The combination of laparoscopy and gastroscopy makes up the defects of each of them when used alone, and further extends the application range of minimally invasive techniques. A 53-year-old patient with gastric stromal tumor was admitted to the Tenth People's Hospital of Tongji University on March 4, 2011. The result of gastroscopy showed that the tumor was at anterior wall of stomach with a size of 3.0 cm×3.5 cm. the result of CT scan preliminarily diagnosed the patient with gastric stromal tumor. Partial gastrectomy with laparoscopy combined with gastroscopy was applied to the patient on March 9, 2011. The operation time was 32 minutes and the blood loss was 10 ml. The duration of hospital stay was 4 days, and no postoperative complication occurred. Laparoscopy combined with gastroscopy for the treatment of gastric stromal tumor is feasible and safe with a favorable short-term outcome.

As multidrug resistance related genes and cell factors are discovered one after another,people have a more thorough understanding to the oncological mechanisms of cancer metastasis.Many evidences of the inherent link between the two tips have been found.These researches provide new ideas to further clarify the regulation mechanisms between them.It is revealed that the inherent link maybe occur on the gene expression and transcription,and with complicated regulative factors.Indepth study of the relations between cancer multidrug resistance and metastasis will help to guide the clinical treatment of tumor.

ObjectiveTo analyze the risk factors of complications after laparoscopic gastrectomy.Methods The clinical data of 76 patients who received laparoscopic gastrectomy at the Tenth Hospital of Tangji University from April 2009 to July 2011 were retrospectively analyzed.All patients were divided into complication group (13patients) and non-complication group (63 patients).Seventeen variables,including gender,age,abdominal surgery history,comorbidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),palliative operation,operative data ( operation time,blood loss,method of alimentary tract reconstruction),postoperative TNM staging,vascular or nerve invasion and number of lymph nodes dissected were analyzed by using the univariate and Logistic regression analysis to screen out the risk factors of postoperative complications.All data were analyzed using the t test or chi-square test.ResultsThere were 67 patients received laparoscopic curative gastrectomy and 9 received laparoscopic palliative gastrectomy.Sixty-three patients received distal gastrectomy ( including 49 received BillrothⅠgastrectomy and 14 received Billroth Ⅱ gastrectomy) and 13 patients received total gastrectomy + Roux-en-Y esophagojejunostomy).The mean operation time,blood loss,number of lymph nodes dissected were ( 263 ± 72) minutes,( 200 ± 191 ) ml and 17 ±8,respectively.There were 25 patients in TNM stage Ⅰ,18 in stage Ⅱ,27 in stage Ⅲ and 6 in stage Ⅳ.The incidence of complications was high in the old patients,but there was no effect of gender and age on the incidence of complications ( x2 =0.68,2.32,P ＞ 0.05 ).The operation time of the complication group was longer than that of non-complication group,but no significant difference was observed ( t =1.44,P ＞ 0.05 ).Preoperative comobidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),blood loss and number of lymph node disseeted were not the risk factors of postoperative complications ( x2 =3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P ＞ 0.05).The results of multivariate Logistic regression analysis showed that Billroth Ⅱ alimentary tract reconstruction,more comorbidites,and advanced TNM stage were correlated with postoperative complications ( OR =5.54,7.02,2.33,P ＜0.05 ).The accuracy rate of multivariate Logistic regression analysis was 8 i.6％.Conclusion Billroth Ⅱ alimentary tract reconstruction,more comorbidities,and advanced TNM stage are the independent risk factors of complicatioas after laparoscopic gastrectomy.

Dieulafoy lesion are usually located in the stomach but can also occur in the small or large intestines. It is an uncommon but significant source of massive upper gastrointestinal hemorrhage. A female patient with Dieulafoy lesion was admitted to the Tenth People's Hospital of Tongji University on June 2, 2009. The site of the lesion was diagnosed at the anterior wall of stomach with a bleeding vessel in the center. The size of the lesion was about 1.0 cm×1.0 cm. Partial gastric resection was successfully performed using laparoscopy and endoscopy. The lesion was demarcated by gastroscope, and then it was hung up and removed by laparoseope. Bowel movement recovered at the second day, and the patient was discharged 6 days after surgery. The patient was followed up for 1 month, and no recurrent hemorrhage or other complications were observed. The combined approach of laparoscopy and endoscopy not only resects the lesion completely and widens the scope of minimally invasive surgery but also decreases the risk of operation.

