Pancreatic adenocarcinoma is a highly malignant tumor and its prognosis is poor. The key factors for cure and prolonged survival are early detection, adequate evaluation of resectability and surgical resection with microscopic tumor clearance. Surgeons should pay attention to standardize operative procedures to increase the R0 resection rate. Whipple specimens should be inked and examined carefully. Postoperative adjuvant radiotherapy and chemotherapy are beneficial in the prevention of local tumor recurrence and distant metastasis. Inter-disciplinary cooperation and multimodality treatment are helpful to improve the prognosis and quality of life of patients with pancreatic cancer.

An inductively coupled plasma mass spectrometry ( ICP-MS) was developed for the direct determination of Be, Na, Mg, Al, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Ga, Zr, Mo, Sr, Cd, Ba, Pd, Ag, Sn, Au and Pb in lithium hexafluorophosphate. The sample was dissolved with absolute ethyl alcohol to analyze the above 26 impurity elements in the solution by ICP-MS. The condensation and deposition of high concentrations of carbon in mass cone interface and ion lens, which will decrease the sensitivity of element analysis, can be avoided effectively by introducing O2 to plasma. The mass spectral interferences of polyatomic ions to analytes were corrected by collision reaction cell (CRC). The matrix matching method was used to corrected matrix effect. Satisfactory linearity of each working curve of 26 impurity elements was obtained. The correlation coefficients being over 0. 9995, the detection limits for the investigated elements were in the range of 0. 6-32 ng / L, the relative standard deviation of each element within 2. 5% -7. 3% , and the recovery of each element at 90. 6% -108. 6% . The method had been applied to the determination of trace elements in lithium hexafluorophosphate with satisfactory results.

Pancreatic cancer is highly malignant with a poor prognosis. The resectability and prognosis of early pancreatic cancer are much better than the advanced, so early diagnosis is crucial for saving patients' lives. Because the symptoms of pancreatic cancer are non-specific, most of the patients are misdiagnosed as gastrointestinal or hepatobiliary diseases. Early diagnosis rate of pancreatic cancer can be greatly improved by combined application of tumor marker detection, endoscopic ultrasound, computed tomography, positron emission tomo-graphy, and etc. Early screening of high-risk population has been advocated by the experts, and its value in early diagnosis of pancreatic cancer has been confirmed by relevant studies. The colaboration of multiple pancreatic surgery centers in conducting prospective studies and setting gnidlines for the pancreatic cancer diagnosis, and relevant fundamental reseaches should also be emphasized.

Farnesoid X receptor(FXR), a member of the metabolic nuclear receptor superfamily, plays key roles in maintaining bile acid and lipid homeostasis.FXR is highly expressed in the entero-hepatic system where it transcriptionally regulates bile acid metabolism, intestinal barrier function and liver regeneration, etc.Loss or down regulation of FXR expression can lead to a lot of diseases, such as cholecystolithiasis, biliary cirrhosis,primary hepatic carcinoma, colon carcinoma, etc.Activation of FXR may protect against or provide a pharmacological target for these diseases.

Purpose:A comparison of the therapeutic effect studied by ?-rag,selec- tive asteriography and TAIC on advancing gastric carciomas with HM(hepatic metastasis) in 41 cases and NHM(without hepatic metastasis)the other 35 were reported.The correla- tion of primary and metastatic lesions including the efficacy of TAIC were also evaluated, Materials and Methods:Every case was undergone CAG;in addition LGA+CA were al- ways performed in cases of carcinoma of cardiac end of stomach so as CHA,either CA or LGA for gastric antrum carcinomas;while FDM(5Fu+CDDDP+MMC)were the drugs used for the majority of the patients.Results showed the number with large extent gastric carcinoma(≥one part of gastric zone)accompanied by moderate to severe deformaties in HM group were obviously greater than those of the NHM group(P

Objective To observe the change of early postoperative cognition in the elderly under low central venous pressure (LCVP) after lobe resection to investigate the safety and feasibility of LCVP in Geriatrics.Methods A total of 45 ASA class Ⅰ ～ Ⅱ old patients (60 ～ 75 y)with elective liver resection were divided into L group and C group.In the LCVP group (L group),CVP was maintained below 5 cmH2O during liver resection until the lobe was done.The patients in the control group (C group) received standard care (The CVP was controlled between 6 cmH2O to 12 cmH2O).To compare the anesthesia recovery after surgery,all patients were tested with a battery of neuropsychologic assessment of cognitive function preoperatively and on the 7th day postoperatively.Results During liver resection,the MAP [(75.8 ±7.9)mmHg] and CVP [(3.1 ±0.4)cmH2O] of experimental group were lower than the control group [MAP (92.3 ± 10.6)mmHg,CVP(9.3 ± 1.4)cmH2O].The difference was statistically significant (t' =20.08,P ＜0.05,t =5.89,P ＜0.01) ;There was no statistically significant difference in postoperative recovery of spontaneous breathing,respiratory,eye opening time,extubation time and leave the operating room time between two groups[(18.1 ±6.7)min,(25.4±8.3)min,(31.9±11.7)min,(42.8±17.8)minvs (15.3 ± 7.0)min,(22.6 ±9.4)min,(30.2 ± 10.8) min,(45.4 ± 13.6) min,P ＞ 0.05].The incidence of POCD was 30.0％ in the experimental group and 27.3％ in the control group.The difference was no statistical significance between two groups(P ＞0.05).Conclusious There was no significant influence of low central venous pressure on anesthesia recovery time and early postoperative cognition in the elderly under hepatic resections.

