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 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 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 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 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 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 prepare the monoclonal antibodies against chicken CARP.Methods:The chicken CARP cDNA encoding the N-terminal 110aa length of encoding region was cloned into prokaryotic expression vector pET28b.The BALB/c mice were immunized with purified the recombinant protein,spleen cells of mouse were fused with SP2/0,and the positive clones were screened by indirect ELISA.The properties of McAb were analyzed by ELISA and Western blot.Results:Two hybridomas were proved to have the capability of stably secreting McAb against chicken CARP,designated as 4A8 and 4E6,the subtype of both was IgG1,and the light chain was ?.The titers of ascites were 3.2?104 and 1.28?105 respectively.The Western blot results suggested that they could recognize chicken CARP protein.Conclusion:Two murine hybridomas secreting anti-chicken CARP McAbs have been successfully obtained.

Objective To evaluate the role of double stapling technique in low rectal anastomosis that can save anus.Methods 114 patients with low rectal cancer from June 1994 to January 2002 were treated by low anterior resection of the rectal carcinoma in which the double stapling technique was used,were valuated and the experience was presented.Results Operations of all the 114 patients were successful. Complication included anastomotic fistula in 4 patients (3.5%)and anastomotic stenosis in 5 patients (4.4%) and they were healed by irrigating ?draining the wound and enlarging anus respectively.Conclusion The low anterior resection of the low rectal carcinoma which can save anus becomes safe and time-saving .

Thoracoscopic esophagectomy is an alternative to open thoracotomy in treatment of esophageal carcinoma, but its role in esophageal surgery is still controversial. Between May 2000 and May 2002, 9 patients affected by esophageal carcinoma underwent esophagectomy with thoracoscopic dissection of the esophagus. Seven patients were male, 2 were female,and the mean age was 51 (range, 42～56) years.One patient had the carcinoma at cervical segment, 2 at upper third thoracic segment, 5 at middle third, and 1 at lower third.All tumors were squamous cell type and were below stage II.Thoracoscopy and cervical esophagogastrostomy were successfully performed in 8 patients except in one case, in whom conversion to thoracotomy was necessary because of extensive tumor invasion.Thoracoscopic dissection took an average of 70 (range,40～120) minutes and the mean operative time was 252(range,230～270) minutes. the mean operative blood loss was 250ml (range,150～400ml) and the mean number of thoracic lymph nodes harvested was 7(range,5～12).One patient experienced a cervical infection,which healed with conservative treatment.One patient had a temporary left recurrent nerve palsy that disappeared during the following 6 months.These initial data indicate that thoracoscopic esophagectomy is safe and feasible. The short term result of thoracoscopy is comparable with that of open thoracotomy, and the long term result and its role in esophageal surgery deserve further investigation.

AIM: To elucidate the effects of platelet-activating factor (PAF) on eosinophil activation and the action of dexamethasone or theophylline during this process. METHODS: Eosinophils (EOS) from the peripheral blood of normal subjects were isolated. The hypodense eosinopil (HE) and normodense eosinophil (NE) were studied with electron microscopy. The effects of PAF on eosinophil activation and the action of dexamethasone or theophylline during the above process were measured. RESULTS: Hypodense eosinophil had significantly smaller individual granules than normodense eosinophil had. PAF induced eosinophil peroxidase release, and generated. Eosinophils incubated with 10~(-8) mmol/L PAF and 10~(-5) mmol/L dexamethasone released (101.17?10.32) mg/L eosinophil peroxidase (P