Objective To overcome disadvantage of double stapler technique in anterior resection of rectum.Method Using single stapleris combined with suture by hand.Results There is no fistula and no death in 52 cases of patients with carcinoma of middle rectum with above methods,and there is 4 fistula and no death in 41 caces of patients with carcinoma of middle rectum using suture by stapler(P

Objective To develop the job burnout scale for military personnel and examine the reliability and validity of this scale. Methods A total of 1000 military personnels were chosen by random cluster sampling to outline the Job Burnout Scale for Military Personnel, with the subjects divided into group A and group B, 280 of them were tested by this scale and Chinese Maslach Burnout Inventory simultaneously (CMBI), In group A ( n=500 ) Exploratory Factor analysis and Correlation analysis were used, and in group B ( n = 500) Confirmatory factor analysis was used. Results The results of correlation analysis indicated that the Cronbach'α of total scale was 0.917, and that of subscales was 0.719 ～ 0.847; split-half reliability coefficient of total scale was 0.920, and that of subscales was 0.723 ～ 0.867. The correlation coefficient of total scale scores and each factor was 0.731 ～ 0.808 (P＜0.01 ) ,and the correlation coefficient ranged from 0.386 to 0.627 between the factors(P ＜ 0.01 ). According to the results of exploratory and confirmatory factor analysis, the sample data fitted better to the hypothesized structure of theoretical model ( Sense of achievement, Somatization, Self-assessment, Human relation, Demotivation) and the indexes of Chi-Square was 771. 914, the degrees of freedom was 395, the probability level was 0.000, the relative Chi-Square was 1.954, the root mean square error of approximation (RMSEA) was 0.044, and the goodness of fit index ( GFI ), comparative fit index ( CFI ), incremental fit index ( IFI ) were 0.904,0.919, 0.920 respectively. The correlation was significant between this scale and CMBI. Conclusion The Job Burnout Scale for Military Personnel has good reliability and validity.

Objective To investigate the effect of zerumbone on the proliferation and apoptosis of human pancreatic cancer cell line PANC1 and its possible mechanism.Methods Zerumbone of various concentrations (3.75, 7.5, 15, 30, 60 μg/ml) were used to treat PANC1, and cells without treatment were used as control.CCK-8 assay was used to detect the inhibitory rate of cell proliferation.Cell apoptosis analysis was determined by using Hoechst 33342 staining and flow cytometry.Western blotting was performed to evaluate the phosphorylation Statl ( p-STAT1 ), and Bax and Bcl2 protein expression.Results Zerumbone caused a time- and dose-dependent reduction of cell viability in PANC1 cells.After 48h treatment of Zerumbone of 15 μg/ml, cells inhibitory rate was increased to (72.8 ± 2.72 )%, and classic apoptosis morphology was observed, with apoptosis rate was 14.2%.At the same time, p-STAT1, and Bax protein expression was significantly increased (0.654 ±0.048 vs 0.074 ±0.011, 0.577 ±0.044 vs 0.218 ±0.027,P＜0.05);Bcl-2 protein expression was significantly decreased (0.162 ± 0.029 vs 0.459 ± 0.034, P＜0.05).Conclusions Zerumbone may inhibit the proliferation of PANC1 cells and inducing cell apoptosis,which may be related to the up-regulation of STAT1's activity and Bcl-2/Bax ratio.

