D2 radical lymphadenectomy is currently the worldwide standard operation for locally advanced gastric cancer. The most common organs affected by intraoperative injuries include perigastric blood vessels, the spleen, the common bile duct, the pancre-as, and lymphatic vessels. Postoperative complications usually include bleeding, lymphatic leakage, anastomotic leakage, and delayed gastric emptying. Annual volume is an important factor in the mortality and morbidity of the operation. The learning curve for the proce-dure involves approximately 50 operations. Adequate living anatomical knowledge and skilled surgical techniques are prerequisites for D2 lymphadenectomy.

Gastrointestinal stromal tumor (GIST) arises from gastrointestinal tract,omentum,mesentery or peritoneal surface.Of which,about 60％ arises from stomach.The principle of surgical treatment is removing the tumor as completely as possible.The indications of operation for metastatic and recurrent GIST are perforation,obstruction and hemorrhage.The majority of gastric stromal tumor can be removed with local or wedge excision.Proximal gastrectomy is a choice for GIST locating at the cardia since local resection may cause cardia stenosis.Distal gastrectomy is suitable for GIST locating at lesser curvature of gastric antrum.Total gastrectomy is not a common procedure for gastric stromal tumor.Combined spleen,tail of pancreas and transverse colon resection may necessary for R0 surgery.Local resection is the first choice for duodenal stromal tumor,pancreaticoduodenectomy can be performed in large medical center.Operative procedure must be carefully carried out for small intestinal stromal tumor to avoid tumor rupture.Combined resection is a right choice when tumor involved surrounding organs or structures.In principle,low anterior instead of abdominoperineal resection is the only reconmend procedure for rectal stromal tumor.

The rational extent of lymphadenectomy for local advanced gastric cancer is a controversial issue in the past decades.D2 radical gastrectomy is recommended as a worldwide standard procedure for local advanced gastric cancer based on the international publications of randomized clinical trials.Because of the limitations of design in the randomized clinical trial (JCOG9501),the significance of No.16 lymph node dissection for patients with T4 and N3 stage of gastric cancer which is very common in China is not very clear.The clinical efficacies of splenectomy for complete resection of No.10 lymph node need to be confirmed by the final result of the randomized clinical trial (JCOG0110).Although positive No.14v and No.13 lymph nodes metastasis are defined as distal metastasis (M1) according to the Japanese gastric cancer treatment guidelines 2010 (ver.3),D2 radical gastrectomy plus No.14v and No.13 lymphadenectomy should be applied to the potential patients with positive No.6 lymph node metastasis or distal advanced gastric cancer with duodenal invasion.The number of lymph node dissection and extra-nodal soft tissue dissection are significantly associated with the prognosis of patients.

On the basis of randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a globally stan-dard procedure for locally advanced gastric cancer. However, the rational extent of lymphadenectomy for locally advanced gastric can-cer has remained a topic of debate in the past decades. The examined lymph node and extra-nodal metastasis are significantly associ-ated with the survival of gastric cancer patients. Furthermore, the role of splenectomy for complete resection of No. 10 nodes has been controversial;however, the randomized trial of JCOG0110 is yet to be completed. Gastric cancer with No. 14 lymph node metas-tasis is defined as M1 stage in the current version of the Japanese classification. We propose that D2+No.14v lymphadenectomy may be an option in a potentially curative gastrectomy for tumors with apparent metastasis to the No. 6 nodes or infiltrate to duodenum. In view of the limitation of low metastatic rate in para-aortic lymph nodes in Japan Clinical Oncology Group (JCOG9501), the clinical benefits of D2+PAND for patients with stage T3 and/or stage N3 disease, both of which are very common in China and many other coun-tries except Japan and Korea, cannot be determined.

Digestive tract reconstruction after distal gastrectomy for gastric cancer includes Billroth Ⅰ (B Ⅰ),Billroth Ⅱ (B Ⅱ),Roux-en-Y (RY),uncut-RY,RY-double tract (DT) and jejunal interposition (JI).B Ⅰ reconstruction is the most common method,with an advantage of keeping normal duodenal pathway for food.The disadvantage of B Ⅱ reconstruction is that it could cause dumping syndrome-related syndroms compared with RY reconstruction.RY reconstruction was not superior to B Ⅰ reconstruction in terms of keeping body weight and improving nutritional status,although it could significantly decrease the incidences of reflux residual gastritis and reflux esophagitis.Uncut-RY reconstruction is better than Roux-en-Y reconstruction in the prevention of Roux stasis syndrome.DT reconstruction has not only the advantages of descending the incidences of reflux residual gastritis and reflux esophagitis but also kept the normal duodenal pathway for food.JI is feasible and safe with the advantages as mentioned above,however,it has complicated surgical process and time-consuming,and anastomotic ulcer may occur after the surgery.

