Pancreatic cancer is a highly malignant tumor and its treatment is still a challenge.Recent studies have shown that medication plays an important role in preoperative and postoperative adjuvant therapy for locally advanced pancreatic cancer and is also a major thera-peutic method for advanced pancreatic cancer.It can improve the survival time and quality of life in patients with pancreatic cancer.Tradi-tional chemotherapy regimens based on gemcitabine and fluorouracil have limited effects in the treatment of advanced pancreatic cancer,and studies on molecular targeted therapies have achieved some progress in recent years.With reference to related guidelines or consensus on the diagnosis and treatment of pancreatic cancer and important clinical trials of the treatment of pancreatic cancer,this article elaborates on the selection and therapeutic effect evaluation of chemotherapy regimens for pancreatic cancer.We believe that with the research and develop-ment of new drugs and the application of new techniques,the treatment of pancreatic cancer will achieve new breakthroughs in future.

Objective To investigate the protection of superior parathyroid glands by improving dissection procedure of thyroid superior pole in total thyroidectomy surgery.Methods 136 consecutive cases undergoing two-step dissociating procedure of thyroid superior pole(the improved group) in total thyroidectomy plus central compartment dissections from Sep.2012 to Oct.2015 were retrospectively analyzed.Intraoperative observation of superior parathyroid and incidences of postoperative hypoparathyroidism were compared with conventional surgical methods (the conventional group) containing 113 cases from Jun.2009 to Sep.2012.All operations were performed by the same treatment group.Results Intraoperatively,249 (249/272,91.5％) superior parathyroid glands were identified in the improved group and 215 (215/226,95.1％) superior parathyroid glands were identified in the conventional group.The difference had no statistical significance (P＝0.114).Whereas,among identified superior parathyroid glands,242 (242/249,97.1％)of them were conserved in situ in the improved group and 198 (198/215,92.0％) were conserved in situ in the conventional group.The difference had no statistical significance (P＝0.013).Among superior parathyroid glands conserved in situ,225 (225/242,93.0％) had good blood supply in the improved group and 170(170/198,85.9％) in the conventional group.The difference had statistically significance (P＝0.001).28 (28/136,20.5％) patients displayed temporary hypoparathyroidism and 2 (2/136,1.5％) cases suffered permanent hypoparathyroidism in the improved group after surgery.Whereas,in the conventional method group,a higher incidence was observed in 37 (37/113,32.7％) cases of temporary hypoparathyroidism and 7 (7/113,6.2％) cases of permanent hypoparathyroidism respectively.The difference had statisticall significance (P＝0.003).Conclusions Two-step dissociating procedure technique offers protective effect on superior parathyroid glands function.It is worthy of popularization.

Objective To investigate the correlation between PaCO2 and cerebral blood flow (CBF), cerebral metabolism of oxygen (CMRO2), glucose (CMRglu) and lactate (CMRlact) and intracranial pressure during intracranial surgery. Methods Twenty ASA Ⅰ - Ⅱ patients (6 male, 6 female), aged between 26-54yr, weighing (65 ? 11) kg scheduled for elective intracranial surgery were studied. The patients were unpremedicated. Before general anesthesia radial artery was cannulated and a catheter was inserted into internal jugular vein and advanced cranially until jugular bulb. Lumber puncture was performed at L3-4 and a catheter was inserted into subarachnoid space for 3 cm, for pressure monitoring and CSF sampling. Anesthesia was induced with diazepam 10mg, fentanyl 3-4?g?kg-1, propofol 2mg?kg-1 and vecuronium 0.08mg?kg-1 iv. The patients were mechanically ventilated with a mixture of oxygen and argon (O2 : argon = 3 : 1) after tracheal intubation. Anesthesia was maintained with sevoflurane and intermittent iv boluses of vecuronium. Arterial and cerebral venous blood gases, glucose and lactate levels, CBF, ICP and CSF level of lactate were determined before anesthesia when patients were awake(Ⅰ) and during anesthesia when PETCO2 = 40, 30, 20 mm Hg (Ⅱ,Ⅲ,Ⅳ). CBF was measured by modified Kety-Schmidt inert gas saturation technique with argon. CMRO2 and CMRglu were calculated based on the difference in their arterial -cerebral venous blood levels. Results At PETCO2 20mm Hg (Ⅳ) CBF decreased by 57.75% and CMRO2 by 58.70% as compared with the baseline; CMRglu decreased by 46.93% as compared with the baseline. There was no significant change in lactate level, jugular venous blood O2 saturation and pH. ICP decreased from (22.14 ? 7.88)mm Hg( Ⅰ) to (17.57?5.03)mm Hg( Ⅱ ),(13.43?4.89)mm Hg(Ⅲ) and (10.00? 2.31)mm Hg(Ⅳ) and the differences were significant. All measurements were done when MAP and HR were stable. PET CO2 was (10? 2) mm Hg lower than PaCO2 . Conclusions Cerebral blood flow, cerebral oxygen and glucose metabolism and intracranial pressure change with changes in PET CO2 . Cerebral vascular reactivity to CO2 is not impaired by 1.3 MAC sevoflurane. Mild hypocapnia is necessary during neurosurgery.

