Robotic-assisted transanal total mesorectal excision (R-TaTME) has unique advantage in low rectal cancer. Single incision plus oneport (SIPOP) laparoscopic operation can synchronously cooperate with robotic-assisted transanal operation, in order to the difficulty of operation, improve the quality of operation and shorten the time of operation. A retrospective analysis was conducted on the clinical and pathological data of one patient who underwent SIPOP synchronously combined with R-TaTME + sigmoid-anal anastomosis + ileostomy at the Department of General Surgery, Army Characteristic Medical Center on September 11, 2019. This 71-year-old patient was male with body mass index of 24.08 kg/m 2 and received preoperative chemotherapy. Rectal adenocarcinoma was confirmed by colonoscopy biopsy, and distance from tumor lower edge to anal verge was 3 cm. MRI indicated T2N1 stage. The operation was completed successfully, and the transabdominal and robotic transanal surgery totaled 117 minutes, with 15 minutes for the robotic transanal preparation step. There was about 20 ml of intraoperative blood loss and no blood transfusion was performed. The patient was discharged 6 days after operation. No intraoperative or postoperative complications occurred. The postoperative TNM staging was stage I (pyT2N0cM0). No recurrence or metastasis was found at postoperative 7 month. It is a safe, effective and feasible technique for patients with low rectal cancer.

Robotic-assisted transanal total mesorectal excision (R-TaTME) has unique advantage in low rectal cancer. Single incision plus oneport (SIPOP) laparoscopic operation can synchronously cooperate with robotic-assisted transanal operation, in order to the difficulty of operation, improve the quality of operation and shorten the time of operation. A retrospective analysis was conducted on the clinical and pathological data of one patient who underwent SIPOP synchronously combined with R-TaTME + sigmoid-anal anastomosis + ileostomy at the Department of General Surgery, Army Characteristic Medical Center on September 11, 2019. This 71-year-old patient was male with body mass index of 24.08 kg/m 2 and received preoperative chemotherapy. Rectal adenocarcinoma was confirmed by colonoscopy biopsy, and distance from tumor lower edge to anal verge was 3 cm. MRI indicated T2N1 stage. The operation was completed successfully, and the transabdominal and robotic transanal surgery totaled 117 minutes, with 15 minutes for the robotic transanal preparation step. There was about 20 ml of intraoperative blood loss and no blood transfusion was performed. The patient was discharged 6 days after operation. No intraoperative or postoperative complications occurred. The postoperative TNM staging was stage I (pyT2N0cM0). No recurrence or metastasis was found at postoperative 7 month. It is a safe, effective and feasible technique for patients with low rectal cancer.

BACKGROUND: In China, population aging makes pension become prominent, so different pension patterns haven been developed. However, the existing patterns pay bare attention to the physical exercise of the elderly, and the elderly need regular exercise to delay the aging and improve the quality of life. Vibration training is an exercise method that popularized in the past decade. It can effectively enhance the muscle strength and balance function of the elderly. Little is reported on sitting posture, and exploring the effect of vibration training in sitting position on the elderly provides reference for physical intervention of the elderly. OBJECTIVE: To explore the effect of 12-week vibration training in sitting posture on muscle strength of lower extremity, balance and walking ability of the elderly living in the day-care center. METHODS: Thirty-six elderly with an average age of 82.9 years were randomized into trial (n=20) and control (n=16) groups. The trial group underwent 12-week vibration training in sitting posture (amplitude: 3 mm; frequency: 3-13 Hz; 5 min/set, 1 minute in between; 2-4 sets/session; 3 times/week) by using vibration platform BODYGREEN. The control group received no vibration training in sitting posture with normal rest. Only investigators were blind to grouping. RESULTS AND CONCLUSION: Compared with the baseline, the five times sit to stand test, intensive Romberg test results, time up and go test results and 10-m walking test results showed no significant changes in the trial group. The deviation length, deviation area and Y-axis deviation of eyes open, and the deviation length and Y-axis deviation of eyes closed in Win-Pod balance test were significantly reduced (P ＜ 0.05). The indexes showed no significant changes in the control group before and after training. The elderly had good adaptability to vibration training in sitting posture, with no dizziness or other adverse reactions. These results imply that 12-week vibration training in sitting posture is beneficial to overcome the deviation of the center of gravity in older adults. Nevertheless, the effect of improving muscle strength of lower extremity and walking ability is not obvious. Vibration training in sitting posture can be accepted by the elderly, which may be regarded as a way of daily exercising for older adults.

