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 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.

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 observe the expressions of NMDAR2 and GLAST in the hippocampal gyrus and supraoptic nucleus(SON) under sleep deprivation in young rats.Methods: The changes in expressions of NMDAR2 and GLAST in SON and hippocampal gyrus under sleep deprivation in younger rats were observed by immunohistochemistry method. Results:The expressions of NMDAR2 and GLAST in SON and the hippocampal gyrus were significantly increased on the 3rd day of sleep deprivation,even more sigificantly on the 5th day,decreased gradually on 7th day,and became similar to those of control group on the 14th day.Conclusion: Sleep deprivation can affect the expressions of NMDAR2 and GLAST in the hippocampal gyrus and supraoptic nucleus,but the effect diminisshes gradually with prolonged time,which may be associated with self-regulation and self-protection of the central nervous system.

Objective: To construct and identify the eukaryotic expression vector targeting the CD40 gene in rats.Methods: Two sequences corresponding to the rat CD40 gene were designed on Ambion's Web.The two complementary oligonucleotide strands of DNA fragments were synthesized by chemosynthesis.After annealing of the complementary strands,the DNA fragments were connected to the polyclone sites of the pSilencer 4.1-CMV neo vector,followed by transformation,amplification,plasmid extraction and identification of the recombinant plasmids by BamH Ⅰ and Hind Ⅲ digestion and DNA sequence analysis.Results: The connections between the DNA fragments encoding CD40-targeted siRNA and the pSilencer 4.1-CMV neo vector were correct,as confirmed by agarose gel electrophoresis and DNA sequence analysis.Conclusion: The two recombinant plasmids expressing siRNA of the rat CD40 gene were successfully constructed,which prepared the groundwork for future research on the role of the CD40 gene in homograft rejection.

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 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 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 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.