With the standardization and promotion of laparoscopic technology,totally laparoscopic radical gastrectomy(TLRG) has been applied widely.The main difficult points of TLRG focus on digestive tract reconstruction.The common methods of digestive tract reconstruction in TLRG include circular stapler,linear stapler and manual suture.Compared with the circular stapler method and manual suture method,the linear stapler has the advantages of simple operation,better field of vision and larger caliber of anastomotic stoma.This article introduces and evaluates the common anastomotic methods of digestive tract reconstruction with linear stapler in TLRG.

Objective To investigate the diagnosis and treatment of cystic adenoid tumor of the pancreas. Methods Retrospective analysis was made on the clinical data of 11 cases of pancreatic cystic neoplasms confirmed by operation and pathology at our hospital from 1978 to 1998. Results Cystic adenoid tumor of the pancreas is more likely to occur in young females with middle age, clinical presentations were as follows: a long-term persistent mass and distending pain in the epigastrium. Utrasounography, CT and ERCP could contribute to the diagnosis. Of the 11 cases, pancreaticoduodenectomy was performed in 2, distal pancreatectomy and splenectomy in 6, local excision of the mass in 2, and loop type cystojejunostomy in 1. The rete of resection was 90.9%. Of them, 1 case died of abdominal abscess and septicemia postoperatively. All the 10 cases who survived postoperatively were followed up. Among the 10 cases, 1 case of pancreatic cystoadenoma died of cardiac infarction 3 months after operation, and 1 case of cystoadenocarcinoma died of metastasis 51 months after tumor excision. The other 8 cases still alived well now. Conclusions Cystic tumor of the pancreas should be suspected when young or middle aged female patients have a long term big mass in epigastrium or left upper quadrant. Ultrasonography and CT scan are helpful in the diagnosis of the tumor including cystoademoma and cystoadenocarcinoma, Although the volume of the tumors may be very big, they often have a intact capsure,so easy to excise. The excision of the total tumor and some arounding pancreatic tissue is the first choice of the treatment for cystic tumor of the pancreas, and the curative effectiveness is satisfctory.

Objective To study the method and significance of preserving anterior thoracic nerve(ATN) and intercostobrachial nerve(ICBN) during breast-conserving operation for breast cancer.Methods A total of 382 cases with breast-conserving operation for breast cancer in recent 5 years were reviewed.In 312 cases the opeeration was performed by preserving ATN and ICBN,and in 70 cases the ATN and ICBN were not preserved.The patients were followed-up postoperatively.Results Among the patients whose operation was performed by preserving ATN and ICBN,skin sensation of armpit and upper arm was normal in 80.4%(251/312) and abnormal in 19.6%(61/312) of patients,but in most of them,it recovered in 2-3 months.Among the patients with out preservation of ATN and ICBN,skin sensation was normal in only 16 cases(22.9%),and had varying degrees of abnormal sensation in 54 cases(77.1%).Conclusions Preservation of ATN and ICBN during breast-conserving surgery for breast cancer is feasible,can decrease the incidence of hypoesthesia of axilla and upper arm and atrophy of pectoralis muscles,and the quality of life of patients after operation is improved.