BACKGROUND: Whole body vibration (WBV) training has gained increased attention at the beginning of 21st century as a sort of exercise. WBV instruments are popularized gradually; in the meanwhile, WBV training has showed its values especially for people who are too feeble to attend conventional exercises, among whom, the elderly accounts a lot.OBJECTIVE: To summarize the effects of WBV training on low extremity functions and chronic diseases in older individuals, and to explore the underlying mechanism, thus providing reference for the study on WBV training.METHODS: Web of Science, PubMed and CNKI databases were searched for the literatures addressing WBV training published between 1998 and 2015 with the subject word of whole body vibration and the keywords of older adult, elderly,seniors, aging in English and Chinese, respectively. The articles related to the lung diseases were excluded. The subjects were more than 60 years old, the low extremity functions included neuromuscular function, balance and walking abilities, and the chronic diseases included stroke, type 2 diabetes mellitus, hypertension and Parkinson disease.RESULTS AND CONCLUSION: WBV training is likely to increase muscle strength, body balance and functional mobility.In terms of chronic diseases, WBV training contributes to muscle strength, relieving muscle stiffness, amyostasia,enancing improving some indexes of chronic diseases. WBV training is a safe and feasible exercising way for elderly people scheduled for improving the muscle strength, balance and walking abilities. Considering the existed evidences,WBV cannot replace the conventional therapy to treat chronic diseases in the elderly. Furthermore, a large number of high quality trials should be conducted in the future to clarify its effectiveness and application values.

Objective To investigate the intra-and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO),hemihepatic vascular occlusion (HVO),and selective vascular occlusion(SVO).Methods Retrospective analysis the data of 41 cases of laparoscopic liver resection were conducted in three groups of patients under different occlusion methods,including 15 cases of intermittent total pedicle occlusion (IPO),12 cases of hemihepatic vascular occlusion (HVO) and 14 cases of selective vascular occlusion (SVO).Intraoperation blood loss,operation time,conversion to open operation,changes in postoperative liver function,hospital stays and complications were compared among the three methods.Results There was no operative death in any of the 41 patients.There was no conversion to open surgery.Generally,there was no significant difference among the three groups in blood loss,clamping time or operative time.Ten patients had postoperative complication and all were cured.The effect on liver function for Gro-HVO and Gro-SVO was significantly less severe than that for Gro-IPO (P ＜ 0.05) after operation.Conclusions Both HVO and SVO are feasible and safe in laparoscopic hepatectomy(LH),and have advantage in reducing liver remnant ischemia injury and modality rate over IPO.HVO is easy to do for left lateral lobe or resection of the left half of the liver.SVO is suitable for right lobe resection.

Objective To explore the operative main point and clinical effects of laparoscopic treatment for hepatic cyst. Methods Between August 2006 and April 2009, Forty-eight cases of laparoscopic treatment for hepatic cyst were performed, and the data were analyzed retrospectively. Of these treatments, there were laparoscopic fenestration (46 cases) and laparoscopic anatomical resection of left hepatic lobe (2 cases). Of the patients, there were solitary cyst (41 cases) and multiple cyst (7 cases). Results Fortyeight cases all performed laparoscopic treatment successfully. There were no converting to open operation, no biliary leakage and no bleeding. Except for resection of left hepatic lobe, the operating time was 30 -96 minutes (mean, 45 minutes), the intraoperative blood loss was 10 -90 mL (mean, 26 mL) and the postoperative hospital stay was 3 - 9 days (mean, 5 days). All the 48 patients were followed up for 6 to 36 months (mean, 32 months), 2 cases were found recurrence. Conclusions Affluent experience and proper standard of operation are key points for avoiding recurrence and complication in laparoscopic treatment for hepatic cyst. Laparoscopic treatment for hepatic cyst is safe, characterized by less pain and rapid recovery.