Objective To inveatigate the effect of 15-HETE, a metabolite of arachidonic acid, on isolated hypoxic pulmonary arterial ringa ( PARs) , trying to find appropriate treatment for pulmonary hypertension and its complications during anesthesia in order to avoid hypoxemia. Methods Sixteen healthy Wistar rats of either sex weighing (230 ? 10) g were randomly divided into two groups : A control group breathing fresh air (FiO2 =21%) and B hypoxia group breathing hypoxic air (N2 = 90% , O2 = 10% ) in a hypoxic box. After breathing hypoxic air for 9 days the animals were anesthetized. Heart and lungs were immediately removed and PARs (0.5-1.0 mm in diameter and 3 mm in length) were prepared. Four PARs were prepared from each animal. The PARs were suspended in baths filled with Krebs-Hensleit (K-H) solution maintained at 37℃ and aerated with 95% O2 and 5% CO2. Preload was gradually increased to 0.3 g in 30 min. The isometric tension was measured using a four-channel force-displacement transducer. 15-HETE was added to K-H solution and the concentration was gradually increased from 10-8 to 10-6 mol?L-1 at 5 min intervals. Contractility of PARs was analyzed by a software of Medlab 6.0. Concentration-tension curve was drawn and contraction rates were calculated. 2 mmol?L-1 4-AP, 10-2 mol?L-1 TEA and 10-6 mol?L-1 GLYB were added to separate K-H solution baths and 40 min later 15-HETE was added in order to detennine the effect of difierent potassium channel blockers on contraction response of PARs to 15-HETE. Results With increasing concentration from 10-8 to 10-6 mol?L-1 , 15-HETE increased PARs tension gradually in a dose-dependent manner from 106% ?6% to 139% ? 4% in group A and from 113% ?6% to 163% ?6% in group B. The difference in PARs tension between group A and B was statistically significant (P

Objective To evaluate the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) in aged patients undergoing thoracic surgery. Methods Physiological and operative severity scores were kept in 206 aged patients undergoing thoracic surgery, in which peritoneal soiling was converted to pleura soiling. The physiological score and the operative risk score were compared between the groups with or without the postoperative complications. The mortality and morbidity rates were calculated. Actual mortality and morbidity rates were compared with the rates predicted by POSSUM. Results Among 206 patients, there were postoperative complications in 97 patients. The physiological score and the operative severity score were significantly higher in the group in whom complications occurred compared with those without complications (19.3?0.7 vs 15.1?0.6 for physiological score, P

