Objective To compare the short-term efficacy between da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.Methods Database including PubMed,EMBASE,the Cochrane Library,Medline,the China National Knowledge Infrastructure (CNKI),Wanfang Database,VIP and China Biomedicine were searched with the key words of gastric cancer,gastrectomy,da Vinci surgical system,laparoscopic,laparoscopy,胃癌,胃切除术,达芬奇机器人手术系统and腹腔镜.Literatures published between May 2002 and March 2014 were retrieved.Related controlled trials containing the clinical efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer were enrolled in the study,and then the literatures were screened and the data were extracted by 2 independent reviewers.The quality of the literatures was assessed,and the data were analyzed using the RevMan 5.2 software.Patients receiving da Vinci robotic surgery and laparoscopic surgery were allocated into the robotic group and laparoscopy group,respectively.The count data were analyzed using the relative risk (RR) and 95％ confidence interval (95％ CI),and the measurement data were analyzed using weighted mean difference (WMD) and 95％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Eleven literatures including 3 698 cases were enrolled in the study.There were 953 patients in the robotic group and 2 745 patients in the laparoscopic group.There were significant differences in the operation time,volume of intraoperative blood loss,time of postoperative flatus,time of first oral intake and duration of postoperative hospital stay between the 2 groups (WMD =51.23,-36.96,-0.24,-0.26,-1.11,95％ CI:28.01-74.46,-61.28--12.65,-0.42--0.06,-0.39--0.14,-1.92--0.29,P ＜ 0.05).There was no significant difference in the number of lymph nodes resected,the distance to proximal and distal resection margin and overall incidence of postoperative complications (WMD =1.63,0.21,0.06,RR =1.11,95％ CI:-0.49-3.76,-0.65-1.06,-0.13-0.25,0.90-1.37,P ＞ 0.05).Conclusion Da Vinci robotic radical gastrectomy for gastric cancer is safe and feasible,with the advantages of minimal invasion and rapid postoperative recovery.

Objective To investigate the expression of Ezrin in gastric cancer tissues and its clinical significance.Methods Gastric cancer tissues and adjacent normal gastric tissues from 60 patients with gastric cancer were collected from June 2008 to May 2009 at the Southwest Hospital.The mRNA and protein expressions of Ezrin were detected by using the reverse transcription polymerase chain reaction and western blot.The relationship between Ezrin and the gender and age of patients,and tumor differentiation,pathological staging,depth of invasion and lymph node metastasis was analyzed.All data were analyzed using the t test,chi-square test and Spearman rank correlation.Results The Ezrin mRNA expression level was increased in 33 (55％) cases of adjacent normal gastric tissues and 21 (35％) cases of gastric cancer tissues; the Ezrin protein expression level was increased in 45 (75％) cases of adjacent normal gastric tissues and 22 (37％) cases of gastric cancer tissues.The mRNA and protein expressions of Ezrin in the normal adjacent gastric tissues were 1.30 ± 0.04 and 3.57 ± 0.45,respectively,which were significantly higher than 0.53 ± 0.36 and 0.96 ± 0.18 in the gastric cancer tissues ( t =5.309,22.617,P ＜ 0.05 ).The mRNA expression of Ezrin was positively correlated with the protein expression of Ezrin (r =0.602,P ＜ 0.05 ).The mRNA and protein expressions of Ezrin were related to the pathological stages,depth of invasion and state of lymph node metastasis (x2 =6.41,6.49,4.62; 5.40,8.87,4.12,P ＜ 0.05),but not to the gender,age and tumor differentiation (x2 =0.50,0.07,1.07 ; 0.01,1.16,1.96,P ＞ 0.05).Conclusion The mRNA and protein expressions of Ezrin are significantly decreased in the gastric cancer tissue,which might be responsible for genesis,development and metastasis of gastric cancer.

