donor cardiac graft using modified perfusion method (PM) ,then stored in a -80 ℃ refrigerator after filtration and centrifugation. Whole BMCs (IBM-BMT) (monocytes 1.2 ×107/kg,CD34+ cells 2.38× 105/kg) in host iliac bones were injected into the bone marrow cavity 40 days after heart transplantation. Preconditoning regimens that consisted of fludarabine, antithymoctye globin and total lymphoid irradiation were performed 3 days before BMT. Tacrolimus (Tac) was administrated intravenously after BMT or orally in conjunction with mycophenolate mofetil (MMF) 3 weeks later.Cyclosporine and MMF were orally administrated 6 weeks later. Donor chimerism was detected using short tandem repeats-polymerase chain reaction in monocytes from peripheral blood at the 2nd,4th, 8th or 12th week after BMT or BMCs at the 4th, 8th or 12th week after BMT. Intramyocardium electrocardiography examination or endomyocardial biopsy was performed weekly or monthly respectively. Mixed lymphocyte reactions (MLR) were performed 3 months after BMT. Results Donor chimerism in monocytes in peripheral blood or BMCs in iliac bones measured at the 1 st,2nd and 3rd month after BMT was 26.3%, 19.1%,4.8% ,and 46.3%, 24.4%, 7.6%, respectively. After 3-month follow-up, there was no rejection confirmed by endomyocardial biopsy or intramyocardium electrocardiography. Echocardiography revealed that the diastolic and systolic function of the cardiac graft was maintained well 3 months after BMT. MLR revealed donor-specific hyporesponsiveness while immunocompetence was preserved to third-party antigens. Conclusion These findings indicate that the two-stage BMT strategy is a safe and feasible method for the induction of donor-specific tolerance via stable mixed chimerism and needs to be further confirmed after a long-term observation.