Objective To analyze the reason of necrosis for pedunculated skin flaps repaired after floor of the mouth defect repair.Methods 56 cases of pedunclated-flaps restoring the floor of the mouth from 1996 to 2001 were reviewed, and pedunclated-flap repair was performed after operation in 11 cases suffering from malignant tumors in the floor of the mouth, and 5 kinds of pedunculated flaps were compared.Results Five kinds of pedunculated flaps were used to reconstruct the floor of the mouth defects. Its successful sequence was as following: forehead flap, pectoralis major myocutaneous flap, sternocleidomastoid flaps,trapezius myocutaneous flaps, and subhyoid flap.Conclusions Causes of those flaps necrosis might relate to furnishing blood with supplied-flaps region and structure of anatomy in received-flaps region, also it is related to operater's skill.So the reason of repair failure of skin flaps with pedicle needs comprehensive analysis.

Objective To observe the treatment effect of Shah Mette Lo/fluticasone inhalation(Seretide)for stable stage of chronic obstructive pulmonary disease (COPD).Methods 50 patients with COPD were randomly divided into treatment group and control group.The treatment group was given Seretide (specifications of 250μg)1 -2 ceiling/time,2 times/day,after 24 weeks of treatment,the control group was given 2mg of regular salbutamol com-bined with budesonide 1mg atomization inhalation,2 times daily.The clinical symptoms were compared before and aftertreatment.Results In the treatment group,acute seizure frequency was significantly reduced,cough,wheezing singing decreased or disappeared,self -care ability improved,the control group had no obvious change.The control group:before treatment FEV1 (1.1 ±0.4)L;FEV1 % predicted value(22.5 ±5.1 )%;FEV1 /FVC%:(25.3 ±5.8)%;after treatment FEV1 (1.5 ±0.7)L;FEV1 % predicted value(29.4 ±6.2)%;FEV1 /FVC%:(32.8 ±6.6)%.The treatment group:before treatment FEV1 (1.1 ±0.6)L;FEV1 % predicted value (24.5 ±5.6)%;FEV1 /FVC%:(26.7 ±6.6)%;after treatment FEV1 (1.7 ±0.6)L;FEV1 % predicted value(33.4 ±7.8)%;FEV1 /FVC%:(37.8 ± 8.6)%.Conclusion In patients with stable COPD inhaled Seretide treatment can significantly improve lung func-tion,and it is better than sardine an alcohol combined with budesonide inhalation therapy.

Objective To study the significance of repeated washing in reducing the positive rate of intra-abdominal exfoliated cancer cells. Methods Sequential intraoperative peritoneal lavages were performed in each of the 160 patients with gastric cancer one time before tumor resection,three times after excision.Four sub-peritoneal washing fluid was assayed for cytology smears with routine pathology.The results were then compared. Results Exfoliated tumor cells were positive in the intraoperative peritoneal lavages of 56 patients before resention.Exfoliated tumor cells were positive in the first three intraoperative peritoneal lavages of 64 patients before resention,42 at the second,3 at the third.Tumor cells positive and forward setting lotion shed after the first time,with the number of detected cases increased but had no significant statistical significance.Compaving the positive result of the 3rd exfoliated cancer cells with the first 1,we found that the difference was statistically significant. Conclusion Sequential intraoperative peritoneal lavages is an useful method in reducing the positive rate of peritoneal exfoliated tumor cells in patients with gastric cancer.