Objective To investigate the anti tumor effects of cytotoxic T lymphocytes induced by tumor antigen specific dendritic cells. Methods Soluble tumor antigen was prepared by four freeze thaw cycles of gastric tumor cell line SCG7901. Anti gastric tumor vaccine was acquired by co incubation of tumor antigen and mouse bone marrow derived dendritic cells and cultured with granulocyte/macrophage colony stimulating factor and interleukin 4. Antigen specific cytotoxic T lymphocytes were induced by this tumor vaccine from the spleen and were applied to tumor bearing nude mice. Results Tumor growth was significantly inhibited and the apoptosis of tumor cells was promoted extensively. Conclusions Antigen specific dendritic cell tumor vaccine may play an important role in future immunotherapy of gastric cancer.

Although the surgical procedure and approach of da Vinci robotic surgical system-assisted radical resection of gastric cancer are gradually mature,it is rarely used for the resection of gastric stump cancer because of the complexity and low resection rate.In November of 2012,resection of gastric stump cancer using da Vinci robotic surgical system was performed in the Southwest Hospital.The short-term efficacy was satisfactory after the follow-up for 12 months.Da vinci robotic surgical system has the advantages of clear vision,easy manipulation of abdominal adhesion detaching,flexible operation and stable traction during resection of gastric stump cancer.

Objective To compare the effects and significance of laparoscopic and open D2 gastrectomy on the expression of interleukin (IL)-6 and IL-10.Methods The clinical data of 146 patients with gastric cancer who were admitted to the Southwest Hospital from November 2010 to October 2011 were prospectively analyzed.All the patients were randomly divided into the laparoscopic group (75 patients) and open group (71 patients)according to the sealed envelope method.Laparoscopic or open D2 gastrectomy were performed according to the 14th edition of gastric cancer treatment guidelines of Japan Gastric Cancer Association.Peritoneal lavage fluid was collected at the beginning and the end of operation,and the concentrations of IL-6 and IL-10 in the peritoneal lavage fluid were detected by enzyme linked immunosorbent assay.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test.Results The preoperative concentrations of IL-6 in the laparoscopic group and the open group were (34 ± 13)μg/L and (35 ± 12)μg/L,respectively,with no significant difference between the 2 groups (t =-5.110,P ＞ 0.05).The postoperative concentrations of IL-6 in the laparoscopic group and the open group were (4015 ± 1592)μg/L and (6724 ± 2112)μg/L,respectively.The postoperative concentration of IL-6 in the laparoscopic group was significantly lower than that of the open group (t =-8.367,P ＜ 0.05),and the postoperative concentrations of IL-6 were significantly higher than those before operation in the laparoscopic group and open group (t =-59.065,-87.123,P ＜0.05).The preoperative concentrations of IL-10 in the laparoscopic group and the open group were (43 ±9) μg/L and (42 ± 10) μL,respectively,with no significant difference between the 2 groups (t =1.190,P ＞0.05).The postoperative concentrations of IL-10 in the laparoscopic group and the open group were (92 ± 32)μg/L and (62 ± 23)μg/L,respectively.The postoperative concentration of IL-10 was significantly higher than that of the open group (t =6.408,P ＜ 0.05),and the postoperative concentrations of IL-10 were significantly higher than those before operation in the laparoscopic group and the open group (t =-12.680,-6.802,P ＜ 0.05).Conclusion Peritoneal inflammatory reaction is relatively lighter after laparoscopic D2 gastrectomy when compared with open D2 gastrectomy,which might prevent the peritoneal metastasis of gastric cancer mediated by IL-6.

The Internet Public Opinion Monitoring and Early Warning System for medical and health industry was designed and implemented due to the frequent occurrence of Internet public opinion, which has all-directional data collecting and analyzing functions, including big data collection, near duplicate detection, spam filtration, key public opinion early warning, region identification and tendency analysis, and can thus provide evidence for relevant departments to take effective measures for the control of Internet public opinion.

Advanced gastric cancer is usually dealt with D2 radical dissection. There are different opinions as to whether it is necessary to perform D3 radical lymphadenectomy.Some scholars thought that properly enlarged radical dissection can improve long-term outcomes for the treatment of advanced gastric cancer.In recent years,laparoscopic D1 and D2 radical dissection of gastric cancer could be carried out in many hospitals.However,the technique and related skills for performing D3 radical lymphadeneetomy through laparoscope remains to be explored.Based on our previous experiences,D3 radical lymphadeneetomy using artery suspension method and medial-to-lateral approach for advanced gastric cancer is proved to be safe and feasihle.