Objective To investigate the protective effect of rosiglitazone on acute necrotizing pancreatitis (ANP) associated lung injury in rats.Methods Seventy-five male Wistar rats were randomly divided into sham operation group (SO group),acute necrotizing pancreatitis group (ANP group) and rosiglitazone pretreatment group (ROSI group).ANP model was induced by retrograde infusion of 5％ sodium taurocholate into the biliopancreatic duct.Thirty minutes after ANP induction,ANP groups were injected with 10％ DMSO (0.2 ml/100 g) through femoral vein,and ROSI group were injected with ROSI dissolved with 10％ DMSO (6 mg/kg) through femoral vein,while SO group was injected with normal saline,and 30 minutes later was injected with same amount of 10％ DMSO.Rats were sacrificed at 3 h,6 h and 12 h after the operation.Serum amylase and lung wet/dry weight ratio (W/D) were measured,lung tissues were harvested for pathologic examinations.STAT1 protein and phosphorylation-STAT1 protein (p-STAT1) expression were detected by Western blot.Results The serum levels of amylase,lung W/D,pathologic score of lung tissues in ANP group were increased with time,and reached the peak at 12 h,which were (5017 ± 203)U/L,3.12 ±1.30,(3.33 ±0.18) score,and these were significantly higher than those in SO group (P ＜ 0.05 or 0.01),the expression of STAT1 protein was not statistically significant,but the expression of p-STAT1 reached the peak at 3 h (5.23 ± 0.03),then it gradually decreased,but it was still significantly higher than that in SO group (0.16 ± 0.04,p ＜ 0.01).The serum levels of amylase,lung W/D,pathologic score of lung tissues in ROSI group at 12 h were (1912 ± 164) U/L,1.83 ± 1.26,(2.78 ± 0.16),which were significantly lower than those in ANP group (P ＜ 0.05).The expression of STAT1 protein was not statistically significant,and the expressions of p-STAT1 at 3 h,6 h,12 h was 0.41 ±0.04,0.22±0.05,0.15 ±0.03,which were significantly lower than those in ANP group (P ＜ 0.05).Conclusions Rosiglitazone has the protective effect on ANP associated lung injury by inhibition of phosphorylation-STAT1 protein expression in the early phase.

Objective To investigate the prevention and management of anastomotic leakage in patients with middle and lower rectal cancer after neoadjuvant therapy.Methods In this study,50 cases of middle or lower rectal carcinoma underwent anus preserving radical resection and anastomosis after a 4 cycles of chemotherapy with FOLFOX and 46 Gy(2 Gy×23)radiotherapy.Anastomotic leakage,the prevention and management of this complication were analyzed retrospectively.Results All these 50 patients received low anterior resection after chemoradiotherapy,among the 19 cases receiving prophylactic ileac stoma simultaneously,there was no anastomotic leakage,whereas anastomotic leakage developed in 4 out of the 31 patients who did not receive prophylactic ileac stoma,including concomitant rectovaginal fistula in 2 cases.All these fistulae were cured conservatively.Conclusion Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer could increase the rate of anal interior sphincter reservation,prophylactic ileac stoma helps to reduce the rate of anastomotic leakage after a anus-preserving low anterior resection of the cancer.

Objective To evaluate the clinical and pathological characteristics and risk factors of the prognosis of Cardia cancer.Methods Clinical data of 52 cases of cardiac cancer patients who were treated by surgery and follow-up data were collected from June 2009 to August 2011.Factors influencing the prognosis of the patients were analyzed by univariate and multivariate analysis.Results The survival rates in 1,2,3years were 73％,54％,46％.Single factor analysis showed that there was a significant correlation between T stage,N stage,TNM stage,classification Siewert,MSLN and venous invasion.Stepwise Cox proportional hazard model showed that T stage,N stage and MSLN were independent risk factors.Peritoneal and liver were the main way of recurrence and metastasis.Peritoneal metastasis was related to T stage and lymph node invasion,while the liver metastasis was related to MSLN.The survival curves of patients with Kaplan-Meier showed that the survival period of patients with liver metastasis and peritoneal metastasis was significantly shortened.Conclusion Standardization of lymph node cleaning is a key factor affecting prognosis,D2 surgery should be an operation standard in cardia cancer.