The prognosis of pancreatic cancer is the worst in all kinds of digestive tract tumors. Fifty percent of pancreatic cancer patients have distant metastasis at the time of diagnosis, and liver is the most common site of metastasis. For pancreatic cancer patients, the presence of distant metastasis has been always considered as an absolute contraindication for surgical resection. However, with the establishment of multidisciplinary team, especially the researches of chemotherapy and targeted drugs and the application of new chemotherapy regimens in recent years, there are more and more evidences which show the survival benefit of surgical resection for some selected patients with liver oligometastasis after systemic chemotherapy. In this paper, the authors review current situation and progress in the treatment strategy for pancreatic cancer with hepatic oligometastasis, further investigate the indication of surgical treatment and evaluate its clinical outcomes.

Objective To observe the efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly.Methods T he elderly patients w ith osteoporotic intertrochanteric fracture meeting inclusion and exclusion criteria were recruited. They received proximal femoral nail anti-rotation(PFNA)surgery with the combined intakes of calcium of 600 mg/day and 1-alpha ,25-(OH)2-vitamin D3 analogs of 0.5 μg/day as a basic standard treatment protocol(BSTP).The study subjects included control group(n= 10)who underwent PFNA surgery plus oral calcium and vitamin D supplements without teriparatide (20 μg/d) ,and the observation group who received PFNA surgery plus oral calcium and vitamin D supplements with teriparatide (20 μg/d) , for more than twelve months or over at our department from October 2012 to February 2016. Gender ,age ,socio-demographics and clinical values of the American Society of Anesthesiologists (ASA )score ,fracture types ,preoperative serum albumin level ,preoperative BM I ,bone mineral density 1 week postoperatively ,serum N-terminal propeptide of type I collagen (PINP) and C-terminal telopeptides of type 1 collagen(β-CTX)1 week postoperatively were matched between the two groups , no statistically significant difference was found(all P＞0.05).Levels of PINP and β-CTX 3 ,6 and 12 months postoperatively ,BMD 1 year postoperatively ,fracture healing time and complications were compared between the two groups. The prognosis of 1 case of patient undergoing conservative treatment was observed. Results There was no significant difference between the two groups in serum levels of PINP and β-CTX 1 week postoperatively(P=0.362 and 0.517 ,respectively).Serum level of PINP was significantly increased in observation group at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively(P= 0.008 ,0.001 and 0.004 ,respectively) ,while serum level of PINP had no significant difference in control group at 3 ,6 and 12 months postoperatively versus at 1week postoperatively(P＞ 0.05).Serum levels of PINP 3 ,6 and 12 months postoperatively were higher in the observation group than in control ( P= 0. 002 ,0. 002 and 0. 000 ,respectively ). In the observation group ,serum β-CTX level reached the peak at 6 months after surgery ,which was higher than that at 1 week after surgery(P=0.041) ,and slowly decreased at 12 months after surgery.In the control group ,β-CTX slowly increased at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively ( P ＞ 0.05 ). There was no significant difference in BMD of lumbar spine and contralateralhipbetweenthetwogroupsat1weekpostoperatively(P=0.440and0.325).At1year postoperatively versus at 1 week postoperatively ,the BMD of lumbar spine and contralateral hip was increased(P=0.039 and 0.009)in the observation group ,while was decreased(P＞ 0.05)in control group. The fracture healing time was shorter in observation group than in control group (13.6 ± 2.2 weeks vs.17.6 ± 3.4 weeks ,P=0.033).No one had a delayed fracture healing in observation group and 1 patient showed a delayed fracture healing in the control group. There were no complications such as lag screw sliding ,refracture ,pressure ulcer and deep vein thrombosis in both groups. The fracture nonunion was found in the patient undergoing conservative treatment after 20 months of teriparatide treatment. Conclusions The medium-and long-term of teriparatide treatment can significantly promote bone formation ,improve BMD of the lumbar spine and hip ,and shorten fracture healing time in patients with osteoporotic intertrochanteric fracture ,but it is not a substitute for surgical treatment.

The concept of enhanced recovery after surgery(ERAS) has been widely accepted and applied in clinical practice.However,as one of the most complex surgical procedures in abdominal surgery,pancreaticoduodenectomy is characterized by long operation time,high incidence rate of postoperative complications and delayed recovery,there still remain some controversies about application of ERAS approaches in perioperative managements of pancreaticoduodenectomy.Although more and more studies has revealed the safety and efficacy of ERAS approaches in pancreaticoduodenectomy,the implementation of ERAS approaches should be still individualized in clinical practice to ensure safety of the patients.

The concept of enhanced recovery after surgery(ERAS) has been widely accepted and applied in clinical practice.However,as one of the most complex surgical procedures in abdominal surgery,pancreaticoduodenectomy is characterized by long operation time,high incidence rate of postoperative complications and delayed recovery,there still remain some controversies about application of ERAS approaches in perioperative managements of pancreaticoduodenectomy.Although more and more studies has revealed the safety and efficacy of ERAS approaches in pancreaticoduodenectomy,the implementation of ERAS approaches should be still individualized in clinical practice to ensure safety of the patients.

Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are the effective methods for treating carotid artery stenosis, but postoperative restenosis remains a challenge. The pathogenesis of postoperative restenosis is currently not fully understood. However, multiple factors, including biomarkers, imaging features, and surgical related factors, have been proven to be associated with postoperative restenosis and can predict the occurrence of postoperative restenosis. This article reviews the predictors of restenosis after carotid endarterectomy and carotid artery stenting.

Objective:To explore the effects of Ophiopogon D combined with cyclooxygenase-2 (COX-2) gene silencing on the proliferation, migration and invasion of human pancreatic cancer BxPC-3 cells.Methods:BxPC-3 cells were divided into blank control group, Ophiopogonin D high-dose group (40 μmol/L), medium-dose group (20 μmol/L) and low-dose group (10 μmol/L). The COX-2-slienced cells were divided into control group, COX-2 inhibited group (50 pmol/ml siRNA-COX-2), Ophiopogonin D group (20 μmol/L) and combination treatment group (Ophiopogonin D 20 μmol/L+ 50 pmol/ml siRNA-COX-2). The proliferation activity of BxPC-3 cells was detected by CCK-8, and the migration distance of BxPC-3 cells was detected by scratched assay. The invasion degree of BxPC-3 cells was detected by Transwell, the relative expression level of COX-2 gene in BxPC-3 cells was detected by real-time quantitative PCR (RT-qPCR), and the relative expressions of COX-2, hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) proteins in BxPC-3 cells were detected by Western blotting.Results:The cell proliferation rates of blank control group, Ophiopogonin D high-dose, medium-dose and low-dose groups were (100.0±4.9)%, (71.8±5.4)%, (80.5±5.8)% and (89.7±5.7)%, respectively. The migration distances were (279.8±24.0) μm, (141.9±21.2) μm, (168.8±37.1) μm and (224.6±19.9) μm, respectively. The absorbance ( A) values of invasion number were 1.107±0.095, 0.390±0.030, 0.596±0.017 and 0.826±0.034, respectively.There were statistically significant differences ( F=19.770, P<0.001; F=48.270, P<0.001; F=198.400, P<0.001). The above indexes of the Ophiopogonin D high-, medium- and low-dose groups were significantly lower than those in the blank control group (all P<0.05). The relative expression levels of COX-2 gene were 1.007±0.178, 0.387±0.169, 0.567±0.142 and 0.740±0.030, respectively, and the relative protein expression levels were 1.000±0.033, 0.654±0.085, 0.762±0.110 and 0.881±0.049, respectively, with statistically significant differences ( F=10.280, P=0.004; F=11.780, P=0.003). The above indexes of the Ophiopogonin D high- and medium-dose groups were significantly lower than those in the blank control group (all P<0.05), and there was no statistically significant difference between the Ophiopogonin D low-dose group and blank control group (both P>0.05). The medium-dose of Ophiopogonin D (20 μmol/L) was selected as the subsequent concentration.After COX-2 silencing, the proliferation rates of the control group, COX-2 inhibited group, Ophiopogonin D group and combination treatment group were (100.0±2.8)%, (68.4±6.7)%, (67.7±5.9)% and (57.0±8.5)%, respectively, the migration distances were (274.4±23.8) μm, (217.0±18.8) μm, (186.2±18.6) μm and (115.7±15.8) μm, respectively, and the A values of invasion number were 1.143±0.092, 0.791±0.058, 0.715±0.026 and 0.424±0.058, respectively, with statistically significant differences ( F=34.430, P<0.001; F=103.400, P<0.001; F=131.100, P<0.001). The proliferation rates, migration distances and invasion numbers in each treatment group were significantly lower than those in the control group (all P<0.001). Compared with the COX-2 inhibited group and Ophiopogonin D group, the cell proliferation, migration and invasion were significantly inhibited in the combination treatment group (all P<0.05). Compared with the Ophiopogonin D group, only the migration distance of the COX-2 inhibited group was significantly different ( P<0.05). The relative expression levels of COX-2 protein in the above groups were 0.995±0.037, 0.779±0.060, 0.806±0.076 and 0.645±0.079, respectively, the relative expression levels of HIF-1α were 1.083±0.104, 0.749±0.070, 0.736±0.070 and 0.394±0.016, respectively, and the relative expression levels of VEGF protein were 1.016±0.103, 0.757±0.090, 0.745±0.021 and 0.603±0.023, respectively, with statistically significant differences ( F=14.650, P=0.001; F=45.220, P<0.001; F=18.180, P<0.001). The expression levels of the three proteins in each treatment group were significantly lower than those in the control group (all P<0.05). Compared with the COX-2 inhibited group and Ophiopogonin D group, the relative protein expression levels of COX-2, HIF-1α and VEGF in the combination treatment group were significantly decreased (all P<0.05). Compared with the Ophiopogonin D group, there were no significant differences in the expression of the three proteins in the COX-2 inhibited group (all P>0.05). Conclusion:Ophiopogon D combined with COX-2 gene silencing can inhibit the proliferation, migration and invasion of pancreatic cancer cells, and the mechanism may be related to the inhibition of COX-2 pathway and the decrease of HIF-1α and VEGF protein expression levels.