The operation path, lymph node dissection and reconstruction of the alimentary tract are the three most technical difficulties of laparoscopy-assisted gastrectomy. The essential difference between laparoscopy-assisted gastrectomy and open gastrectomy is the operation path. Based on our clinical experience, we investigated reasonable paths for laparoscopyassisted gastrectomy. Patients were placed in a supine position with their legs apart, and the operator stood on the left side of the patient. Five trocars were placed in the abdominal wall in a curved line. The operation was carried out in the order of greater gastric curvature, the lower region of the pylorus and antrum,the upper region of the pancreas, omentum minus, cardia, and arcuate diaphragm. From May 2004 to April 2010, we successfully carried out 761 laparoscopy-assisted gastrectomies with satisfactory outcomes.

Objective To investigate the effects of different CO2 pneumoperitoneum pressures on gastric cancer cells' growth and proliferation in nude mouse model of implanted tumor. Methods Human gastric cancer cell lines MNK-45 were exposed under 0、10、12 and 15 mm Hg CO2 pneumoperitoneum for 4 hrs respectively. 2 × 106 processed cells were inplanted into nude mice subcutaneously. Three weeks later, mice were sacrificed and the weight and bulk of the tumor measured. Then we observed the transplantation tumor by HE stain and Ki-67 stain. Results There was no significant difference in tumor's growing time, bulk and weight between 0, 10, 12 mm Hg CO2 pneumoperitoneum groups (7. 8 d, 7. 2 d, 7. 8 d; 1. 2 cm3, 1. 3 cm3, 1. 3 cm3; 1.5 g, 1. 9 g, 1. 6 g)and the control group (7. 3 d, 1. 2 cm3, 1.4 g) (P > 0. 05 ). The growing time of tumor in 15 mm Hg CO2 pneumoperitoneum (12. 5 d) was obviously longer than the control group ( P < 0.05 ) , the bulk and weight of tumor in 15 mm Hg CO2 pneumoperitoneum (0. 5 cm3, 0. 5 g) group significantly decreased compared with the control group (P <0.05). The positive rate of Ki-67 in 15 mm Hg CO2 pneumoperitoneum (27. 5% ) group was obviously lower than the control group (59.6%) (P<0.01). However, there were no significant differences between 0, 10, 12 mm Hg CO2 pneumoperitoneum groups (61.2%, 60.5%, 63.4%) and the control group (P > 0.05). Conclusion Clinically adopted CO2 pneumoperitoneum pressures have no significant effect on gastric cancer cells growth and proliferation.

Objective To investigate the effects of different CO2 pneumoperitoneum on cell cycle and cell cycle protein of a gastric cancer cell line. Methods Human gastric cancer cell line MNK-45 were exposed to 0,10,12 and 15 mm Hg CO2 pneumoperitoneum in vitro for 4 hrs. Cell cycle was measured by flowcytometry, the expression of CDK4 ,Cyclin D1、Rb and pRb was studied by Western-blot, and the binding ability of CDK4 and Cyclin D1 was evaluated by immunoprecipitation. Results The cell proliferation index in 15 mm Hg CO2 pneumoperitoneum group dropped significantly (27.4% ± 3. 7%) vs. (36. 4% ±3. 3%) ,P <0. 05, while that in other groups did not change significantly. The protein of CDK4、Cyclin D1and binding ability of Cyclin D1 and CDK4 dropped dramatically in the 15 mm Hg CO2 pneumoperitoneum group (0.71%±0.12%),(0.93% ±0.21%),(0.54%±0.11%),(0.18% ±0.02%) vs. (1.05% ±0.16%),(1.40% ±0.24%),(0.75% ±0.14%),(0.31% ±0.02%), all P<0.05. There were no changes of Rb in protein levels, while the phosphorylated Rb dropped obviously. Conclusion There was no obvious effects of clinical CO2 pneumoperitoneum on gastric cancer cells growth and proliferation.