Objective To adopt Fst statistical method to assess the heterogeneity sources of meta‐analysis by dichotomous varia‐ble .Methods The case‐control studies on the relationship between KIF1B gene rs17401966 polymorphism and hepatocellular carci‐noma(HCC) risk were collected by retrieving the databases including Google Scholar ,EMBASE ,PubMed ,ISI Web of Knowledge and CNKI .The meta analysis was performed by using the Stata12 .0 software .The genetic differentiation degree among populations was analyzed and researched by using the Arlequin 3 .5 software .Results A total of 5 case‐control studies were finally included ,in‐volving 12 research populations .The meta analysis on 12 populations showed that KIF1B gene rs17401966G allele was negatively correlated with HCC risk (OR=0 .77 ,95% CI:0 .65-0 .93 ;P=0 .005) .However ,the strong heterogeneity existed in this pooled re‐sults .The genetic differentiation test in the included 12 populations found that Zhang′s five research populations had varying de‐grees of genetic differentiation compared to other populations .Then the proper subgroup analysis was further conducted based on Fst value ,and then the I2 value of the heterogeneity test in the group 8 and 9 was descended to less than 25% .However ,the meta analysis results of the group 8 and 9 were inconsistent .Conclusion This study showed that conducting the meta‐analysis of KIF1B gene rs17401966 polymorphism and the HCC risk can find the heterogeneity sources of meta‐analysis by conducting the genetic dif‐ferentiation test in the included population .

Objective To assess the change of CEA in the peritoneal lavage fluit at pre-,post-laparoscopy-assisted radical gastrectomy, and after hyperthermic perfusion chemotherapy, and to investigate the influence of laparoscopy-assisted radical gastrectomy on drop off of cancer cells, the efficiency of hyperthermic perfusion chemotherapy. To investigate whether CEA in the peritoneal lavage fluit detected by flow cytometry (FCM) is an effective predictor of intraperitoneal free cancer cells and peritoneal metastasis. Methods Peritoneal washings of 40 patients with gastric carcinoma were collected to detect CEA using FCM. The peritoneal lavage cytology examinations ( PLC)were detected by H-E staining. Results Laparoscopic surgery in patients with gastric cancer,before resection of gastric cancer the peritoneal washing CEA positive rate 35. 0% (14/40) ,and after operation, the positive rate was 40. 0% ( 16/40) .which was not significantly higher than that before operation ( P > 0. 05 ). After intraperitoneal hyperthermic perfusion chemotherapy the CEA positive rate was 7. 5% (3/40) ,which was significantly lower than that pre-operation(P<0. 05). Before operation there were 4 cases of positive PLC in the peritoneal lavage fluid, 14 CEA-positive detected by flow cytometry, and there was significant difference ( P < 0. 05 ) . All PLC-positive cases were positive for CEA, whereas 10 PLC-negative cases showed CEA-positive. None of CEA-negative cases showed PLC-positive. Conclusions Laparoscopic radical gastrectomy does not increase the intra-abdominal gastric cancer cell shedding. Intraoperative hyperthermic perfusion chemotherapy is simple and feasible approach with high efficiency.Peritoneal washing CEA detected by flow cytometry is an effective index to predictor for intraperitoneal free cancer cells and prediction of peritoneal metastasis.

Objective To observe the distribution of sentinel nodes(SN) in gastric cancer,and investigate their clinical significance.Methods The extent and features of intraoperatively stained sentinel nodes in 288 cases of gastric cancer were analyzed retrospectively.Methylene blue was injected intraoperatively into the(subseral) muscle and submucosa of the normal gastric wall adjacent to the neoplasms,then lymphadenography was performed,and the nodes were resected for histopathological examination.Results The pathological(diagnosis) of the 288 cases with gastric cancer was T_1 in 102 cases,T_2 106 cases and T_3 60 cases.Stained nodes were detectable in 270 cases(success rate: 93.8%).One hundred and two cases were found to have lymph node metastasis;66 cases had metastasis in both SNs and non-SNs;18 cases in SNs alone;and 18 cases in non-SNs alone.Conclusions Sentinel lymph nodes can accurately predict the lymph node metastatic status of gastric cancer patients during operation.Intraoperative sentinal lymph node mapping can avoid routine lymph node dissection in patients with gastric cancer with negative lymph node metastasis.