Objective To explore the surgical skills and clinical efficacy of laparoscopic splenectomy (LS). Methods The operative duration, perioperative blood loss and postoperative complications were determined in 42 patients receiving LS in our hospital from October 2006 to May 2008 were retrospectively analyzed. Of the 42 patients, 12 suffered from splenomegaly due to blood disease, 1 from splenic tuberculosis, 1 from splenic cyst, 4 from traumatic splenic rupture,1 from malignant lymphoma and 23 from hypersplenism due to portal hypertension. Results LS was successfully performed in all the 42 patients. The mean perioperative blood loss was (300±110.60)ml, average operative duration (170±45.65) min (60-260 min) and mean postoperative inhospitalization duration (8.10±3.52)d. There was no severe complication after the operation. Conclusion For most types of splenic diseases, LS is safe and feasible. It is crucial to manage the splenic pedicle according to disease type, size, morphology and splenic hilus.

Objective To explore the operative main points and clinical effects of LC treatment for acute calculous cholecystitis. Methods Between August 2006 and June 2008, LC treatment for acute calculous cholecystitis in 120 cases as performed, the data of which were analyzed retrospectively. Of these patients, there were gallbladder with adherent omentum (72 cases), gallbladder with adherent hepatic flexture of the colon (9 cases), gallbladder with duodenum (5 cases), obstruction of the cystic duet by a gllstone (68 cases), and Mirizzi syndrome(2 cases). Results All the 120 cases performed LC successfully. There were no converting to open operation, and no biliary leakage. The mean operating time was (45. 0 ± 13. 1) minutes. Conclusions Acute calculous cholecystitis was not a contraindication for LC. Rich experience and skilled technique were key points for the success of operation. It shows advantages of less pain, less complications and more rapid recovery.

Objective:To study the methods of protecting recurrent laryngeal nerve(RLN) in endoscopic thyroidectomy through the upper part of sternum.Methods:The clinilical data of 46 cases underwent endoscopic thyroidectomy through the upper part of sternum was analyzed.RLN was revealed when we performed nodulectomy or partial thyroidectomy.But during subtotal and near-total thyroidectomy the RLN was always revealed.Results:Forty-five of forty-six cases were compeleted successfully with endoscopic thyroidectomy.One case was converted to open thyroidectomy because of thyroid carcinoma.No intraoperative or postoperative hemorrhage,RLN injuried and deadlimb occurred.Conclusion:In order to reduce the injury of RLN,we should select the fitting cases strictly,master the opportunity and methods of revealed RLN.

Objective To study the mechanism of cytotoxic T lympocytes in the acute rejection of xenogenic liver transplantation(XLT). Methods Hamster to rat orthotopic liver transplantation model was performed with three cuff method. In XLT,lymphocytes including CD8 and CD4 subsets were observed by histology and immunohistochemistry; the expression of perforin and Fas- L was observed by immunohistochemistry; and apoptotic cells of XLT were observed in situ end-labelling of fragmented DNA. Results In the XLT, T cell infiltration firstly ocurred on the 2nd day posttansplantation and located at the portal triads; the infiltrating lymphocytes proliferated increased with time and reached the peak on the 5th to 6th days.Perforin and Fas-ligand were expressed on the 4th day after XLT, and peaked on the 5th to 6th day,and the expression of perforing was still higher than the expression of Fas-ligand. Conclusions T lymphocyte participates in the acute rejection of XLT through the expression of perforin and Fas-ligand, which leads to apoptosis or necrosis of hepatocytes.