Colorectal cancer (CRC) ranks among the most prevalent malignant tumors globally and poses a severe threat to human health. Surgical resection remains the cornerstone of CRC treatment. With the rapid advancement of minimally invasive techniques, the Da Vinci surgical robot has been increasingly adopted in CRC management. This article will systematically review the current application of the Da Vinci robotic system in minimally invasive CRC treatment, analyzes its advantages and limitations, and discusses future prospects, aiming to provide references for clinical practice and further research.

Fluorescence imaging technology was initially used for liver reserve function assessment and sentinel lymph node biopsy in breast cancer.Subsequently,its application across various fields of oncologic surgery has gained widespread recognition.Fluorescence laparoscopy combines the advantages of fluorescence imaging and minimally invasive techniques,demonstrating significant research value and promising application prospects in the auxiliary diagnosis and treatment of colorectal cancer(CRC).In laparoscopic CRC surgery,indocyanine green-near infrared imaging technology enhances the visualization of tumor lesions,facilitates lymph node tracing,and assesses anastomotic blood supply.In recent years,fluorescence laparoscopy has developed rapidly but remains in the exploratory stage.Minimally invasive surgical experts at home and abroad have summarized existing clinical experiences and developed a series of expert consensus guidelines for laparoscopic colorectal surgery.However,there is still no fully standardized protocol regarding indocyanine green dosage,concentration,administration method and timing,injection site,and learning curve.Therefore,further multicenter,large-scale clinical trials are needed to establish consistent guidelines,promoting the standardized and widespread application of this technology in disease diagnosis and treatment.Here,the authors introduce the development background,application progress,technical debates,and future prospects of fluorescence laparoscopy in colorectal surgery.

Acute pain is a common complication after injury of a peripheral nerve but the underlying mechanism is obscure. We established a model of acute neuropathic pain via pulling a pre-implanted suture loop to transect a peripheral nerve in awake rats. The tibial (both muscular and cutaneous), gastrocnemius-soleus (muscular only), and sural nerves (cutaneous only) were each transected. Transection of the tibial and gastrocnemius-soleus nerves, but not the sural nerve immediately evoked spontaneous pain and mechanical allodynia in the skin territories innervated by the adjacent intact nerves. Evans blue extravasation and cutaneous temperature of the intact skin territory were also significantly increased. In vivo electrophysiological recordings revealed that injury of a muscular nerve induced mechanical hypersensitivity and spontaneous activity in the nociceptive C-neurons in adjacent intact nerves. Our results indicate that injury of a muscular nerve, but not a cutaneous nerve, drives acute neuropathic pain.

Objective To investigate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol in patients with gastric gastrointestinal stromal tumors (GISTs) in favorable sites.Methods Between March 2015 and January 2017,86 gastric GISTs patients undergoing laparoscopic resection in favorable sites were retrospectively analyzed.The patients were divided into ERAS protocol group (n =44) and conventional protocol group (n =42).Perioperative data and postoperative recovery parameters were compared.Results Compared with conventional group,postoperative recovery parameters in ERAS group such as time to first flatus,the first defecation,return to normal diet,physical activity outof-bed,and the hospital stay were obviously shortened.The postoperative pain score [(3.1 ± 3.0) vs.(5.2±3.2),P ＜0.05] and insulin resistance [(4.0±7.5) vs.(9.5 ±2.2),P ＜0.05] were significantly reduced in the ERAS protocol group than in the conventional protocol group.However,no statistically significant differences were observed in terps of operation time and intraoperative blood loss (P ＞ 0.05).There were no martality in both groups.The postoperative complications were 4.5％ and 4.7％ respectively.Conclusion Laparoscopic technique in favorable sites combined with the ERAS protocol enhance postoperative recovery and shorten hospital stay in gastric GIST patients.

