The development of science and technology dramatically promotes the application of minimally invasive technique in the field of gastrointestinal surgery.Today,almost all kinds of gastrointestinal operations can be accomplished through or with the assistance of a laparoscope.Compared to traditional open surgery,lapm'oscopic surgery,which is accomplished by experienced surgeons.can leads to a similar or even better surgical outcome.Although the endoscopic technique was firstly invented as a diagnostic method,its application has expanded to many different medical areas.Now,endoscopic gastrointestinal polypectomy is extensively applied in primary hospitals.Moreover,endoscopic mucosal resection and endoscopic submucosal dissection are also ca~ied out in many large medical centers in China.More and more patients are benefiting a lot from the minimally invasive technique.As the concept of minimally invasive technique is widely accepted,minimally invasive surgery will be a major aspect in the development of gastrointestinal surgery.As a contemporary gastrointestinal surgeon,it is imperative to handle the minimally invasive technique proficiently.

@@

With the change of diet and lifestyle,the development of medical concepts and techniques,the spectrum of disease has changed dramatically. The standardization of gastrointestinal surgery will be the key to further improvement.Endoscopic ultrasonography,computed tomography,magnetic resonance imaging, positron emission tomography-computed tomography and laparoscopy are helpful for preoperative staging of gastrointestinal carcinoma.The standards of operation,such as D2 lymph node dissection for gastric cancer and total mesenteric excision for rectal cancer,are also very important.Creating standards for multi-disciplinary treatment of gastrointestinal diseases will be important factors for improving outcomes.

Purpose:To evaluate the role of CT in diagnosing local recurrence after surgery of gastric carcinoma. Methods:Two groups of 51 patients after surgery of gastric carcinoma were prospectively studied by means of CT performed with the water as oral contrast,hypotonic agent and dynamic or spiral CT technique. 15 patients proved to be without local recurrence measured the thickness and observed the CT findings of anastomosis stoma ,36 patients proved to have local recurrence ,those patients included male 21 and female 15.Results:90.19%(46/51)anastomosis stoma was clearly demonstrated ,and 32 lesions was detected and confirmed the diagnosis in 29 of 32 cases . The CT findings of local recurrence after gastric resection for gastric cancer were irregular gastric wall thickening ( n =14),local mass ( n =6) and mixed lesions ( n =9).Conclusions:Using the optimal technique can improve the detectability and accuracy of CT for diagnosing the local recurrence after surgery for gastric carcinoma.

Background and purpose:Gallbladder carcinoma, lacks of specific clinical manifestations,and is usually diagnosed at advanced stages of the diseases and even fewer can be resected.Chemotherapy has not shown significant activity in gallbladder carcinoma,so new agents should be applied to its treatment.Arsenic trioxide,verified as a breakthrough in the management of acute promyelocytic leukemia,has been applied in the research of a variety of solid tumors.This study is to investigate the biological effect of As_(2)O_(3) on human gallbladder carcinoma cell GBC cells and its mechanism.Methods:Hoechest33258 staining,DNA gel electrophoresis and flowcytometric were used to determine apoptosis.Western blot was performed to analysis apoptotic proteins expression.Results:The treatment of As_(2)O_(3) in gallbladder carcinoma cells could induce apoptosis in a dose-dependent manner and downregulate the expression of anti-apoptotic protein Bcl-2.Moreover,Bcl-2 overexpression could protect gallbladder carcinoma cells from As_(2)O_(3)-induced apoptosis.Conclusions:As_(2)O_(3) induces gallbladder carcinoma cell apoptosis via down regulation of Bcl-2.

Objective To retrospectively investigate the endoscopic characteristics and pathological features of colorectal polyps in over-aged patients (≥80 years). Methods The 1617 colonoscopies performed between January 2006 and December 2010 were enrolled in our retrospective analysis. The detection rate, size, location, form and pathological feature of polyps in 150 over-aged patients were investigated, and they were compared with those in 832 young patients (＜60 years) and 635 old patients (60-79 years) with colorectal polyps. Results The detection rate of polyps was 62.0% in over-aged group, and was significantly higher than in young group and old group (30.2% and 48.7%, respectively, χ2=56.58 and 8.64,both P＜0.001). The malignant transformation rate of ascending colon polyp was 5.4% in over-aged group, and was significantly higher than in young group (1.2%, χ2=4.90, P＜0.05), but there was no significant difference between over-aged group and old group (3.9%, χ2=0.36, P＞0.05). There were no statistical differences in canceration rate, polyp diameter, morphology and adenomatous polyp rate among the three groups. The malignant transformation rate was significantly increased in adenomatous polyps with diameter over 2 cm, but didn't reach statistical significance. Conclusions The polyp detection rate is noticeably higher in the over-aged than in the old and the middle-aged, and the malignant transformation probability is also increased. The colonoscopy indications in the high risk age groups should appropriately be broadened, they should receive regular intervals follow-up, and undergo polypectomy in time if necessary.

