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.

Objective To investigate the relationship between metabolism syndrome (MS) and fatty liver. Methods Plasma lipids, plasma glucose, liver function, blood pressure, body height and body weight were determined in 666 leaders receiving physical examination. Their livers were also examined by ultrasound. Whit analysis of variance and chi-square test, the effect of plasma lipids, plasma glucose, blood pressure, and weight index on fatty liver, and the relation between MS and fatty liver were analyzed. Results The weight index, systolic pressure, diastolic pressure, and the levels of total cholesterol, triglyceride, apolipoprotein B and plasma glucose in the patients with fatty liver were higher than those in healthy subjects. The levels of high-density lipoprotein and apolipoprotein A were lower in patients with fatty liver than those in healthy subjects. The morbidity of fatty liver in the patients with MS was higher than that in healthy subjects. Conclusion There was a close relation between MS and fatty liver. It was necessary to early treat MS.

Objective To investigate hemodynamie change in uremia complicating heart failure of elderly patients. Methods Totally 241 cases with uremia complicating heart failure received measurement of circulation dynamic detection(CD).The volume load,myocardial contractility and blood pressure were analyzed in the elderly group aged(71±6)years (n=116) and young and middleaged group aged(38± 10)years(n =125). Results The central venous pressure(CVP)[(26.7±11.3)cmH2O vs.(23.6 ± 10.7) cm H2O,t=2.410,P =0.010],effective circulation volume (ECV)[(4362± 1340)ml vs.(3085 ± 1001 ) ml,t =7.674,P =0.000],stroke volume(SV) [(185 ± 52) ml vs.(114±41)ml,t=7.803,P=0.000],cardiac output (CO)[( 13.9±4.3)L/min vs.(11.2±3.6)L/min,t=4.802,P=0.000],left ventricular end diastolic volume (LVD)[(388± 145)ml vs.(258±98)ml,t =7.673,P =0.000],left ventricular end systolic volume ( LSV ) [( 223 ± 95 ) ml vs.( 135 ± 59) ml,t =7.186,P=0.000] were significantly higher group than in young and middle-aged group.The ejection pressure (EP)[(178±29)mm Hg vs.(183±24)mm Hg,t=2.323,P=0.012],myocardium negative inotropic(MNC) [(0.609±0.149)vs.(0.683±0.188),t=3.113,P=0.002],ejection fraction (EF) [(0.433± 0.034) vs.(0.445 ± 0.031 ),t =2.451,P =0.010],diastolic blood pressure (DBP) [( 87 ±14)mm Hg vs.(1.08±22)mm Hg,t=8.141,P=0.000],systematic vascular resistance(SSR)[(952±207)gcm-4 s-2 vs.(1217± 308) gcm-4 s-2,t =7.143,P=0.000],ejection resistence(ER) [( 178± 29)vs.( 183 ± 24),t =2.323,P =0.012] were lower in elderly group than in young and middle-aged group.DBP(x2 =16.474,P=0.000,OR=0.752,95％CI:0.714-0.790),SBP(x2 =11.913,P=0.000,OR=1.148,95％CI:1.091-1.205),ER(x2 =17.892,P=0.000,OR=0.906,95％CI:0.861-0.951),CVP(x2 =14.672,P=0.000,OR=0.698,95％CI:0.663-0.733) and LDV(x2 =21.080,P=0.000,OR=0.942.95％ CI:0.895-0.989) were dangerous factors of uremia complicating heart failure.Conclnsions The increased volume load,decreased myocardial contractility and cardiac afterload may appear in the elderly patients with uremia complicating heart failure.

Objective To analysis the effect of compound betamethasone injection combined with radiation on keloid in frontal facial region. Methods 60 cases of keloid patients in zhejiangprovincial people's hospital from January 2014 to January 2016 were selected,all patients were treated with surgery,the patients were randomly divided into observation group and control group,30 cases in each group,radiotherapy was used in the control group,the observation group was treated with local injection of compound betamethasone on the basis of the control group,the therapeutic effects, pain scores, adverse reactions and complications were compared between the two groups. Results The recurrence rate of the observation group was 3.33% which was significantly lower than that of the control group 10%,the improvement rate of the observation group 93.33% was significantly higher than the control group 80%,the difference was statistically significant (P<0.05).one,two and three months after operation,the pain scores in the observation group were significantly lower than those in the control group at the same time point,the difference was statistically significant (P<0.05).The adverse reaction rate was 6.66% (2/30) in the observation group and 23.33% (7/30) in the control group, there was no significant difference between the two groups.The incidences of skin sag, pigmentation, incision delayed union and telangiectasia in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Compound betamethasone injection combined with radiation on the frontal facial keloid patients with significant effect,can significantly reduce the recurrence rate,improve the rate of improvement,reduce pain and complications in patients.

Aim To search the effective malaria mixed gene vaccine and to explore the immune response of vaccinated host. The recombinant pcDNA3-EBA175/HRP Ⅱ was injected alone or mixed with pcDNA3-Pfs25 of Plasmodium falciparum into mice by intramuscular route. The muscle of injected parts were treated previously, e.g. injecting 50μl of 0. 5％bupivacaine into the muscle of left latter leg, with 2mm depth. To observed the changes of IgG antibody value, the splenic lymphocyte proliferation, the ratio of CD4+/CD8+ subgroups and NK cell killing activity. After injecting recombinant pcDNA3-EBA175/HRP Ⅱ alone or mixed with pcDNA3-Pfs25 into mice by intramuscular route, it showed that sera IgG value increased, the splenic T lymphocyte proliferation stimulated by specific antigen of Plasmodium falciparum increased, the ratio of CD4+/CD8+ decreased and NK cell activity increased. Enhanced immune injection could improve host's immune reaction.It is suggested intramuscular injection is an effective immune route, and mice inoculated with coding two gene recombinant alone or that mixed with sexual stage gene recombinant could all induce increased humoral and cellular immune response, and NK cell activity.