Objective To explore the feasibility and application value of low dose CT with automatic tube current modulation (ATCM) in the diagnosis of pneumoconiosis.Methods Forty-five patients with pneumoconiosis confirmed by the occupational agency underwent standard dose CT scanning with a fixed tube current of 150 mA and low dose CT scanning with ATCM (50-200 mA) with noise index (NI) of 14.The CT dose index volume (CTDIvol) and dose length product (DLP) under the different scanning condition were recorded.The image quality,specific image manifestations of pneumoconiosis (shadow size,shadow concentration,pneumoconiosis stages) were reviewed in double-blind methods by two radiologists,and the statistical analysis was performed.Results CT characteristics of pneumoconiosis could be detected efficiently with low dose CT scanning with ATCM.There were no significant differences in showing the shadow size,shadow concentration,pneumoconiosis stages and the image quality between the two groups (P＞0.05).The CTDIvol and DLP of standard dose CT scanning were 13.53 mGy and (337.13 ± 13.53) mGy/cm respectively,and CTDIvol and DLP of low dose CT scanning with ATCM were (7.39 ± 0.45) mGy and (188.78 ± 1.80) mGy/cm,there were statistical differences (P ＜ 0.05).Conclusions Low dose CT scanning with ATCM can reflect the characteristics of pneumoconiosis,and it also can significantly reduce the radiation dose with diagnostic acceptability of the image quality.So low dose CT scanning with ATCM can replace the standard dose CT scan in diagnosing and screening of the pneumoconiosis.

Ovjective To observe the surgically excised specimens from eyes with hemorrhagic agerelated macular degeneration (AMD).Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD,26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM),10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV).All specimens were routinely processed by hematoxylin and eosin,periodic acid-Schiff's stain and Masson stainings.At the maximum horizontal and vertical slice of the specimens,the category and amount of the cells in the specimen were recorded,as well as the relationship between the specimens and the surrounding tissue.Results The 36 specimens are categorized as neovascular membrane dominant (19/36),collagen fiber dominant (6/36),blood clot dominant (8/36) and degenerated thickened Bruch's membrane dominant (3/36).Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch's membrane dominant.The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch's membrane,retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens.Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified.

Objective To investigate the effect of electroacupuncture at bilateral points Quchi on blood pressure variability in hypertensive disease patients.Methods One hundred and two patients were randomly allocated to treatment and control groups, 51 cases each. Methods The treatment group received electroacupuncture at bilateral points Quchi and the control group, no treatment as a blank control. Twenty-four-hour dynamic blood pressure and blood pressure variability were observed in the two groups of patients. Results There were statistically significant post-treatment differences in 24-hour systolic pressure standard deviation (24 hSSD), daytime systolic pressure standard deviation (dSSD) and night systolic pressure standard deviation (nSSD) between the treatment and control groups (P<0.05). There were no statistically significant post-treatment differences in 24-hour diastolic pressure standard deviation (24 hDSD), daytime diastolic pressure standard deviation (dDSD) and night diastolic pressure standard deviation (nDSD) between the treatment and control groups (P>0.05).Conclusion Electroacupuncture at bilateral points Quchi can reduce systolic pressure variability in hypertensive disease patients.

With the development of peaple's life and the change of diet,the incidence rate of colorectal cancer is increasing. There are Twenty-five percent of patients were found liver metastases in the first diago-sis. Surgical resection of liver metastases from colorectal cancer is known to be associated with long term sur-vival. So it is the key to increase the resection rate for colorectal cancer patients with liver metastases. The in-curruence of neoadjuvant therapy may be useful in therapy of colorectal cancer patients with liver mtastases.

Objective To introduce a new anus preserving operation for low rectal cancer-ultralow anterior resection and colorectal/coloanal anastomosis by using supporting-bundling up method.Methods The clinical data of 310 patients who underwent anus preserving operation by supporting-bundling up method for low rectal cancer were retrospectively reviewed.Results The mean distance of tumor from the anal verge was 4.7?1.2cm;the TNM stage was stage Ⅰin 40 cases,stage Ⅱ30 cases,stage Ⅲ109 cases and stage Ⅳ 31 cases.the mean distance of the anastomosis from the anal verge was 2cm(1-4cm).the occurrence rate of postoperative anastomosis leak was 2.3%,the rate of excellent anal sphincter control was 82.25%.The 5-year local recurcence rate was 5.8%.Conclusions Ultralow anterior resection and colorectal/coloanal anastomosis by supporting-bundling up method may be one of the best anus preserving operations for low rectal cancer.It is a safe and feasible operation,and the long-term outcome is excellent.