Objective: To observe the effects of pentazocine on emergence agitation.Methods: Totally 60 patients with scheduled upper limb operation with general anesthesia were randomly divided into two groups (n =30).Group Ⅰ was given pentazocine 0.25 mg·kg-1 (diluted to 10ml) and group Ⅱ was treated with 0.9% sodium chloride (10 ml) and both were with slow intravenous injection above 3 min before the surgical stitching.BP and HR were recorded and compared before the induction (T 0), before the extubation (T 1) ,at the extubation (T 2), and 5, 10 and in 15 minutes after the extubation (T 3 , T 4 and T 5).The time of recovery, time of extubation and agitation scores in 15 min after the extubation were recorded and compared, and nausea and vomiting were observed as well in both groups.Results: Compared with those in group Ⅰ, HR and BP in group Ⅱ were significantly higher (P＜0.05) at T 3 , T 4 and T 5.There were no significant differences in the breathing recovery time and awakening time between the groups (P＞0.05).The restlessness score in group Ⅰ was significantly lower than that in groupⅡ (P＜0.05).The incidence and degree of postoperative nausea and vomiting in groupⅠ were significantly higher than those in group Ⅱ (P＜0.05).Conclusion: Pentazocine (0.25 mg·kg-1) given before stitching can maintain stable circulation, reduce emergence agitation and protect the safety of patients.

Objective:To investigate the clinical features and prognosis of patients with pancreatic metastasis from clear cell renal cell carcinoma(CCRCC).Methods:From Jan 2000 to May 2020, the clinical data of patients pathologically diagnosed as CCRCC with pancreatic metastasis and admitted in Cancer Institute and Hospital of Tianjin Medical University were analyzed retrospectively. The gender, age, metastasis time, relapse time, metastatic sites, numbers of metastatic lesions and whether metastatic pancreatic lesions should be surgerically removed were recorded and the influencing factors were analyzed.Results:Among the 20 patients, there were 12 males and 8 females. The median age of diagnosis was 50 years. There were 12 patients(60%) of left renal carcinoma and 8 patients(40%)of the other side. 12 cases(60%) had single pancreatic metastatic lesion and the other 8 cases(40%) had multiple metastatic lesions. Seven patients(35%) had other organs metastasis besides pancreatic metastasis. Two patients(10%) had simultaneous pancreatic metastasis and renal cancer, and the other eighteen patients(90%) had pancreatic metachronous metastasis after being diagnosed as renal cancer. The median time from the diagnosis of CCRCC to pancreatic metastasis was 102 months. Thirteen patients(65%)had recurrences within 10 years and the other seven patients(35%)had recurrences after 10 years. Pancreatectomy was performed in nine patients(45%) and targeted therapy was conducted in thirteen patients. The mean follow-up was 122.9 months (1-256 months). Three patients (15%) died and 17 patients (85%) survived. The median overall survival was 75.9 months, and the 5 year-survival rate was 66.7%. Simultaneous metastasis and extra-pancreatic metastasis were prognostic factors in patients with CCRCC with pancreatic metastasis.Conclusions:Pancreatic metastases from renal clear cell carcinoma were rare, but the prognosis was good, especially in patients with only pancreatic metastases several years after renal carcinoma was diagnosed.

In recent years,immunotherapy has become an important part of the treatment for advanced non-small cell lung cancer (NSCLC).Tumor cells can escape from the body's immune system by mediating various immune escape mechanisms,among which programmed death-1/programmed death ligand-1 (PD-1/ PD-L1) mediated immune escape plays an important role.Currently,chemotherapy,radiotherapy and molecular targeted therapy have certain limitations in the treatment of advanced NSCLC.Recent studies have found that the combined application of PD-1/PD-L1 inhibitor and other treatment methods has certain synergistic effect,thus enhances the anti-tumor effect and further prolongs the survival of patients.Immunotherapy brings not only changes in the treatment patterns of NSCLC,but also challenges in the screening of target population and the management of treatment-related adverse reactions.Summarizing the research progress on immune checkpoint inhibitors in the comprehensive treatment of advanced NSCLC can provide reference for the best treatment of NSCLC.

Objective To study the clinical experience on pancreaticoduodenectomy (PD) in thepast three years from a single operation group at the Cancer Institute and Hospital of Tianjin Medical Universiy.Methods The clinical data of 118 patients who underwent PD from January 2015 to December 2017 were collected and analyzed retrospectively.Results Of the 118 patients who underwent PDs,102 underwent open pancreaticoduodenectomy (OPD) (86.4％),and 16 laparoscopic pancreaticoduodenectomy (LPD) (13.6％).There were 54.2％ males with a age of (56.0±12.0) years (39.83％ over 60 years).Malignancy was confirmed by pathology in 73.7％ (87/118 patients).The operative time was (324.0±95.6) minutes.Intraoperative blood loss was (192.8±97.5) ml and R0 resection was achieved in all patients.The postoperative complication rate was 46.6％ (55/118).The median postoperative hospital stay was (19.9±9.5) days.There was no perioperative mortality.The operation time of LPD was significantly longer than OPD,but there was no significant difference in intraoperative bleeding,lymph node clearance,postoperative complication rate and postoperative hospital stay (P＞0.05).Conclusions PD is safe and feasible.The postoperative complication rate was relatively high but all patients were discharged from hospital after appropriate treatment.Compared with OPD,LPD is a better alternative for patients.

Objective To study risk factors of newly developed nonalcoholic fatty liver disease (NAFLD) in patients after pancreaticoduodenectomy (PD) and the effect on prognosis.Methods Date of patients undergoing PD surgery at Pancreatic Department,Tianjin Cancer Hospital were collected from Jan 2016 to Dec 2016.Patients were divided into two groups according to occurrence of NAFL Devents.Results There were 22 patients in NAFLD group (group Ⅰ) and 47 patients in non NAFLD group(group Ⅱ).All patients were followed up till the end of 2017.Multi-factor analysis showed that extraintestinal drainage of pancreatic juice (OR =18.118,95％ CI 2.968-114.455,P =0.002) and dissected lymph node number over 30 (OR =8.424,95％ CI 2.272-31.232,P =0.001) were independent factors associated with NAFLD in patients after PD.Survival analysis showed no statistically significance for median progression-free survival (12.7 months in group Ⅰ vs.13.9 months in group Ⅱ,P =0.99) and median overall survival (mOS) (15.4 months in group Ⅰ vs.17.7 months in group Ⅱ,P =0.09).Conclusions Extraintestinal drainage of pancreatic juice and lymph node clearance over 30 are independent risk factors for new NAFLD in PD patients.The effect of new NAFLD on PFS and OS is not statistically significant.