Objective To investigate the relationship between quality of life of the convalescent psychopaths in community and their social supports.Methods A total of 51 psychiatric patients in the rehabilitation period were recruited and investigated from the rehabilitation center of the community rehabilitation center in Beitang district,Wuxi city by using the questionnaire on the quality of life (QLS),social support scale(SSS) and the perceived social support Scale(PSSS).And then,they were compared with 50 healthy subjects.Results The dimension scores of QLS,SSS and PSSS of the psychiatric patients were significantly lower than those of healthy persons (P<0.01).The dimension scores of QLS had significantly positive relationship with most of the dimension scores of SSS and PSSS (P<0.05).Economic status,participation in social activities and family support showed significantly positive prediction to body function(P<0.05).Financial situation showed significantly positive prediction to mental function(P<0.05).Conclusion The quality of life of the convalescent psychopaths is poor,and there is a positive correlation with social support system.Economic status,participation in social activities and family support are the main factors that affect their quality of life.

Objective To investigate the protective role of two-step decapping technique for superior parathyroid glands in total thyroidectomy surgery.Methods The clinical data of 136 consecutive cases underwenttwo-step decapping technique in total thyroidectomy plus central compartment dissection from April 2013 to January 2016 were retrospectively analyzed.And the incidences of postoperative hypocalcemia were was compared with conventional consecutive decapping surgical methods containing 113 cases from January 2010 to March 2013.All operations were performed by the same treatment group.Results In the two-step decapping group,28 cases(28/136,20.6％) displayed postoperative temporary hypoparathyroidism and a higher incidence were was observed in 37 cases (37/113,32.7％) in the conventional method group,the difference was statistically significant(x2 =4.737,P =0.03).Whereas,2 cases(2/136,1.5％) suffered permanent hypoparathyroidism in the two-step decapping group and 7 cases (7/113,6.2％) of permanent hypoparathyroidism in the conventional method group,the difference was statistically significant (x2 =3.954,P =0.047).Conclusion Two-step decapping technique can more effectively protect the parathyroid gland function.It is worthy of popularization.

Carcinoma ; complications ; Carcinoma, Papillary ; Female ; Humans ; Middle Aged ; Thyroid Neoplasms ; complications ; Tuberculosis, Lymph Node ; complications

Objective: To explore the inhibitory effect of gallotannin (GLTN) on the proliferation of rat glomerular mesangial cells (GMC)induced by high sugar stimulation and the influence in the cell cycle of the rats, and to clarify the prevention effect of GLTN in the occurrence and development of diabetic nephropathy (DN). Methods:The experimental cells were divided into normal control group (D-glucose 5.5 mmol·L-1 ,NC group), high glucose group (D-glucose 30 mmol· L-1 ,HC group),high glucose + 5 mmol· L-1 3 - AB group (AB group),high glucose + 20 μmol·L-1 GLTN group (G20 group),high glucose + 40 μmol· L-1 GLTN group (G40 group).The proliferation of GMC in different groups at different time points (4,8,24,48 and 72 h)was observed by MTT assay.The changes of cell cycle of GCM under different culture conditions were examined by flow cytometry,and the expression levels of TGF-β1 and CTGF were detected by Western blotting method. Results:Compared with NC group,the proliferation levels of GMC in HC group were increased (P <0.01),and reached the peak at 48 h ;the percentage of S phase cells was increased (P <0.01).Compared with HC group,the proliferation levels of GMC in 3-AB group and GLTN group were significantly decreased (P < 0.01 ),and the percentages of S phase cells were decreased (P <0.01).Compared with NC group,the protein expression levels of TGF-β1 and CTGF in each drug group were increased (P < 0.05 or P < 0.01),but they were significantly lower than those in HC group (P < 0.01).Conclusion:GLTN can inhibit the proliferation of GMC under high sugar stimulation through arresting the cell cycle and down-regulating the expressions of TGF-β1 and CTGF and delay the occurrence and development of DN.