Objective To investigate the detection of peritoneal free cancer cells and its clinical significance. Methods The peritoneal free cancer cells,the positive rates of CK20 protein and CK20 mRNA expressions of peritoneal lavage fluid were detected by peritoneal lavage cytology (PLC),flow cytometry (FCM) and real-time fluorescent quantitative RT-PCR in 50 cases of gastric cancer patients,respectively. The sensitivity of three kinds of detection method to peritoneal free cancer cells was compared. Results The positive rates of peritoneal free cancer cells,CK20 protein and mRNA expression of peritoneal lavage fluid were 20.0% (10/50),36.0% (18/50) and 58.0% (29/50),respectively. The positive rate of CK20 mRNA expression detected by real-time fluorescencequantitative RT-PCR in peritoneal lavage fluid was significantly higher than those of the CK20 protein expression detected by FCM and peritoneal free cancer cells detected by PLC (P0.05). The positive rate of CK20 mRNA expression of peritoneal lavage fluid was related to the tumor invasion depth,differentiation degree,TNM stage,and lymph node metastasis (P

Objective To investigate the clinical efficacy of open abdomen management for severe abdominal infection.Methods The clinical data of 36 patients with severe abdominal infection who were admitted to the General Hospital of Lanzhou Military Command from January 2009 to January 2014 were retrospectively analyzed.After examination,patients received resuscitation and debridement according to the principle of damage control surgery.The surgery was divided into 2 stages.Open abdomen management was applied during the first stage,and 14 days later second stage surgery for abdominal closure was carried out when the abdominal infection was under control.Abdominal pus was collected during the operation for bacterial culture.Antishock,anti-infection,organ function protection,nutritional support and symptomatic treatment were applied after the operation.Patients were followed up via phone call and out-patient examination till March 2014.Results All the patients successfully received the first and the second stage surgeries.Six patients died of septic shock and multi-organ dysfunction syndrome,and 30 patients were cured.Eight patients underwent operation for 2 times.The operation time,volume of intraoperative blood loss,time for gastrointestinal function recovery,duration of postoperative hospital stay were (157 ±26) minutes,(230 ±64)mL,(44 ± 7) hours and (16 ± 5) days,respectively.Forty-eight bacterial strains were separated,including 31 gram-negative bacterial strains and 17 gram-positive bacterial strains.According to the results of drug sensitivity test,antibiotics including imipenem and cefoperazone were selected.Thirty patients were followed up with the median time of 6 months.Six patients were complicated with adhesive intestinal obstruction and 2 with incisional hernia,and they were cured after enterodialysis and hernia repair.No complications were detected in the other 22 patients.Conclusion The efficacy of open abdomen management and debridement is satisfactory for the treatment of severe abdominal infection in patients who can bear surgery.

Gastric stump carcinoma (GSC) generally refers to the primary cancer in the remnant stomach,which occurs 5 years or latter after subtotal gastrectomy for gastric or duodenal ulcer,or 10 years or latter after gastric cancer resection.Laparoscopic radical gastrectomy for GSC is difficult with low resection rate.Although laparoscopic gastrectomy is technically mature in recent years,there is still few reports about laparoscopic resection for GSC.From January 2009 to June 2012,18 patients with GSC received laparoscopic radical gastrectomy at the General Hospital of Lanzhou Military Area of PLA.Laparoscopic gastrectomy for GSC is technically feasible and safe with satisfactory short-term outcome.Surgeons who have mastered laparoscopic D2 dissection could perform this procedure.

Colorectal cancer is one of the most common malignant tumors.With the improvement of living condition and peoples' life-span,the incidence rate of colorectal cancer has been ascending year by year.In developed countries and developed district of China,colorectal cancer has become the second common malignant tumor.More than one million people were diagnosed as with colorectal cancer,and 500,000 of them died yearly.Colorectal cancer is one of the most common reasons of the death of cancer patients.With the development of molecular targeted agents research,the therapeutic effects for colorectal cancer patients have been improved,and the current status and prospect of targeted therapy for colorectal cancer patients were introduced in this review.