Objective To establish the athrmic inouse model of breast cancer in normal position and imitated metastatic breast cancer. Methods Breast cancer cells MDA-MB-231-luc carrying luciferase gene was injected into the athymie mice.The optieal imaging in vivo system was used to observe the establislament of the model. Reseults The breast tumor emerged after we planted the MDA-MB-231-lue cells in the mammary gland fatpads,the volume and photon of the tumor increased during the second weekto the fifth week.After injection by the tail vein,the tumors mainly located in the lungs While after infusion in the left alrtrium.the tumolrs metastate to all over the body. Conclusions We succeeded in the establishment of the athymic mice model of breast cancer.in situ and imitated metastatic breast cancer by iniection into the vena caudalis and the left alttrium.The optical imaging in vivo system could distinctly show the formation of the tumors.

Objective To detect the gene expression difference between gastric cancer tissue and lymph node metastasis,screen different express genes,and study its mechanism of metastasis and the relationship with biological behavior.Methods Using U133plus 2.0 gene chip technology,we detected the gene expression difference between gastric cancer tissue and epithelial cells of lymph node metastasis in five patients,and screened out the differentially expressed gene Twist-l.In vitro,the cell proliferation and apoptosis level were measured by using gene over-expression and gene knockout.Metastasis ability of carcinoma cells was detected by cell scratch assay.The expression changes of epithelial-mesenchymal transition (EMT)-associated protein (E-cadherin,Vimentin) in Twist-1 overexpression and gene knockout cells were determined by Western blot.Finally,we detected the expression of Twist-1 in gastric cancer tissue,and its correlation with TNM stage was analyzed.Results The expression of Twist-1 was higher in epithelial cells than in gastric cancer tissue (12.12±3.21 vs.2.07±0.71,P＜0.01).There was no correlation of the expression of Twist-1 with cell proliferation(absorbance of cell proliferation:negtive control 0.84±0.16,null vector control 0.74 ±0.06 and Twist-1 expression cell 0.71 ± 0.07) and apoptosis [cell apoptosis rate:negtive control (2.05±0.08)％,null vector control (4.31±0.07)％ and Twist-1 expression (3.95±0.09)％],but cell migration ability enhanced.In Twist-1 over-expression group,the level of E-cadherin was decreased,while vimentin increased.Conclusions Twist-1 gene changes might be correlated with the metastasis of gastric cancer by the way of EMT.

Objective To investigate the association between CYP2C19 polymorphisms and efficacy of clopidogrel in Chinese Han patients with coronary atherosclerotic heart disease.Methods A total of 176 Chinese Han patients who underwent percutaneous coronary intervention and were treated with dual antiplatelet therapy with aspirin and clopidogrel were enrolled.Polymorphisms of CYP2C19 * 2,* 3 were measured by PCR-restriction fragment length polymorphism (PCR RFLP).The correlation between the genetic variants and cardiovascular events was analyzed.Results In the 176 patients,the allele frequencies of CYP2C19 * 2 and * 3 were 34.38％ and 5.97％ respectively,the percent of patients with poor metabolizer genotypes (* 2/* 2,* 2/* 3,* 3/* 3) was 14.20％.Among the 176 patients,11 patients reoccured acute coronary syndrome,1 patient suffered from stroke,and 4 patients had stent thrombosis.The incidence of cardiovascular events was 9.09 ％.Thecumulative incidence of cardiovascular events had no significant differences between poor metabolizer genotype carriers and extensive and intermediate metabolizer genotype carriers (16.00％ vs.7.95％,x2 =1.683,P=0.195).Conclusions The frequencies of CYP2C19 poor metabolizer genotypes are higher in Chinese Han population than in Caucasians,but the incidence of cardiovascular events in Chinese Han population is not increased.

Objective To explore the expression of human epidermal growth factor receptor -3( HER3) in human epidermal growth factor receptor-2(HER2)-positive breast cancer and its relationship with the therapeutic effect of trastuzumab and clinical prognosis .Methods Clinicopathological characteristics of 235 HER2-positive breast cancer patients undergoing surgery in Jiangsu Cancer Hospital from Jan .2007 to Jun.2012 were analyzed retrospectively.The expression of HER3 was detected using immunohistochemisty staining .The expression of HER3 and its correlation with the clinicopathological characteristics were analyzed .All patients were followed-up to find out the impact of HER3 on the disease free survival and the therapeutic effect of trastuzumab .Results The positive rate of HER3 in Luminal B ( HER2 +) and HER2-overexpressing breast cancer was 100/135 (74.1%), and 85/100(85%)respectively.The difference had statistical significance (P<0.05).The histolog-ical grading and the lymph node metastasis were significantly different in Luminal B ( HER2+) breast cancer .The tumor volume , histological grading and lymph node metastasis were significantly different in HER 2-overexpressing breast cancer .The 5-year disease free survival of HER 2-positive breast cancer patients with negative HER 3 was higher than that with positive HER3.The non-relapse survival time was not significantly different between the pos-itive and negative HER 3 expression in Luminal B ( HER2+) breast cancer patients receiving trastuzumab treat-ment , but was significantly different in HER 2-overexpressing breast cancer patients .Conclusions HER3 is cor-related with unfavourable prognosis in HER 2-positive breast cancer .The treatment targeting HER3 may improve the clinical prognosis of both HER 2-positive and HER3-positive breast cancer patients .The HER2-overexpressing breast cancer patients with negative HER 3 may benefit more from trastuzumab treatment .