Objective:To study the comparison of advantages of 3D and 2D laparoscope applied in clinical surgery.Methods: 42 cases were received retrospective analysis using 3D and 2D laparoscopic technology to complete abdominal surgery and were divided into 3D group and 2D group according to the methods of surgery. We observed the indexes for operation time, intraoperative blood loss, postoperative exhaust, catheter indwelling time, placement time of abdominal cavity drainage tube and postoperative hospitalization days, etc.Results: The two groups of patients completed smoothly laparoscopic surgery. There was no significant difference between 3D and 2D laparoscopic monitoring on indexes in the postoperative exhaust, catheter indwelling time, placement time of abdominal cavity drainage tube and postoperative hospitalization days. But the difference was statistically more significant in the operation time and intraoperative blood loss in 3D than that in 2D group (t=0.358,t=2.455;P<0.05).Conclusion:3D high definition amplification of three-dimensional surgical field similar with the traditional laparotomy is the future trend in the development of minimally invasive surgery. Compared with 2D, 3D technology can improve the overall level of the operation, with the features of easier and faster operation, smaller wound, quicker recovery, less postoperative complications, etc.

Objective:To study the trace injection pump in the application of the common problems and treatment measures.Methods: 246 cases of general surgery patients were used trace injection pump problems for retrospective analysis, in order to propose the improvements about engineering and management.Results: The incidence rate of non-standard operation procedures or the incidents are 6.1%, injection pump failure and infusion speed is 2.03%, mismatched injection pump attachments is 1.22% and phlebophlogosis is 0.41%. The non-standard operation procedures and imperfect trace injection pump management are the major problems. Therefore, some solutions are proposed, which includes strengthening technical training for medical staff, standard operation procedures, regular quality monitoring and healthy education to the patients.Conclusion: The operation procedures of trace injection pump should be standard and programmatic. It is of great significance to clinical application of the trace injection pump and to work properly by strengthening operation personnel quality, dealing with problems timely and correctly.

Objective To evaluate the therapeutic methods and the key points in the management of delayed complications of bile duct stenosis after iatrogenic bile duct injuries.Methods Five patients with bile duct injuries developed delayed complications of bile duct stenosis after cholecystectomy were retrospectively studied.All clinical information were derived from the medical data of these 5 patients treated in our department from June 2002 to July 2006.Results Of the 5 patients with delayed complications of iatrogenic bile duct injuries,2 patients developed common bile duct occlusion,2 patients developed hilar bile duct stenosis,and 1 patient developed anastomotic stenosis after cholangiojejunostomy.Bile duct injuries occurred in 3 patients after laparoscopic cholecystectomy,and in another 2 patients after mini-laparotomy-cholecystectomy.The locations of the bile duct injuries,according to Strasberg classification,were type E1 (n=1),type E2 (n=1),type E3,(n=1),and type E5 (n=2).All 5 patients received PTCD initially to relieve obstructive jaundice and then they received surgical exploration and biliary reconstruction.These patients received cholangioplasty at the porta hepatis,and hepaticojejunostomy using a Roux-en-Y anastomosis.Two patients received Roux-en-Y anastomosis of the common hepatic duct to the jejunum.All these patients had good recovery and were discharged well postoperatively.All patients had been followed-up for 7 years or more,with no evidence of obstructive jaundice or biliary tract infection.Conclusions For patients who present with delayed complications of bile duct stenosis after iatrogenic bile duct injuries,primary PTCD is carried out to relieve jaundice and to control infection.Meticulous dissection of the porta hepatis,reliable anastomosis of the proximal healthy bile duct tissues to a jejunal loop,and adequate size of anastomosis guarantee success of surgery.

International Classification of Functioning, Disability and Health issued by the World Health Organization is the international general theoretical framework for describing and measuring healthy on individual and population level, which the evaluation for cerebral palsy should follow with. This paper discussed the tools of evaluation for cerebral palsy in the view of ICF, especially the 4 dimensions of body function, body structure, activities and participation, and environmental factors.

