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.

Objective To explore the principle and methods of surgical management of acute distal colon obstruction caused by colorectal cancer.Methods The data of the cases who received one stage resection in our hospital were analyzed retrospectively,and their surgical management was evaluated comprehensively.Results 34 patients received one stage resection and anastomosis and 6 received delayed anastomosis.All the patients were cured,and no anastomosis fistula or other complications occurred except for 3 cases who were complicated with infection.Conclusion One stage resection and anastomosis was safe for the patients of colorectal cancer complicated with acute disatal colon obstruction as long as the indications were determined appropriately.Colonic irrigation during the operation is essential for one stage anastomosis.

Objective To compare the influence of regular intermittent bolus of different con-centrations of ropivacaine for epidural labor analgesia on maternal intrapartum fever.Methods One hundred parturients aged from 20 to 35 years,of ASA Ⅰ or Ⅱ,singleton pregnancy,head presenta-tion,were randomly divided into two groups:Group H with 0.1% ropivacaine and 0.4 μg/ml sufen-tanil,Group L with 0.08% ropivacaine and 0.4 μg/ml sufentanil,50 cases in each group.Both groups were given epidural analgesic solution of 8 ml every 60 minutes respectively.Maternal tympanic membrane temperature,pain visual analogue scale (VAS),and modified Bromage score were recorded at the beginning of analgesia,1,2,3,4,5 h post analgesia,delivery,and 1 h post de-livery.And the anesthetics consumptions,labor duration,and neonatal Apgar score of 1,and 5 min were also observed.Results Compared with the beginning of analgesia,maternal tympanic membrane temperature significantly rose at 4,5 h post analgesia,delivery,and 1 h post delivery in both groups (P <0.05).Compared with group L,maternal tympanic membrane temperature significantly rose at 4,and 5 h post analgesia in group H (P <0.05).There was no significant difference in the incidence of intrapartum fever between the two groups.Compared with the beginning of analgesia,maternal VAS significantly decreased from 1 h post analgesia to 1 h post delivery in both groups (P <0.05);but there was no statistically significant difference between the two groups.Conclusion Regular inter-mittent epidural bolus of 0.08% or 0.1% ropivacaine combined with 0.4 μg/ml sufentanil can provide satisfactory labor analgesia,and body temperature rises more dramatically in women receiving higher concentration of local anesthetic than those receiving lower concentration.

Objective To explore the clinical application of antibiotics Ceftazidime(CAZ) and Cefotetan(CTT)by analysis susceptibility and scatter of the CAZ adn CTT against Escherichia coli(ECO) and Klebsiella pneumoniae(KPN).Methods The drug sensitivity analysis of 1 311 strains of ECO and 898 strains of KPN isolated from 2012 to 2015 and the relationship between CAZ and CTT was analyzed by using the Whonet 5.6 software.Results The resistance rate of ESBL+ KPN to CAZ was 41.2％ and the rate to CTT was 14.1％,the difference was statistically significant(P<0.05).The resistance rate of ESBL+ ECO to CAZ was 34.6％ and the rate to CTT was 1.1％,the difference was statistically significant(P<0.05).The average value of MIC of CAZ was highest in group of ESBL+KPN,it was 6.39 μg/mL.And it was lowest in group of ESBL-KPN,it was 1.37 μg/mL.The average value of MIC of CTT was highest in group of ESBL+KPN,it was 6.8 μg/mL.And the lowest was in group of ESBL-KPN.The range of MIC of CAZ was 1-64 μg/mL,and the range of CTT was 4-64 μg/mL in all groups.The cross sensitivity of CAZ and CTT was more than 90.0％.The cross resistance was less than 5.0％.The cross sensitivity of CAZ and CTT was less than 70.0％ in ESBL+ group.And the cross resistance was up to 13.4％.Conclusion The cross resistance and cross sensitivity of the two antibiotics is very important in guiding clinical antibiotic selection or replacement.