Objective:To evaluate the effects of surface modification with different concentration silica sol through sol-gel processing on bond strength between dental zirconia ceramic and resin cement. Methods:Silica coating was prepared by colloidal silica sol with concentrations of 20%,30%,40% on dental Zirconia ceramic. 32 discs zirconia ceramic specimens were fabricated and randomly divided into four groups respectively after polishing and sandblasting.The ceramic surfaces of different groups were received different treatments:(1)silane couple agent;(2)20% silica coating and silane couple agent;(3)30%silica coating and silane couple agent;(4) 40% silica coating and silane couple agent. Each ceramic block was bonded to light curing composite resin. All samples were stored in distilled water at 37 degrees for 24 h before a shear bond test to measure the bond strength of the resin cement to the ceramic surface. Scanning electrical microscopy (SEM) and energy depressive spectrum (EDS) were used to analyze the silica coating. Results:Contents of surface silicon increased after modification with silica coating prepared by sol-gel method. Bond strengths of groups with silica coating were significantly higher(P

Surgical resection and liver transplantation are still the preferred treatments for patients with hepatocellular carcinoma (HCC).For the patients with advanced HCC which are not suitable for surgical resection,traditional chemotherapy can not improve the prognosis.Molecular targeted therapy is a new method and tendency in the treatment of HCC.Multiple targets inhibitors,vascular endothelial growth factor inhibitors and monoclonal antibodies for HCC are widely researched and applied.

Objective To study the value of microwave coagulation therapy for liver malignant tumors.Methods Under local anesthesia,19 cases with hepatic malignant tumors treated with microwave knife under CT-guided.Results There were totally 23 tumors in 19 cases,13 tumors with≤3.5 cm in diameters were destroyed absolutely after the first treatmet,10 tumors among them were followed-up for 6-12 months and no recurred.10 tumors with＞3.5 cm in diameters treated at multiple points or angle,3～6 months later,CT showed that the tumors were destroyed completely in 6 and mostly in 4,by the hot condensate treatment secondly,3 tumors of 4 were destroyed completely 3 months later.There were no obvious complications.Conclusion The therapeutic effect under CT-guided microwave coagulation therapy for liver tumor which are ≤3.5 cm in diameter of the tumors is very reliable,the tumors＞3.5 cm in diameter can be destroyed mostly or completely by microwave treatment.

Objective To investigate the resistant mechanism of carbapenem-resistant Escherichia coli and its relationship with endogenous infection. Methods Two carbapenem-resistant Escherichia coli strains were isolated from blood and stool of a same patient, respectively. The minimal inhibition concentrations (MIC) of the two isolates against imipenem and meropenem were determined by E-test. The susceptibility against other antimicrobial agents were done by disc diffusion method. Isoelectric focusing electrophoresis (IEF), polymerase chain reaction (PCR) amplification,cloning and sequencing, conjugation, Southern blotting were carried out to analyze the encoding gene of β-lactamases. Homology analysis of the two strains was done by pulsed field gel electrophoresis (PFGE). Results MIC against imipenem and meropenem of the two strains were both≥32 mg/L.Both strains produced KPC-2 (pI 6.7) and SHV-12 (pI 8.2) β-lactamases. blaKPC2gene was located on a 54 kb transferable plasmid. PFGE showed that the two Escherichia coli strains were derived from the same clone. Conclusions The resistance and enzyme digestion map of chromosome DNA of the two Escherichia coli strains are coincident. The Escherichia coli septicemia of this patient is probably an endogenous infection caused by the immigration of Escherichia coli from the gut.

Objective To analyze the relation of hypermethylated secreted frizzled-related protein 2 (SFRP2) gene in feces and peripheral blood of colorectal cancer(CRC) patient with Dukes stages and histological types,and to evaluate SFRP2 gene for screening and judging the pathogenetic condition of CRC.Methmls Methylation-specific PCR assay was performed to analyze SFRP2 gene promoter methylation status in a blinded fashion in tumor tissues,stool and pefipheral blood samples taken from 169 CRC patients,63 patients with adenoma,46 with hyperplastic polyp and 30 endoscopically normal subjects.Results SFRP2 gene Was hypermethylated in 88.2%.65.1%and 45.7% of CRC.adenoma and non-adenomatous polyp tissues,in 84.0%,46.0% and 32.6%of corresponding fecal samples,and in 66.9%,6.4%and 2.2% of corresponding peripheral blood samples,respectively.In contrast,no methylated SFRP2 gene was detected in mucosal tissues and peripheral blood of normal controls,while two cases of matched fecal samples from normal controls were detected with hypermethylated SFRP2.Moreover,no significant correlation were observed between SFRP2 hypermethylation and clinicopathological features including sex,age,size,location and Dukes stage,but there was a significant correlation between SFRP2 hypermethylation and tumor difierentiation and infiltration.SFRP2 hypermethylation in peripheral blood of CRC patients was positively correlated with the Dukes stage. Condusions Hypermethylation of SFRP2 gene in feces works as a molecular biomarker for CRC screening.The hypermethylation of SFRP2 gene is positively related with Dukes stage.