As one of the gastrointestinal malignancies,pancreatic cancer is well known because of high degree of malignancy,low survival rate and very poor prognosis.Lymphatic metastasis,the most important metastasis of pancreatic cancer,has the characteristics of metastasis in an early stage and high occurrence rate.Recently,some studies have suggested that widespread micrometastasis of lymph nodes occurring in the early stage of pancreatic cancer could play an important role in influencing postoperative neoplasm recurrence.Further studies on lymph node micrometastasis of pancreatic cancer are needed to help to understand pancreatic cancer more deeply and to comprehend metastasis rule more clearly.So we can choose more reasonable surgical treatment for every patient,achieving individual treatment,so as to improve the prognosis of the pancreatic cancer patients.

Objective To study the current status of morning blood pressure peak in elderly masked hypertension patients and study the correlation between morning blood pressure peak and cognitive function.Methods A total of 72 elderly masked hypertension patients were selected in this study,.Morning blood pressure peak was measured by ABPM examination.The patients were divided into three groups according to the morning blood pressure peak.Morning blood pressure peak ≤ 30 mmHg were divided into non-Morning blood pressure surge group ( NMS group),morning blood pressure peak ＞30 mmHg were divided into Morning blood pressure surge group ( MS group).The cognitive function scale was determined (MMSE and MoCA).T-test and linear regression analysis were performed.Results MMSE score(27.69±2.04) and MoCA scores(24.85 ± 1.52) in MS group were lower than NMS group (28.87 ± 1.34,26.54± 1.53) ( P ＜0.01 ).MMSE and MoCA scores were negatively correlated with the morning blood pressure peak ( r =- 0.308,- 0.447,P ＜ 0.01 ).Conclusions Elderly masked hypertension patients remained the phenomenon of the morning blood pressure peak,the morning blood pressure peak could lead to cognitive impairment.

Objective To evaluate the prevalence of aspirin resistance in old-aged patients with cerebral infarction and to analyze the mechanisms and clinical predictors of aspirin resistance. Methods 300 old-aged patients with cerebra] infarction were selected and the platelet aggregation ratio was determined by nephelometry with CHRONO-LOG PA-meter. And some information of these patients, such as age, sex, smoking, taking non-steroid anti-inflammatory drug (NSAD)or proton pump inhibitor (PPI), obesity, coronary artery disease (CAD), peripheral vascular disease, hyperpiesia, diabetes and hyperlipemia were recorded. Results 112 cases (37.33%) were aspirin sensitiveness, 108 cases(36.0%) were aspirin semi-resistance and 80 cases (26.67%) were aspirin resistance. These cases were divided into two groups. One was aspirin sensitive (AS) group, which included 112 patients of aspirin sensitiveness. The other was aspirin resistant (AR) group, which consisted of 188 patients of aspirin semi-resistance and aspirin resistance. The prevalence of CAD, hypercho]esteremia and RBC count in AR group was higher than that in AS group The percentage of patients who took NSAD, PPI and smoke in AR group was also higher than that in AS group. Conclusion Aspirin resistance existed in old-aged patients with cerebral infarction to great extent, and which was correlated with CAD, hypercholesteremia, smoking, RBC count, taking NSAD and PPI.