Objective To study the safety, reasonableness and feasibility of D 3 lymphadenectomy(LC) for advanced right colon cancer(ARCC). Methods 97 cases of ARCC were divided randomly into two groups: D 2.LC group (55cases) and D 3 LC group (42cases). The climical data between D 3 LC and D 2LC were compared. Results Comparing to D 2 LC,D 3 had higher operative invasive degree, but the incidence of postoperative complications did not increase, the ratio of the curable resection and the three-year and five-year survival rate after operation were significantly higher (88.1% and 73.8% vs 72.8% and 52.7%) (all P

Objective This study is to summarize the experience of microsurgical reconstruction for donor liver anatomical variations of hepatic arteries in orthotopic liver transplantation. Methods During the bench surgery, the anatomy of donors′ hepatic arteries was carefully examined and microsurgical techniques were used for the anomalous arteries. The graft arterial flow was checked by Doppler ultrasound daily in the first week in postoperative period and periodically thereafter. Results The arterial anatomy was anomalousin 20 out of 141 (14%) donor livers. Nine cases (6.3%) needed arterial reconstruction. In these cases, 7(4.9%) aberrant right hepatic arteries originating from superior mesenteric artery were anastomosed to gastro-duodenal arteries and another two aberrant hepatic left or right arteries were anastomosed to the stump of the donor splenic arteries. Conclusions The variations of hepatic arteries in donors are common. To obtain the ideal arterial supply of liver graft, both careful checking on the origin of donor's artery and appropriate plastic performance with refined microsurgical techniques are necessary.

Objective To evaluate the diagnostic performance of plasma miR-499 in acute myocardial infarction (AMI) diagnosis.Methods Diagnostic accuracy test.The suspected AMI patients,who with chest pain for more than half an hour and been admitted in the Second People's Hospital of Wuxi and First People's Hospital of chuzhou during October 2010 and July 2011,were consecutively and prospectively enrolled in the present study.Sixty apparently healthy individuals were designed as healthy control.The plasma samples of the suspected AMI patients were collected within two hours after admission.The plasma miR-499 was determined by real time polymerase chain reaction (RT-PCR).The diagnostic performance of plasma miR-499 for AMI was estimated by receiver operating characteristic (ROC) curve analysis.The association between plasma miR-499 and AMI was analyzed by multivariable logistic model.The plasma miR-499 was determined and explained in blind fashion.Results Two hundred and nine suspected AMI patients,including 131 confirmed AMI patients (46 STEMI and 85 NSTEMI) and 78 AMI free patients were enrolled in the present study.The delta cycle threshold (ΔCT) was 1.01 ± 3.34 for AMI patients,-2.76 ± 2.90 for non-AMI patients and-3.79 ± 2.21 for healthy controls.The differences had statistical significance (x2 =96.77,P ＜ 0.01).The area under curve (AUC) of plasma miR-499 was 0.80 (95％ C I:0.74-0.86),lower than that of cardiac troponin Ⅰ (AUC =0.90,95％ CI:0.86-0.94) on admission (P ＜0.01).At the optimal cut-off of 0.18,the diagnostic sensitivity and specificity were 0.69 (95％ CI:0.61-0.77) and 0.77 (95％ CI:0.66-0.86),respectively.The coefficient of correlation between plasma miR-499 and cTnI was 0.72 (P ＜0.01).The odds ratio (OR) of plasma miR-499 ＞0.18 for AMI was 2.59 (95％ CI:1.10-6.07),after adjusted cTnI.Conclusions Plasma miR-499 is a useful biomarker for AMI diagnosis.It can provide additional diagnostic information beyond cTnI.Combination utility of plasma miR-499 and cTnI may improve the diagnostic accuracy for AMI.