Objective To evaluate initial results of Ivor Lewis minimally invasive esophagectomy (MIE) for esophageal carcinoma using a diamond-shaped anastomosis with 45 mm linear-stapler.Methods Clinical data of 12 patients diagnosed middle to distal esophageal carcinoma and undergoing Ivor Lewis minimally invasive esophagetomy using a diamond-shaped anastomosis technique during Dec.2015 and Nov.2016 in Peking Union Medical College Hospital were collected and analyzed retrospectively.Results The mean operation time was (378 ± 56) min,the mean blood loss was (280 ± 120) ml,and the mean postoperative hospital stay was (12.2 ± 2.0) days.No positive margin,no peri-operative death occurred.Postoperative complication included atelectasis and pulmonary infection in 1 patient,paresis of left recurrent laryngeal nerve in 1 patient.No anastomotic leak or constriction occurred.Median follow up was 7 months,11 patients had no evidence of disease progress,1 patient had subcutanecous metastasis and was reoperated.Conclusion The diamond anastomosis technique utilizing in Ivor Lewis MIE for esophageal carcinoma is feasible,easy to manipulate,safe and reliable.

Objective To explore the effectiveness of 125I seed implantation for gastric cancer and to determine whether the therapy could increase the survival rate.Methods Seventy-six gastric cancer patients in stage Ⅱ or Ⅲ were involved and randomly divided into treatment group (n =42) and control group (n =34)by simple random sampling method.The patients in the control group underwent D2 or D3 surgery and the patients in treatment group underwent D2 or D3 surgery plus interstitial implantation of 125I seeds.All patients signed the informed consents.Treatment results were evaluated as CR,PR,NC and PD.CR and PR were considered as effective and the effective rate was calculated.All patients were followed up and the three-or five-year survival rate was calculated,the complications were examined.x2 test was used to compare the significant difference between the two groups.Results The total effective rate in control group was 50.00％ (17/34),lower than that of treatment group (73.81％,31/42; x2 =4.578,P＜0.05).In the treatment group,the three-year and five-year survival rates were 61.90％(26/42) and 42.86％(18/42) respectively,and the corresponding rates in the control group were 11.76％(4/34) and 0(0/34) respectively (x2=19.771,19.094,both P＜0.001).Both of the two groups had few severe side effects.Conclusion Radical surgery plus 1~Iseed implantation is effective and safe for the treatment of stage Ⅱ or Ⅲ gastric cancer and can further improvelong-term survival.

Objective:To observe the clinical efficacy of Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy (CP) complicated with intellectual disabilities. Methods:A total of 300 CP cases aged between 1 and 5 years were randomly allocated into a treatment group (n=150) and a control group (n=150). Patients in the treatment group were treated with Governor Vessel-unblocking and brain- refreshing scalp acupuncture combined with rehabilitation training, whereas patients in the control group received rehabilitation training alone. The Beijing Gesell developmental (Gesell) scale and gross motor function measure (GMFM) scale were used to assess the motor and intellectual development before and 3 months after the treatment. In addition, the head CT/MRI examination was applied to assess the brain nerve repair before and after the treatment. Results:After the treatment, the total effective rate in the treatment group was 78.0%, versus 42.7% in the control group, showing a statistical significance (P<0.05). As for scores of five subscales in the Gesell scale, there were significant intra-group differences in the treatment group (allP<0.05); and the scores in the treatment group were significantly better than those in the control group (allP<0.05). As for scores of five dimensions in GMFM scale, there were significant intra-group differences in the treatment group (allP<0.05); and the scores in the treatment group were significantly better than those in the control group (allP<0.05). According to the head CT/MRI findings, the total effective rate was 73.3% in the treatment group, versus 62.0% in the control group, showing a statistical significance (P<0.05). Conclusion:When used in combination with rehabilitative training, Governor Vessel-unblocking and brain-refreshing scalp acupuncture can significantly improve the clinical efficacy for cerebral palsy complicated with intellectual disabilities. It can also improve the patients' motor function, intelligence and language ability.

Objective To discuss the relationship of drip velocity of nitrate on blood pressure while treating coronary disease,in order to provide appropriate drip velocity for clinical treatment.Methods 155 patients with coronary disease using nitrate to lower blood pressure were selected.They were divided into the nitro glycerin group(85 cases) and the isosorbide mononitrate group( 70 cases) according to difference of medication.The velocity of drugs was adjusted on basis of blood pressure changes.The blood pressure changes at different drip velocities were observed and compared.Results The systolic pressure and the diastolic pressure between two groups showed no difference at 20 drops/min,but the results were the opposite at 30 drops/min.The systolic pressure and the diastolic pressure in the nitro glycerin group showed evident changes at different drip velocities,but in the isosorbide mononitrate group,these changes were not so significant.9 patients in the nitro glycerin group had headache during treatment,no headache occurred in the isosorbide mononitrate group.Conclusions Intravenous use of nitrate at a velocity of 20 drops/min is relative secure.The risk of hypotension will increase if the medication speed increases.lsosorbide mononitrate has little influence on blood pressure.

