Gastrectomy with D2 lymphadenectomy is considered as the standared operation to treat gastric cancer by the major of experts at home and abroad.Laparoscopic gastrectomy with D2 lymphadeneetomy is safe,feasible, minimally invasive and can achieve the same result of abdominal opening.This article is a review to summarize the overview,necessity and feasibility,the indication,the points for attention in operation,preoperative evaluation, complication,the result and the perspect about lapamscopie gastrectomy with D2 lymphadenectomy.

Colorectal cancer is one of the most common malignant tumor with high mortality rate.About a third of patients with colorectal cancer have either simultaneously or metachronous liver metastasis with poor prognosis.Therefore,the studies on the mechanisms of colorectal liver metastasis is significant.Recently,the research on the molecular mechanisms of colorectal liver metastasis is increasing,this paper summarizes some of them,and we hope providing new ideas for the diagnosis and treatment of colorectal cancer patients with liver metastasis.

Gastric cancer is one of the most common gastrointestinal malignant tumor in our country,with the continuous development of minimally invasive surgical technology,laparoscopic radical gastrectomy has gradually been developed,but whether CO2 pneumoperitoneum can cause peritoneal metastasis remains controversial.This article has synthesized the recent reports to illustrate the influence of Heat-CO2 pneumoperitoneum on adhesion molecules,and introduce the latest viewpoint of adhesion molecules affect gastric cancer metastasis.This article can provide clues to evaluate the clinical application value of Heat-CO2 pneumoperitoneum.

Gastrointestinal neuroendocrine tumor is a group of heterogeneous tumors and was considered as a rare tumor.According to the data of recent years,its incidence has been increased significantly.The clinical manifestations of gastrointestinal neuroendocrine tumors are varied,and serum chromogranin-A is considered the most important biomarker of both non-functioning and functioning neuroendocrine tumors.The traditional imaging examination and somatostatin receptor scintigraphy are helpful to diagnosis.Its treatments include surgery,biological treatment,radionuclide therapy and chemical therapy.The aim of this paper is to summarize briefly the clinical symptoms,diagnostic methods and treatment options of gastrointestinal neuroendocrine tumors.

With the increasing confrontation between doctors and patients and the increasing number of medical conflictions, case reports, as convincing evidence, have played a more and more important role. How to improve medical students’ capability of writing case reports and avoid the occurrence of some medical conflictions turns out to be a problem that has to be solved. This article makes a tentative exploration in this respect.

Objective With the increasing number of medical disputes,it is urgent to train the interns'skills. Methods Interns improved their doctor-patient communication skills by enhancing awareness on the doctor-patient communication,learning a variety of medical laws and regulations,improving clinical skills,training good medical ethics to master some communication skills. Results Through such training,medical disputes due to interns never happened during the internship period. Conclusion Our training program is practicable.

Objective To investigate the expressing of Ki-67 in breast cancer tissues and explore the relationship between it and the clinic pathology characteristics.Methods Immunohistochemical SP was used to investigate Ki-67,ER,PR,C-erbB-2 expression in 120 cases of female breast cancer.Analysis the relatiouship between Ki67 and ER,PR,C-erbB-2,tunor size,lymph node metastasis,patients age,menstruation state and clinic pathology characteristics.Results Six cases' Ki-67 expression in 120 eases of female patients with breast cancer tissue were (-) (5％),36 cases' ki-67 expression were (+) (30％),31 cases Ki-67 Expression were (+ +)(25.83％),37 cases' Ki-67 expression were (+ + +) 39.17％.The expression of ki-67 did not correlate with the expression of C-crbB-2,tumor size,lymph node metastasis,patients age and menstruation state(P ＞0.05).The expression of ki-67 correlate with hormone receptor status and histology pathology classification.Conclusion Ki-67 cannot serve as an important index of evaluating prognosis of breast cancer and to guide clinical treatment.

The adipokines is a class of active substances secreted by adipose tissue,with the function of regulating the body glucose balance and others.Some experiments prove Roux-en-Y gastric bypass postoperative plasma levels of adipokines will change that play an important role in improving islet function in the treatment of type 2 diabetes mellitus.Here,the author will make a review about the adipokines role in pathways and postoperative level changes,etc,in order to further explore the mechanism of the surgical treatment of diabetes.

Objective To clarify mechanism of Roux-en-Y gastric bypass (RYGB) and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass (RYGB) group (group RYGB, n=10), gastric banding group (group GB, n=10 ), diet control group (group F, n=10), control group (group C,n= 10). The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding(GB) descended to (12.6±3.7) mmol/L, the fasting plasma insulin rose to (58.7±9.2) mIU/L, the fasting plasma leptin descended to (14.6±3.3) pg/ml, the weight was (212.6±15.1) g.There were significant differences between before and after operation on 16 th week(P<0.01). The fasting blood glucose of the group of Roux-en-Y (RYBG) descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to (148.6±7.3) ng/L, the fasting plasma insulin rose to (14.1±3.5) pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was (200±15.1) g. There were significant differences between before and after operation 16 th week (P<0.01). There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation (P<0.05). Compared the weight of the group F and the group C on the third week of operation, there were significant differences (P<0.05), and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.(P<0.05). Conclusions The fasting blood glucose and the fasting insulin level of the group F improve more than of the group GB at the same time. The plasma insulin and the plasma leptin of the two groups all work in glucose control. The diet control and the modification of the plasma insulin and the plasma leptin all play a major role in the gastric banding mechanism, and the IGF-1 may work in the descending the blood glucose after the operation of Roux-en-Y. In the operation time and die rate, the group of F surpass the group of GB.

Special weight has been laid on young teachers in the buildup of teaching staff in medical universities.Aimed at promoting their active and creative involvement in exploring their potentials and helping them develop into qualified teachers in the current new era,this article performs some tentative research on approaches to their self-improvement.