Objective To investigate the expression and signaling pathway of TAGLN2 gene in low-grade glioma (LGG),and the relation of its expression with prognoses of patients.Methods The expression of TAGLN2 gene in Oncomine and TCGA databases was analyzed by bioinformatics analysis.The TAGLN2-related protein-protein interaction network was mapped using STRING database,and the interacting protein coding genes involved in the network were enriched.According to the expression level of TAGLN2 gene in glioma,the patients were divided into high expression group and low expression group;the differences of overall survival (OS) and disease free survival (DFS) were compared between the two groups.Results The expression level of TAGLN2 gene was up-regulated in most of the tumors.The expression level of TAGLN2 gene in the tumors of LGG patients was obviously higher than that in the corresponding normal brain tissues.The missense mutation of TA GLN2 gene was analyzed in TCGA database,and 1.5％ of TAGLN2 gene missense mutation occurred in glioma tissues.There were 51 nodes in TAGLN2-related protein-protein interaction network and 254 interaction relations,and the regional clustering index was 0.69.The network protein enrichment was obvious (P=1.0E-16).The proteins encoding and interacting with TAGLN2 gene were mainly concentrated in vesicles,extracellular matrix and cell membrane.Their molecular functions were mainly protein binding,iron binding and accounting binding;their biological processes were mainly concentrated in the regulation of biological functions,cell development and multicellular tissue processes.OS and DFS of TAGLN2 high expression group were significantly lower than those of low expression group (HR=2.7,HR=1.8,P＜0.05).Analysis of LGG cell subtypes showed that OS and DFS of astrocytoma in TA GLN2 high expression group were lower than those in low expression group (P＜0.05).The OS of oligodendroglioma in the TA GLN2 high expression group was significantly lower than that in the low expression group (P＜0.05).There were no significant differences in OS and DFS of oligodendrocytoma and DFS of oligodendroglioma between the TAGLN2 high and low expression groups (P＞0.05).Conclusion TAGLN2 is highly expressed in LGG tissues and is associated with poor prognosis.

Objective: To compare the surgical accuracy of the 3D printing surgical guide and traditional occlusal splint in the treatment of skeletal facial asymmetry cases. Methods: 12 facial asymmetric patients underwent joint orthognathic and orthodontics treatments were included in this research. In the 3D printing group (n=6) the pre-surgical CT scan for the skeleton and laser scan for the dentures were performed and 3D orthognathic procedures including Le FortⅠ and BSSRO combined with genioplasty were planned. The 3D printing surgical guides were manufactured and applied during surgeries. Another 6 cases were received same procedures by traditional occlusal splint techniques as the control group. Post-surgical CT reconstruction and 3D superimposition with pre-surgical planning was carried out for outcome comparison. Results: The maximal error of maxillar was 0.65 mm and average error was less than 1 mm in 3D printing group, while the maxillary maximal error was 2.11 mm and average error was greater than 1 mm in traditional group which showed the statistical significance (P<0.05). Conclusions The usage of 3D printing surgical guide could improve the orthognathic surgical precision by controlling the jaw bone in a three-dimensional way.

OBJECTIVETo develop a new method of presurgical nasoalveolar molding based on computer-aided design technique.

METHODSTwenty patients(16 boys, 4 girls) with complete unilateral cleft lip and palate(UCLP) who received presurgical nasoalveolar molding were recruited as the treatment group. Twenty patients(15 boys, 5 girls) with complete UCLP who did not receive presurgical orthopedic treatment were selected as the control group. All parameters of the digital maxillary model were measured using the Rapidform XOR3 software. The statistical analysis was performed with SPSS 15.0.

RESULTSA'-X and B-Il were reduced significantly after presurgical nasoalveolar molding. However, the mean alveolar height [F- hight (3.7 ± 1.1) mm, F'-height (4.6 ± 0.9) mm] decreased significantly after treatment(P <0.05). There were significant differences between the treatment group and the control group(P<0.05).

CONCLUSIONSMaxillary alveolar morphology could be improved in UCLP infants treated with computer-aided presurgical nasoalveolar molding. The width of the cleft could be reduced and the maxillary midline corrected effectively. However, the alveolar height decreased significantly after the treatment.

Alveolar Process ; pathology ; Case-Control Studies ; Cleft Lip ; therapy ; Cleft Palate ; therapy ; Computer-Aided Design ; Female ; Humans ; Infant ; Male ; Maxilla ; Models, Anatomic ; Nose ; pathology ; Software