Objective To investigate the correlation between arterial carbon dioxide partial pressure (PaCO2 )and end-tidal carbon dioxide partial pressure (PET CO2 )in prone position operation and calculate the value of PaCO2 according to the PET CO2 .Methods Forty patients with ASA Ⅰ orⅡ undergoing spinal surgery were selected,and the values of PaCO2 and PET CO2 as basic value (T0 ) after induction of general anesthesia in supine position monitor and record the value of PET CO2 and PaCO2 in prone position after 30 min (T1 ),60 min (T2 )and 90 min (T3 ).The correlation between PaCO2 and PET CO2 in each time point were analyzed,and the equation of PaCO2 (y)and PET CO2 (x) with curve fitting and difference of PaCO2 and PET CO2 were calculated.Results There was significant correlation between PaCO2 and PET CO2 in the supine and prone position,their correlation coefficients were r 0 =0.84,r 1 =0.88,r 2 =0.84,r 3 =0.82 (P <0.01).The Pa-ET CO2 was (5.3±2.1)(T0 )in supine position and (6.6± 2.1 )mm Hg (T1 ),(5.8 ± 2.2 )mm Hg (T2 ),(5.9 ± 2.1 )mm Hg (T3 )in prone position.The equation in each time point PaCO2 (y)and PET CO2 (x)were y0 =1.1 x0 +2.5,y1 =1.1 x1 +2.3,y2 =1.1 x2 +2.4,y3 =1.1 x3 +4.6,and the Pa-ET CO2 was 3.7-8.7 mm Hg. There was no significant difference between PaCO2 and PET CO2 at T1-T3 .Conclusion Whenever in prone position or supine position,PET CO2 and PaCO2 have significant correlation in prone position and supine position.The overall range of Pa-ET CO2 is 3.7-8.7 mm Hg,and the PET CO2 can be as indica-tor to estimate PaCO2 in prone position.

Objectives To assess the prevalence of and risk factors for some sebaceous glands diseases (seborrhoeic dermatitis, acne, seborrhoeic alopecia and rosacea) and their relation to gastrointestinal dysfunction in adolescents. Methods A questionnaire survey was carried out for the epidemiologic information of sebaceous glands diseases from September to October 2001. A total of 4 600 youngsters aged from 12 to 20 years were recruited from 7 middle schools in Macau by random cluster sampling. The statistical software of SPSS 10.0 was used to analyze the data. Results The prevalence of seborrhoeic dermatitis, acne, seborrhoeic alopecia and rosacea was 2.7%, 45.5%, 1.6% and 0.7% respectively. Based on multivariate logistic regression analysis, the risk factors of sebaceous glands diseases included age, gastrointestinal dysfunction, season (summer), spicy and fried food, a family history of acne and the presence of long hairs on areolae of breasts. Gastrointestinal dysfunction was correlated with the incidence rates of seborrhoeic dermatoses (P = 0.007, OR = 1.208, 95% C.I 1.053 ~ 1.385). Conclusion Gastrointestinal dysfunction is an important risk factor for diseases of the sebaceous glands and correlates with the occurrence and development of these diseases.

Objective To investigate the effects of intrathecal (IT) lidocaine on propofol-induced sedation and content of lidocaine in brain tissues in rats.Methods Twenty male Sprague-Dawley rats,aged 2-3 months,weighing 250-350 g,were equally and randomly assigned to one of four groups:control group (group C),iv lidocaine group (group IV-L),IT normal saline group (group IT-NS) and IT lidocaine group (group IT-L).Groups IT-NS and IT-L received IT normal saline 15μl and 2％ lidocaine 15 μl,respectively.Group IV-L received iv 2％ lidocaine 15 μl.Propofol was infused starting from 10 min after IT or iv administration.When the eyelash reflex disappeared,the infusion of propofol was stopped and the dose of propofol consumed was recorded.The rats were sacrificed in IT-L and IV-L groups and brains were removed for determination of lidocaine level in brain tissues (by RP-HPLC).Results Compared with groups C,IV-L and IT-NS,the dose of propofol consumed when the eyelash reflex disappeared was significantly decreased in group IT-L (P ＜ 0.05).No significant difference was found in the propofol requirement when the eyelash reflex disappeared between groups C,IV-L and IT-NS and in the content of lidocaine in brain tissues between groups IV-L and IT-L (P ＞ 0.05).Conclusion Sedation induced by lidocaine administered intrathecally is not due to a direct action of lidocaine on the brain in rats.

Objective To retrospectively study the variation of glucose in patients with insulinomas. Methods The medical records of patients who underwent operations in the last 20 years at Peking Union Medical College Hospital were reviewed retrospectively. Patients who received repeated operations, or just exploratory laparotomy or liver biopsy were excluded. The clinical data were collected and analyzed. Results There were 245 patients, including 103 males and 142 females. The mean age was (42.2+ 14.6) years old. The mean value of preoperative fasting glucose was (1.47+0. 57) mmol/L, and the ratio of insulin to glucose was greater than 0.3 in 87.4% patients. The glucose level rose gradually after removal of the tumor(s). The blood sugar rising more than 1 time over the baseline value at one hour after resection was observed in 79.6% patients. For all the other patients, the glucose level rose to this level in the morning of the first postoperative Day 1. Rebound hyperglycemia was common after operations, and the glucose gradually returned to normal, with a mean level of 5.56 mmol/L at the time when the patients were discharged home. Conclusions Patients with insulinomas had a serum fluctuation in glucose (low→high→normal) during the perioperative period.Intraoperative glucose test combined with ultrasound and frozen section helped to localize and to remove all the lesions. Rebound hyperglycemia after surgery should be treated with insulin pump actively to minimize the incidence of complications.