BACKGROUND: Kadsurenone is characterized by obvious anti-oxidation and calcium ion resistant effect and can effectively clear oxygen-derived free radicals, decrease activity of pancreatic enzyme, and relieve self-digestion of pancreatic tissue.OBJECTIVE: To observe the effects of kadsurenone on the splanchnic blood flow in rats with severe acute pancreatitis (SAP), especially the mechanism of pancreatic blood flow.DESIGN: Contrast observational animal study.SETTING:Laboratory of General Surgery and Central Laboratory of Tangdu Hospital, the Fourth Military Medical University of Chinese PLA.MATERIALS: A total of 40 male Sprague-Dawiey (SD) rats, of clean grade and weighing 200-280 g, were selected in this study. Kadsurenone (150 mg) was provided by Pharmacological College of Peking University (batch number: 20050347); sodium taurocholate by Sigma Company (batch number: 86339); amylase reagent by Roche Company (batch number: irp 170505); Imexlab9100 Doppler ultrasound diagnostic meter by Imex Company; 8 mHz probe privated by Doppler ultrasound diagnostic meter by Imex Company, USA (number: X1-M0008).METHODS: The experiment was carried out in the Laboratory of General Surgery, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from April to October 2006. Eight rats were randomly selected as sham operation group, and other rats were used to establish SAP models at 12 hours after fasting. Continuously, 32 SAP rats were randomly divided into two subgroups after model establishment, including kadsurenone group (n =16) and model group (n =16). In addition, all rats in the two subgroups were observed at 12 and 24 hours after operation with 8 rats at each time point. However, rats in the sham operation group did not give any treatment. At 3 hours after operation, rats in kadsurenone group were given 10 mg/kg kadsurenone through jejunum fistula once every 6 hours for one or two times in total. Kadsurenone was dissolved in 25 g/L dimethyl sulfoxide. In addition, rats in model group were given the same dosage of dimethyl sulfoxide through jejunum fistula; furthermore, rats in sham operation group were only opened their abdomens. Blood starch was respectively measured in sham operation group at 12 hours after abdominal operation, model group at 12 hours and kadsurenone group at 24 hours after acute pancreatic operation; meanwhile, Doppler ultrasound was used to detect local artery of pancreas (relative to the crossed site between head and body of pancreas), blood flow of portal vein, splenic artery and blood flow of superior mesenteric artery.MAIN OUTCOME MEASURES: Changes of plasma amylase and blood flow at various time points.RESULTS : All 40 SD rats were involved in the final analysis.①Measuring results of plasma amylase: Level of plasma amylase was increased in both model group and kadsurenone group at various time points as compared with that in sham operation group (P＜0.01 ). With the time passing by, level of plasma amylase was still increased in model group, and there was significant difference from that at 12 hours after operation (P＜0.05). ②Blood flow of local pancreatic artery: At 12 and 24 hours after operation, blood flow was lower in kadsurenone group and model group than that in sham operation group (P＜0.01). With the development of illness course, blood flow was still decreased in kadsurenone group (P＜0.05); however, blood flow was obviously higher than that in model group at various time points (P＜0.01 ). ③ Blood flow of superior mesenteric arterial root, portal vein and splenic artery: Blood flow was lower in kadsurenone group and model group than that in sham operation group at 12 and 24 hours after operation, respectively (P＜0.01). In addition, blood flow was remarkably increased in kadsurenone group as compared with that in model group at various time points (P＜0.01).CONCLUSION: Kadsurenone can increase the pancreatic blood flow and relieve pathological injury in SAP rats.

Objective Discussed the efficacy of applying standardized patient in clinical surgical practice teaching.Method Twenty eight-year-medical students in our college were enrolled and students' theoretical knowledge mastering ability,students' evaluation on the teaching and students'clinical ability were surveyed.Result Students' score significantly increased compared to last year scores (P ＜0.01).100％ of the participants found the SP teaching methods can increase the interest in learning; 90％ of students found the SP as a guide to better grasp the teaching content; 95％ of students found the SP teaching methods can improve the ability to communicate with patients.Conclusions The class atmosphere was improved,students' enthusiasm was activated,students' clinical ability was promoted and satisfactory teaching effect was obtained after applying standardized patient.

Objective To study the expression of Paxillin and VCAM-1 in esophageal carcinoma and the relationship between the expression of Paxillin, VCAM-1 and carcinogenesis and progression of esophageal carcinoma. Methods Paxillln and VCAM-1 expression were detected in 24 normal esophageal mucosa and 94 primary tumor tissues with SP immunohistochemistal method. Results The expression rate of PaxiUin was related to invasive depth (P <0.01) ,clinical staging (P <0.01) and metastasis of lymph node (P <0.05). The expression rate of VCAM-1 was related to invasive depth (P < 0.01) ,clinical staging (P < 0.01) and metastasis of lymph node (P<0.05). There was a positive correlation between Paxillin and VCAM-1 expression in this study (r = 0. 247 ,P < 0.05). Conlusion Paxillin and VCAM-1 are over expressed in esophageal carcinoma. They can be used as valuable biomakers to evaluate biological characteristics in esophageal carcinoma.

Objective To study the expression of PI3K and MMP-7 in esophageal carcinoma and the rela-tionship between the expression of PI3K and MMP-7 and carcinogenesis and progression of esophageal carcinoma. Methods PI3K and MMP-7 expression were detected in 24 normal esophageal mucosa,94 primary tumor tissues with SP immunohistochemistal method. Results There were significant differences of PI3K and MMP-7 expressions between esophageal carcinoma and normal mucesa epithelium ( all P < 0.01 ) [71.28% (67/94) vs 4.17% ( 1/24 ) and 52.13% (49/94) vs 0% (0/24)]. There were significant correlations between PI3K expression and the degrees of differentiation,invasive depth,clinical staging and the metastasis of lymph node (all P <0.01 ). The positive ex-pression rate of MMP-7 had the relationship with metastasis of lymph node (P < 0.05 ), the degrees of differentiation ( P < 0.05 ) invasive depth ( P < 0.01 ), and clinical staging( P < 0.05 ) . There was a positive relationship between PI3K and MMP-7 expression in this study (r = 0. 232 ,P = 0.025). Conlusions PBK and MMP-7 play an impor-tant roles in carcinogenesis and progression of esophageal carcinoma and can be used as valuable biomarkers to eval-uate biological characteristics in esophageal squamous cell carcinoma.