Objective To investigate the diagnosis of the diseases that presented with childhood chronic cerebellar ataxia.Method The clinical data of 15 children with chronic cerebellar ataxia were studied,including the clinical features,laboratory results and neuroimaging aspect.Results Of the 15 children with chronic cerebellar ataxia,3 cases had chronic progressive cerebellar ataxia diagnosed as ataxia telangiectasia,and neuroimaging finding that indicated mild to marked cerebellar atrophy.The others 12 cases had non-progressive cerebellar ataxia,2 cases of them had Joubert syndrome,characterized by delayed motor function and speech,lower limbs ataxia and cerebellar vermis hypoplasia; 10 cases had ataxic cerebral palsy with delayed motor skills,9 of them had mental retardation and verbal problem.Of the 10 children with ataxic cerebral palsy,7 cases had cerebellar hemispheric atrophy by computer tomography (CT) or MRI,while the other 3 cases had no positive finding in cerebellum by MRI,but 2 of whom were found reduced metabolism in cerebellar neuron during the test of positron emission tomography and CT.Comparson with the scores in the gross motor function measure (GMFM) and developmental quotient (DQ) of 5 domains (adaption,gross motor,fine motor,language and social development) in Gesell developmental Schedules before and after the rehabilitation approach:the totaI scores in GMFM after the treatment (56.42 ± 15.65) was significantly higher than that of before traatment (44.15 ±20.41) (t =-3.121,P ＜0.05),while the DQ of gross motor after the treatment (28.27 ± 14.65) was sigrificantly lower than that before treatment (35.23 ± 17.23) (t =2.75,P ＜ 0.05).The other 4 domains before the treatment were 37.47 ± 14.47,37.06 ± 11.51,40.69 ± 12.10 and 40.41 ± 15.79,and had no remarkable change after the treatment (39.44 ±16.29,35.96 ±10.76,40.26 ±14.20 and 38.61± 11.95) (allP＞0.05).Conclusions Children with chronic cerebellar ataxia presented as hypotonia with delayed motor function,and ususlly had inherent cerobellum abnormalities,without matter structure or function of the neuron.Chronic ataxia is an important symptom in genetic or metabolic disease,and a systematic approach may enhance diagnostic accuracy.

Objective To discuss the relationship between various T lymphocyte subsets apoptosis and disease progression in chronic antiretroviral-naive HIV/AIDS patients. Methods Thirty-six chronic antiretrovi-ral-naive HIV-infected individuals as well as 16 healthy HIV-negative controls were performed in this study. Ac-cording to the CD4~+ T cell counts, all the patients were divided three groups: < 200/μl, 200-350/μl and > 350/μl. After the peripheral blood mononuclear cells(PBMC) were isolated, T lymphocyte subpopulations were determined by the expression of CD45RO and CD27, and the apoptosis of different T cell subsets were measured by Annexin V staining, then analyzed by flow cytometry. To investigate whether the apoptosis of T cells varied with the culture time in vitro, 4 healthy controls and 4 patients were chosen as subjects, and the lev-els of cell apoptosis were analyzed at the culture time points of 0, 3, 6, 12, 24 h. Results (1)The percenta-ges of the AnnexinV expression on CD4~+ and CD8~+ T cells and all the subsets in HIV/AIDS patients were sig-nificantly higher than that in the healthy controls (P<0.05), but there were no significant differences among the three HIV-infected patient groups(P>0.05). (2) No significant correlations were observed between the levels of apoptosis of all the T cells and subsets and total CD4~+ T cell counts(P>0.05) ,nor with the HIV viral load (P>0.05). (3)As the culture time prolonged in vitro, the levels of apoptosis and necrosis of CD4~6 T cells in HIV/AIDS patients were significantly higher than those in the healthy conlrols, and the CD4~+ T cells were more susceptible to apoptosis and necrosis compared with CD8~+ T cells. Conclusion The levels of T cell apoptosis in HIV/AIDS patients was significantly higher than those in the healthy controls, at the same time, CD4~+ T cells were more susceptible to apoptosis and necrosis compared with CD8~+ T cells, but no correlation was found between the T cell apoptsis and disease progression.