The objectiue was to explore how to improve stem cell derivation from human great saphenous vein. After the saphenous vein was cut into small pieces, the cells of the vessel wall were obtained by tissue adherent method and digestion with type Ⅱ collagenase. The morphological changes of blood vessel wall were observed under inverted microscope. The survival of vascular wall cells was assessed by trypan blue staining. Stem cells doubly positive for CD34 and CD117 were sorted out by immunofluorescent staining and flow cytometry. The cells obtained by tissue adherence method exhibited signs of fibrotic changes and aging at the third passage (P3), while the cells extracted by enzymatic digestion still showed colony-like growth. Survival rates of these two groups of cells were (91.7±1.2)% and (97.2±0.7)%, (P=0.005). The results of flow cytometry showed that the positive rates of CD34 and CD117 double positive cells in these two groups were (0.16± 0.05)% and (0.44±0.07)%, respectively, with statistical significance (P=0.005). Immunofluorescent staining showed that the positive rates of double positive stem cells in the two groups were (89.41±2.06)% and (94.03±1.83)%, P<0.05 one week after the sorted stem cells were cultured. The positive rates of CD31, VEGF2 and SMA in the stem cells determined by flow cytometry were (0.12±0.01)%, (0.19±0.02)% and (0.45±0.01)%, respectively, which were not statistically different from those of the control groups. This could rule out substantial inclusion of mature endothelial cells and smooth muscle cells. Tube forming experiment confirmed that these vascular stem cells had developmental plasticity. More viable and morphologically healthy vascular stem cells can be derived by enzymatic digestion. These cells can be widely used in clinical and basic research.

Background: Aberrant Bcl-2 transcription is closely related with nodal diffuse large B-cell lymphoma (DLBCL), however, the relationship between Bcl-2 and primary gastrointestinal DLBCL (PGI-DLBCL) was not fully studied.Aims: To investigate the relationship between Bcl-2 gene amplification and protein expression and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL.Methods: Clinical data was collected from 136 PGI-DLBCL patients receiving surgical treatment, and a telephone interview was conducted for survival information.Bcl-2 gene amplification and protein expression in tumor tissue were determined by fluorescence in situ hybridization and immuno-histochemistry, respectively, and relationships between Bcl-2 and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL were analyzed.Results: Among 136 PGI-DLBCL patients, 33 (24.3%) showing gene amplification and 90 (66.2%) showing protein expression of Bcl-2;gene amplification was correlated with primary tumor location, Ann Arbor stage, serum lactate dehydrogenase level, B symptom and International Prognostic Index (IPI) score (P<0.05), while protein expression was correlated with primary tumor location and immunophenotype (P<0.05).5-year overall survival (OS) in patients positive for Bcl-2 gene amplification and patients with non-GCB immunophenotype and positive for Bcl-2 protein expression were inferior to those negative ones (41.5%vs.71.5%, P<0.05;54.6% vs.84.6%, P<0.05).In Bcl-2 gene amplification or protein expression positive patients, 5-year OS of CHOP chemotherapy was inferior to that of rituximab combined with CHOP chemotherapy (48.6%vs.80.3%, P<0.05;66.4%vs.83.4%, P<0.05).Conclusions: Detection of Bcl-2 gene amplification is useful for prediction of prognosis in PGI-DLBCL.Both patients with Bcl-2 gene amplification and non-GCB patients with Bcl-2 protein expression have a poorer prognosis.Rituximab may improve the prognosis in patients with Bcl-2 gene amplification or protein expression.

Objective To compare the clinical efficacy of Freka trelumina (FT) vs.feeding jejunostomy (FJ) in carrying out postoperative early enteral nutrition (EEN) in old patients with gastric cancer.Method 168 old gastric cancer cases were derided into FT group (n =54) with EEN, FJ group (n =50) with gastric tube and EEN, and total parenteral nutrition (TPN) group (n =64).Results Compared with TPN group, postoperative body weight, serum albumin and prealbumin level in FT and FJ groups were significantly higher, intestinal function recovery time, days of postoperative hospitalization and costs were significantly lower.The incidence of cough, sputum and sore throat of patients in FT group were significantly higher than those in FJ and TPN groups (P ＜ 0.05).Conclusions Postoperative EEN through FT and FJ was effective to improve nutritional parameter, accelerate intestinal function recovery, reduce the number of days of postoperative hospitalization, total costs, anastomotic stomal leak and gastroparesis rate.

Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.

This paper,according to the characters of vascular disease and experience of the author in the teaching of vascular disease,expatiate on courseware preparation,culturing of students occupational habit,basic treatment of vascular disease and amelioration of teaching methods.

Objective:To explore the effect of bone marrow stem cell mobilization in resolution of deep vein thrombosis.Methods:The SD adult rats were randomly divided into normal,sham,surgical and mobilization group(with subcutaneous injection of rhG-CSF).The peripheral blood mononuclear cell count,pathological change and thrombus organization rate in different time were examined.Results:The peripheral blood mononuclear cell count in mobilization group was significantly elevated,and there was no significant change in other groups.Compared with surgical group,there were more inflammatory cells in thrombus of mobilization group at 7th postoperative day,and the organization area of thrombus was wider and the organization rate was significantly different in mobilization group at 14th postoperative day(P