How to make a surgeon? It's not an easy question to answer for some of the graduates with doctor degree (Ph.D.).Because the lack of systemic training and stringent qualification exams in the filed of surgery in our country,Ph.D.need to improve their clinical ability and also shift their roles when they are entering the world of surgery.In this article,the author would like to discuss the way to help Ph.D.in accelerating their changing process from a Ph.D.to a capable confident surgeon based on the author's personal experience.Ph.D.are suggested to improve themselves in the following ways:study like a humble student,learn how to improve oneself through observation,practice diligently on basic technique skills,be brave in surgical practicing,read and write as much as you can,and last but not least cultivate your professionalism.

Pancreatic surgery has achieved substantial improvement in recent years,which was indicated by the continuous decrease of its mortality and morbidity.However,the over-all 5-year survival rate of pancreatic cancer patients has not been significantly improved,and puzzles together with controversies remain in the field of surgical treatment for this devastating disease.Clinical outcomes of pancreatic cancer patients remain poor,which we thought would largely explained by the extremely malignant biological behavior of pancreatic cancer.In this review,we also focused on the frequently discussed themes in the field of surgical treatment for pancreatic cancer.These themes include differential diagnosis for pancreatic head mass,preoperative biliary drainage for jaundice patients,value of R0/R1 resection for pancreatic cancer,pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy.

Pancreatic neuroendocrine neoplasms (pNENs) can be divided into functional and non-functional.Insulinomas,gastrinomas,glucagonomas and VIPomas are the common types of pNENs.Radical resection is the only way for curing pNENs or for a long-time survival of patients.The basic surgical procedures for pNENs are consist of local resection (tumor enucleation) or anatomical resection [pancreatoduodenectomy (standard or pylorus-preserving pancreatoduodenectomy),distal pancreatectomy (combined with splenectomy or spleen-preserving pancreatectomy) and middle segmental pancreatectomy].Liver is the most common site for metastases.Surgical resection is the method of choice for liver metastases.Radiofrequency ablation,transcatheter arterial chemoembolization and liver transplantation could be the adjunctive therapies.

There was never a time in history that so many disciplines and specialists participate and try to lead the clinical management for acute pancreatitis. Chaos remains at bedside, and episodes of under-intervention and especially over-treatment frequently happened. Physicians are easily confused by questions and controversies in management for acute pancreatitis. We have reviewed the articles in acute pancreatitis and made our recommendations based on the latest evidences.

Pancreaticoduodenectomy (PD) is the procedure for treating adenocarcinoma in periampullary region.This involves resection of multiple organs and complex reconstructions.The modern surgery has witnessed the dramatic improvement in outcomes after PD.Mortality has dropped to less than 4％,however,the complication rate remains high,making this procedure still a big challenge for most surgeons. PD is so complicated that even small mistakes could jeopardize the whole procedure and outcomes.With experiences of over 1000 PDs,we discuss the challenges of this procedure and strategies to deal with them.

Objective To study the clinical evaluation of calf blood as a combination of aspirin and aspirin for ischemic stroke and its effect on peripheral blood BCL-2,BAX and Caspase-3,IL-6 and pathogens.Methods 128 patients with ischemic stroke were enrolled in our hospital from September 2014 to October 2016.The patients were divided into observation group and control group by throwing coin method.The control group was treated with oral aspirin tablets and some conventional medical treatment,and the observation group on the basis of this increase in calf blood to the protein injection for treatment,the hemorheology,Barthel index,the national institutes of health stroke scale(NIHSS score)and peripheral blood BCL-2,BAX and Caspase-3 protein content of two groups were recorded before and after treatment.Results After treatment,the total effective rate in the observation group(96.9％)was significantly higher than that in the control group(71.9％),the NIHSS score and hemorheological index of the observation group were significantly lower than those of the control group,Bclhel index was significantly higher than that of the control group,the content of BCL-2 protein in the peripheral blood of the observation group was significantly higher than that of the control group,the levels of BAX and Caspase-3 protein in the peripheral blood of the observation group were significantly lower than those of the control group,the difference was statistically significant(P<0.05).Conclusion The clinical effect of calf blood protein injection combined with aspirin in the treatment of ischemic stroke can not only improve the daily life ability of patients,but also can improve the hemorheology and peripheral blood BCL-2; BAX,Caspase-3 protein content.

Wheezing is the most common respiratory disease in children.In recent years,the incidence of childhood wheezing showed an upward trend,the hot topic in the current study is how to draw up a rational and effective treatment to reduce wheezing.This paper summarized the latest research progress of pathogenic factors,clinical classifi-cation,pathogenesis and prevention strategies in childhood wheezing.It aimed to provide a theoretical basis for early diagnosis and individual treatment for children with wheezing diseases.