Objective:To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials,so as to provide evidence in making anesthesia plan for intraspinal tumor surgery.Methods:In the study,48 patients scheduled to undergo intraspinal tumor surgery [American Society of Anesthesiology,(ASA)Ⅰ-Ⅱ,18-65 years old]were enrolled. After general anesthesia induction,the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%,0.5%,1 .0% and 1 .5% respectively,under a background of propofol and remifentanil.All the observations were done before the important steps of sur-gery.Remifentanil infusion rate was 0.2 μg /(kg·min),while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50.At each concentration,4 stimulation voltages of 300 V,400 V,500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared.The success ratio was also recorded.Results:The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs.Under each stimulation voltage,the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations,and significant differences were found in comparing 1 .5% sevoflurane (left 20.50 μV,70.71 μV,135.97 μV,190.00μV ,right 14.29 μV,50.71 μV,73.10μV,77.50μV) with 0.0% sevoflurane (left 143.00 μV,388.10 μV,484.53 μV,500.00 μV,right 176.00 μV, 407.60 μV,384.35 μV,451.00 μV)and 0.5% sevoflurane (left 100.00 μV,362.57 μV,444.05μV,435.00 μV,right 115.00 μV,207.15 μV,258.34 μV,358.50 μV),left χ2 =27.46,P<0.01,right χ2 =60.49,P<0.01;left χ2 =20.73,P<0.01,right χ2 =55.05,P<0.01;left χ2 =34.25,P<0.01,right χ2 =33.58,P<0.01;left χ2 =28.61,P<0.01 ,right χ2 =49.04,P<0.01;while there were no statistical differences in the latency changes (P =0.26 ).Under each end-tidal sevoflurane concentration,the MEPs amplitude increased following increasing stimulation voltages,and significant differences were found in comparing 300 V (left 143.00 μV,100.00 μV,61.50 μV,20.50μV ,right 176.00 μV,115.00 μV,41.07 μV,14.29 μV)with 400 V (left 388.10 μV,362.57μV,198.81 μV,70.71 μV,right 407.60 μV,207.15 μV,89.00 μV,50.71 μV)and 500 V (left 484.53 μV,444.05 μV,216.24μV,135.97 μV,right 384.35 μV,258.34μV,187.50μV,73.10μV)and 600 V (left 500.00 μV,435.00 μV,344.00 μV,190.00 μV,right 451.00 μV,385.50μV,156.00μV,77.50μV),leftχ2 =45.55,P<0.01,rightχ2 =25.73,P<0.01;leftχ2 =46.67, P<0.01,right χ2 =55.30,P<0.01;left χ2 =47.36,P<0.01,right χ2 =47.82,P<0.01;left χ2 =38.67,P<0.01,right χ2 =45.87,P<0.01;while the latencies were decreased,and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V(left F=7.50,P=0.01 ,right F=13.33,P<0.01),but the differences had little clinical significance.The success ratio decreased by increasing end-tidal sevoflurane concentration,and significant differences were found in comparing 1 .5%sevoflurane (left 43.8%,70.8%,77.1%,81.3%,right 37.5%,60.4%,75.0%,66.7%)with 0.0%sevoflurane (left 79.2%,87.5%,95.8%,93.8%,right 75.0%,95.8%,95.8%,95.8%)and 0.5%sevoflurane (left 72.9%,89.6%,95.8%,95.8%,right 66.7%,89.6%,95.8%,97.9%);the suc-cess ratio increased by increasing stimulation voltage,and significant differences were found in comparing 300 V(left 79.2%,72.9%,62.5%,43.8%,right 75.0%,66.7%,60.4%,37.5%)with 400 V(left 87.5%,89.6%,77.1%,70.8% ,right 95.8%,89.6%,79.2%,60.4%)and 500 V(left 95.8%, 95 .8%,9 1 .7%,77 .1%,right 95 .8%,95 .8%,8 1 .3%,75 .0%)and 600 V (left 93 .8%,95 .8%, 89.6%,81.3%,right 95.8%,97.9%,89.6%,66.7%),but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V ,end tidal sevoflurane concen-tration of 1 .5% and the group with stimulation voltage of 300 V,end tidal sevoflurane concentration of 0.0% (P=0.22).Conclusion:Sevoflurane inhibited MEPs in a dose-dependent manner.It can de-crease the amplitudes and prolong the latencies.But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio.Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.