Objective To evaluate the value of HE4 ,CA125 in the diagnosis of epithelial ovarian cancer (EOC) .Methods A to‐tal of 54 samples with epithelial ovarian cancer ,64 suspicious benign pelvic mass ,and 60 health controls were consecutively enrolled in this study .Results Good diagnostic performance in discriminating benign from EOC patients was obtained for CA125 and HE4 . Serum level of HE4 of the patients in the three group were 189 .94 pmol/L ,56 .74 pmol/L and 46 .36 pmol/L .Levels of CA125 were 89 .39 U/L ,45 .11 U/L and 34 .24 U/L .There were stastically significant differences between the groups(P<0 .05) .The ser‐um HE4 and CA125 levels of the patients with ovarian cancer at stage Ⅲ ,Ⅳ(HE4=236 .25 pmol/L ,CA125=206 .35 U/L) were significantly higher than the cases at stage Ⅰ ,Ⅱ(HE4=96 .36 pmol/L ,CA125=67 .8 U/L P<0 .05) .Benign pelvic mass as con‐trol ,the specificity (SP) was 86 .6% ,sensitivity (SN) was 82 .6% ,positive predictive value and negative predictive value of the ser‐um HE4 were 85 .71% ,71 .67% ,73 .84% ,and 84 .31% respectively .SN of CA125 was 86 .67% ,higher than that of HE4 (71 .67% ,P<0 .01) .The area under curves (AUC) of HE4 was 0 .87 higher than that of CA125 (0 .81) ,(P<0 .01) .Combing de‐tection of ovarian cancer was higher than that of HE4 and CA125 alone .SP was 95 .15% ,negative predictive value was 92 .13%(P<0 .01) .Conclusion Overall ,the level of serum CA125 and HE4 increase significantly ,which showes well diagnostic perform‐ance to EOC from benign diseases .The combined detection of CA125 and HE4 could improve the diagnostic power in cervical cancer prominently ,so it has great reference value in the diagnosis of epithelial ovarian cancer .

OBJECTIVE:To control the drug quality risk in drug withdrawal links of hospital pharmacy,and provide reference for the application of quality risk management(QRM)in hospital pharmacy. METHODS:Drug QRM was developed in drug with-drawal links through risk identification,risk assessment,risk control,risk assessment and other steps. Using the incidence of risk factors and reusable rate of withdrawal drug as indexes,related data of before(Jul.-Dec. 2015)and after(Jan.-Jun. 2016)devel-oping QRM in our hospital were compared to evaluate the effect of drug QRM. RESULTS:Determining whether specific storage drugs kept the required storage conditions,whether the numbers of withdrawal drugs counted to minimal packaging and other 5 fac-tors were high-risk factors(the risk score of each factor>4 points);control measures were taken separately for high risk factors, then high-risk factors were reduced to acceptable levels(risk score<4 points). After developing QRM,the incidence of risk factors were reduced than before(reduce 1.35%-6.19%),reusable rate of withdrawal drug was increased(98.64% vs. 86.32%)(all P<0.05). CONCLUSIONS:Developing QRM in drug withdrawal links of hospital pharmacy can reduce the drug quality risk.

Objective To explore guide adult giant young cell anemia cause. Methods Retrospective analysis 48 cases adult giant young cell anemia clinical data. Results The adult giant young cell anemia majority in elderly patients of(34/48) 70.8% ,its cause a majority in gastrointestinal diseases (41/48) for 85.4% , among them 9 cases of chronic gastritis(18. 8% ) Gastrointestinal diverticula 8 cases, the digestive tract of release,duodenal ulcer and gastric 16.7% each 4 cases total resection for 8.3, hiatal hernia and gastric ulcer each 3 cases of gastric polyps, oral 6.3% lesions, jejunum resection 2 cases 4.1 percent of all the rest a few Crohn,Crohn's disease,intestinal lymphoma,chronic colitis each 1 case of 2.0%.The gastrointestinal lesions accounted for only 14.6% cases. Conclusion Giant young cell anemia majority with old people,and to the digestive system disease primarily

Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic simple enucleation for renal angiomyolipoma(RAML).Methods Between June 2005 and December 2006,11 patients with RAML underwent simple enucleation of the tumor by retroperitoneal laparoscopy.During the operation,the renal capsule was incised along the edge of the tumor by using spatula or harmonic scalpel,and then the whole tumor entity was removed,and the rest rich-fat tumor tissues were sucked with attractor.Finally,the surface of the wound was cleaned with gauze;the hemorrhage was controlled by bipolar coagulation.Fibrin sealant and hemostatic gauze,and absorbable sutures were used to close the surgical wound in the kidney.Results All the procedures were completed without conversion to open surgery.The mean operation time was 84.5 minutes(60-110 min),the mean blood loss was 51 ml(20-100 ml),and the mean postoperative hospital stay was 8.8 d(6-14 d).No intraoperative complications occurred in this series.The renal function was normal in all the cases after the operation.The patients were followed up for 7-23 months(mean 13.4 months).During this period,radiological examination found no local residual tumor or recurrent tumors.Conclusions Retroperitoneal laparoscopic simple enucleation is superior in less trauma and blood loss,quick recovery,and shoru period of hospitalization.

Objective To study the effects of diabetes mellitus(DM)on fas receptor-induced cardiomyocytes apoptosis and inflammatory response in patients with acute myocardial infarction(AMI).Methods 70 patients with ST-elevated myocardial infarction were divided into two groups:without(n=36)and with diabetes mellitus(n=34).Strepavidin-biotin ELISA was used to examine the serum levels of sFas,sFasL,TNF-? and IL-6.Results As the concentrations of sFas and sFasL immediately after primary PCI were higher in patients of AMI with DM than without DM(4.18?0.86 vs 3.30?0.82 ng/ml,6.15?1.56 vs 4.34?1.37 ng/ml,respectively,P

To inquire into the influence on effect, safety and receiving rate of thrombolysis in acute myocardial infarction (AMI) after extending its selective indications. We observed the main indication changes and effect of 201 cases of AMI receiving thrombolytic therapy who from 108 patients with AMI. Results: (1)On basis of the thrombolytic scheme recommended by the committee of Chinese Journal of Cardiology in 1991,further extend the time of onset to medication from ≤6 hr. to ≤12 hour,age from ≤65 yr,to all yr, unlimited. The ratio of cases receiving thrombolysis/all AMI is 49. 3%, more than before extending indications (28. 1% ,P0. 05) between group 6- 12 hr,medication (n- 32) and ≤6 hr's (n= 169) ,but its mortality in both groups above is significantly lower than group non-thrombolysis (18. 4%,both P

Objective To evaluate the efficacy and safety of interventional therapy for left iliac vein compression syndrome (LICS). Methods A total of 27 patients with LICS that were diagnosed by colour Doppler or venography,were included in this study. Among the cases,the disease course was shorter than 3 weeks in 13 patients,who presented with acute iliac-femoral vein thrombosis; in the other 14 patients,the disease course was longer than 3 weeks,showing the symptoms of chronic venous thrombosis. Venous puncture was performed via the contralateral femoral vein in 13 cases,and through the ipsilateral popliteal vein in 14. Venous filter was placed in 11 cases before thrombolysis,while in the other 16 cases,no filter was used. All of the patients received catheter-directed thrombolysis,afterwards,7 of them underwent percutaneous transluminal angioplasty,and the other 20 received angioplasty plus stent placement. Results In the 13 patients,who received venous puncture via the contralateral femoral approach,the guide wire could advance through the stenosis successfully in 8 patients but failed in 5. Ipsilateral popliteal vein puncture were then employed and succeeded in all the patients. Ipsilateral popliteal puncture were performed successfully in 14 patients. In 11 patients,inferior vena cava filter was placed before the procedure. In this series,the thrombolysis time was (85?16) h with a dose of (3000?320) thousand units urokinase. The thrombosis was dissolved completely in 13 acute patients and partial dissolution was attained in 14 patients in whom blood flow signal were detected color Doppler. After the operation,venogram showed complete patent iliac veins in all of the 27 cases. The patients were followed up for 6 to 26 months (mean,11 months). During the period,19 patients obtained patent iliac-femoral vein with the symptoms disappeared; 8 patients met the standard of improvement. Conclusions Interventional technique can be the first-line treatment for left iliac vein compression syndrome because of its favorable result and minimal invasion.