Objective To observe the effect of cytokine-induced killer (CIK) cells on the apoptosis of human leukemia cells,and explore the role of miR-155 in this process.Methods The cytotoxicity of CIK cells against a variety of leukemic cell lines (NALM-6,Jurkat) was investigated by MTT technique,miR-155 was determined by real time quantitative PCR,and the apoptosis was detected by flow cytometry in NALM-6 and Jurkat cells induced by CIK cells.Psi CHECK2-CEBP/β 3'-UTR containing the binding site of miR-155 was constructed,and then it was transfected into NALM-6 and Jurkat cells.Luciferase activity of CEBP/β (CCAAT/enhancer binding protein beta) was determined with the assistance of dual luciferase report system.Results CIK cells possessed strong cytotoxicity against NALM-6 and Jurkat cells,which was time-dependent and dose-dependent (P ＜ 0.05).CIK cells could increase the expression of miR-155 in NALM-6 cells by (2.87±0.19) fold (t =2.787,P ＜ 0.05),and in Jurkat cells by (1.98±0.25) fold (t =3.513,P ＜ 0.05).Moreover,miR-155 mimics could promote the apoptosis of NALM-6 and Jurkat cells induced by CIK cells (t =4.239,P ＜ 0.05;t =3.565,P ＜ 0.05).However,miR-155 inhibitor might block this process (t =3.772,P ＜ 0.05;t =4.017,P ＜ 0.05).MiR-155 targeted at the site of CEBP/β3'-UTR,and CIK cells could decrease the luciferase activity of NALM-6 cells by (42.89±2.07) ％ (t =3.578,P ＜ 0.05),meanwhile,in Jurkat cells by (37.02±1.95) ％ (t =4.393,P ＜ 0.05).Conclusion CIK cells could enhance human leukemia NALM-6 and Jurkat cells apoptosis by upregulating miR-155,which may provide a new database to elucidate leukemia cell therapy using CIK cells.

Objective To investigate the effect of Atorvastatin on the proliferation and apoptosis of leukemic HL-60-cell line,and to explore the possible role of phosphatidylinositol 3-kinase/serine/threonine protein kinase /mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathway in this process.Methods HL-60 cells were incubated with different concentrations of Atorvastatin (1,5,10 μmol/L),and HL-60 cells without any treatment were used as controls.The proliferation of HL-60 which was investigated by four methyl thiazolyl tetrazolium assay when cells were cultured for 12,24,48 hours.The apoptosis was detected by flow cytometry after cells were incubated for 48 hours.The mRNA and protein expressions of AKT,PI3K and mTOR were detected by reverse transcription-polymerase chain reaction and Western blot methods,respectively.Results The results indicated that Atorvastatin could inhibit the proliferation and induce the apoptosis of HL-60 cells.When treated with 10 μmol/L Atorvastatin after 48 h,the proliferation inhibition of HL-60 was observed most obviously,with a high rate of (39.77 ± 3.01) ％,compared with the control group,it had statistical significance (t =4.016,P ＜ 0.01),meanwhile,the apoptosis of HL-60 was most notable,at a rate of (43.29 ±3.91)％,compared with the control group,it had statistical significance (t =3.625,P ＜ 0.05).There were basal expression of AKT,PI3K and mTOR in the control group.When treated with 10 μmol/L Atorvastatin after 48 h,the mRNA expression of PI3K,AKT and mTOR were down-regulated most obviously,at a decrease of (37.05 ± 4.11) ％,(53.79 ± 3.27) ％,(40.63 ± 2.42) ％ (t =4.805,3.799,4.312,all P ＜ 0.05),respectively,in comparison with the control group.At the same condition,the protein expression of PI3K,AKT and mTOR were decreased most visibly,with a decline of (41.09 ± 3.17) ％,(45.67 ± 2.92) ％,(63.41 ± 3.59) ％ (t =3.576,4.727,4.902,all P ＜ 0.05) respectively in comparison with the control group.Conclusions Atorvastatin can inhibit the proliferation and induce the apoptosis of leukemic cell HL-60,and the mechanism may be associated with the PI3K/ AKT/mTOR signal pathway.

Objective To investigate the expression of Toll-like receptor 4 (TLR4) and myeloid derived suppressor cells(MDSC) in bone marrow cells in children with acute myeloid leukemia (AML),and to detect its relationship with the clinical features,the effect of chemotherapy and prognosis.Methods Twenty-nine cases of children with AML were collected from June 2013 to March 2014 in People's Hospital of Wuhan University,in which 11 cases of low-risk group,10 cases of middle-risk group,8 cases of high-risk group;and 17 cases of non blood disease was as the control group.The expressions of TLR4 and MDSC were detected by using reverse transcription-polymerase chain reaction (RT-PCR),Western blot methods,immunohistochemical staining,and flow cytometry,respectively,in the bone marrow cells of 29 children with AML.Results The mRNA and protein expression of TLR4 in the initial treatment group was higher than those in the complete remission group(t =3.092,3.393,all P ＜ 0.05).The mRNA and protein expression of TLR4 in the relapse group was higher than those in the complete remission group(t =4.013,4.279,all P ＜ 0.05).The positive expression rates of MDSC in the above 3 groups were (29.77 ± 1.39) ％,(5.19 ± 0.65) ％,(38.62 ± 3.54) ％,respectively,compared with the control group [(1.32 ± 0.27) ％] and there was significant difference(all P ＜0.05).The positive expression rates of TLR4 and MDSC in the initial treatment group,relapse group and complete remission group were significantly higher than those in the control group,with significant differences (initial treatment group TLR4:t =3.559,P ＜ 0.05;MDSC:t =3.727,P ＜ 0.05;relapse group TLR4:t =4.043,P ＜ 0.05;MDSC:t =4.125,P ＜ 0.05;complete remission group TLR4:t =2.798,P ＜ 0.05;MDSC:t =3.469,P ＜ 0.05).Pearson rank correlation analysis showed that there was a positive correlation between the expression of TLR4 and MDSC (r =0.673,P ＜0.01).Conclusions The expressions of both TLR4 and MDSC play an important role in onset,progression,curative effect and prognosis in children with AML,and the two may play an importment role in synergistic effect.