Objective To establish a method of inducing dendritic cells(DC)from rat bone marrow cells in vitro,and identify the phenotype and function characteristics.Methods The rat bone malToW cells were collected and cultured in vitro under the condition of recombinant rat GM-CSF(rrGM-CSF)and recombinant rat IL-4(rrIL-4).After 2 weeks,the morphological character of DCs was observed under light microscope and scanning electron microscope.Expression of MHC-Ⅱ,CD80 and CD86 were detected by flow cytometry.The ability to stimulate allogenic T cells of the cultured DCs was detected by mixed lymphocyte reaction.Results DCs showed typical morphology with elongated dendritic processes under inversion microscope and scanning electron microscope.DCs at day 6 revealed immature phenotype,including MHC-Ⅱ(29.03 ±4.39)%,CD80(21.98±7.08)%and CD86(25.94±6.80)%.DCs at day 12 showed higher expression of MHC-Ⅱ(74.05±5.97)%,CD80(79.85±6.53)%and CD86(81.00±7.47)%,and stimulatory capacity of allogenic T cells,compared with that in DCs at day 6.Conclusion Matured DCs could be generated from rat bone marrow cells and attendance with rrGM-CSF and rrIL-4,which present the feasibility for further research on its application to allograft immunorejection.

Objective To analyze the correlation between apolipoprotein E(ApoE) gene polymorphisms and the incidence rate of chronic cardiovascular disease as well as the blood lipid levels of patients.Methods ApoE gene polymorphism and lipid levels were measured by suing gene chip analysis system and biochemical analyze in 1 414 cases of chronic cardiovascular disease patients(experimental groups) and 374 cases of healthy subjects(control group).Results Compared with control group,E3/4 genotype frequency was increased in experimental group,while E2/E3 genotype frequency decreased(P<0.05).Compared with control group,the levels of total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-C) were obviously increased and the level of HDL-C was decreased in experimental group(P<0.05).Compared with patients with E2/E3 genotype,the level of HDL-C in patients with E3/E4 genotype was decreased and the levels of TC,LDL-C were increased significantly(P<0.05).Proportions of different ApoE genotypes in patients with cerebral infarction,cerebral hemorrhage,hypertension,coronary heart disease,type-2 diabete and fatty liver were different.Compared with the E2/E3 genotype,the proportion of the E3/E4 genotype in patients with cerebral infarction,cerebral hemorrhage,hypertension,coronary heart disease,type-2 diabete and fatty liver were increased(P<0.05).Conclusion ApoE gene polymorphism might be important cause of the individual difference of lipid levels and a risk factor for the occurrence and development of chronic cardiovascular diseases.

Objective To investigate the distribution characteristics of serum hepatitis B virus (HBV) markers of population in hospital and to provide the basis for prevention and control of virus B hepatitis .Methods 11 210 people in hospital who had accepted HBV serological testing were enrolled ,and were divided into >0 -25-year old group(n=3 553) and >25 -50-year old group(n=7 651) according to their ages .Enzyme-linked Immunosorbent Assay(ELISA) and Roche Cobas E601 Automatic Electro-chemiluminescence immunoassay analyzer were employed to detect serum HBV surface antigen (HBsAg ) ,anti-HBV surface anti-body(HBsAb) ,HBV e antigen(HBeAg) ,anti-HBV e antibody(HBeAb) and anti-HBV core antibody(HBcAb) .Results HBsAg positive rates of subjects in > 0 -25-year old group and > 25 -50-year old group were 16 .16% and 21 .19% ,respectively .The overall positive rates of HBsAg and HBsAb and full-negative rate were 19 .59% (2 195/11 204) ,37 .02% (4 148/11 204) and 11 .84% (1 327/11 204) ,respectively .Conclusion Distribution characteristics of HBV markers of population in hospital may pro-vide a reliable basis for taking effective protective and control measures against virus B hepatitis .