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.

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

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.

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 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 evaluate the effect of laparoscopic herniorrhaphy(LHR)for inguinal hernia. Methods From December,1998 to December,2001, 176 patients with inguinal hernia were treated by LHR using laparoscopic purse string to ligate the neck of hernia sac and to place the intraperitoneal mesh.There were 160 patients with indirect inguinal hernia, 15 patients with direct inguinal hernia and 1 with indirect and direct hernia in this series. Results In this series,the mean operation time was 30 minutes, and was no intraoperative or postoperative complications; the hospital stay was 2～3 days. All the patients were followed-up for 10～36 months, only 2 recurrences(1.2%) were found. Conclusions LHR is a new herniorrhaphy which is safe and effective.The advantages of LHR are simple procedure, low complication rate, faster postoperative recovery, low recurrence rate.This operation should be widely adopted.

Objective To compare anesthetic effect and safety of general anesthesia and combined spinal and epidural anesthesia used in autonomic nervous hyperresponsive surgery for patients with paraplegia.Methods 26 paraplegic patients were randomly divided into two groups-control group and treatment group from February 2011 to November,2015,each with 13 cases.The control group used general anesthesia,while the treatment group used combined spinal and epidural anesthesia,to observe onset time,duration,intraoperative hemodynamic changes and complications,Complications,length of stay and cost,Days and costs of hospitalization,satisfaction of patients and their families,of anesthesia in two groups.Results The dosage of narcotics and the onset time of the treatment group were better than that of the control group.The difference between the two groups was significant,and had statistical significance (P＜0.05) Two groups of patients after surgery,diastolic blood pressure,systolic blood pressure and heart rate were lower in the treatment group than in the control group,and had statistically significant difference (P＜0.05);The postoperative complications of the treatment group were significantly better than those of the control group,and had statistically significant difference (P＜0.05);There were statistically significant differences in postoperative pain degree between the two groups (P＜0.05);Two groups of patients in hospital days,hospital costs,satisfaction rate had statistically significant difference,Have statistical significance (P＜0.05).Conclusion In autonomic nervous hyperresponsive surgery for patients with paraplegia,anesthetic effect and safety of combined spinal and epidural anesthesia is significantly better than that of general anesthesia,featured by the rapid onset of action,long duration,fewer complications,strong safety and patients' great satisfaction.It is worth generalizing and applying clinically.