Neuroendocrine neoplasm (NENs) is a kind of rare tumor which occurs in multiple human organs.The prognosis of NENs is relatively good,but the diagnosis and treatment of NENs is complicated and involve different specialties.In major medical centers,comprehensive and standard diagnosis and treatment could improve the prognosis of NENs and reduce the waiting and treatment time via multidisciplinary team (MDT) model.The regional variation and differences in the techniques among hospitals are decreasing through communication and learning among the members of MDT.Recently,the excellent MDT is working in a spirit of cooperation and sharing to create the patients-centered model,with professional doctors and complete hardware facilities.The NENs clinical center needs to strengthen diagnosis,treatment,research and training.

The results of observation on experimental photolocalization and photochemotherapy with a new drug photocarcinorin (PsD-007) and argon laser (514.5+ 488nm) for different transplanted animal tumors are reported.The interrelationship among the dose of light irradiation,dose level of the drug and the efficiency of experimental photodiagnosis and photochemotherapy for animal tumors was studied.It has been shown that the degree of photodynamic damage on tumors is proportional to the light dose.The upper and lower thresholds of effective light-dose seem to be about 150 mw/cm2 and 40 mw/cm2 for 30 min respectively.The light dose for curing half of experimental animals ranged from 80 to 100 mw/cm2 for 30 min with a drug dose of 5mg/kg.The photodynamic damage on tumors in closely correlated to drug dose with a given light dose.The photodynamic effects on different tumors are essentially consistent with each other.A bright oranged-red fluorescence appeared on the fumor tissues of S180 sarcoma,Lewis lung carcinoma or U14 cervical carcinoma bearing mice on exposure to argon laser and/or UV light (365nm) 24 and 48 h after the injection of 5mg/kg of PsD-007.But no fluorescence was found on the normal tissues around the tumors under the same conditions.It is suggested that PsD-007 may be specifically uptaken into the malignant tissues.The intensity of fluorecence on tumors is directly proportional to drug dose and inversely proportional to the time interval between drug administration and observation on the fluorescence.The homogeneity of distribution of light energy was improved by using a "lens aperture" placed between the light source and irradiated animal.A model system was thus provided for the evaluation of the efficiency of drugs in the photochemodiagnosis and photochemotherapy for animal tumors.

Extracapsular cataract extraction (ECCE) with primary posterior chamber intraocular lens (IOL) implantation was performed on 31 cases (38 eyes)of cataract with high myopia of axial length over 26mm and preoperative retinal visual acuity of ≥0.5. They were followed up for 3～26 months. Postoperative visual acuity s. c. was ≥0.5 in 65.8％ of the eyes and visual acuity c.c. was ≥0.5 in 92.1％ and 1.0～1.5 in 52.6％ of the eyes. The results showed that it was fairly possible for cataract patients with high myopia to obtain normal vision after ECCE and IOL implantation when the preoperative retinal acuity was ≥0.5. The calculation of lens power and surgical procedures were described, and the indications for the operation and the managements of complications were discussed as well.

Objective To explore the clinical value of the detection of ankle-brachial index(ABI) combined with high-sensitivity C-reactive protein (hs-CRP) for evaluation coronary artery lesions in diabetic patients.Methods According to the diagnostic results of 256 layer speed CT,238 diabetic patients were divided into the group without coronary artery lesions(52 cases),the group with mild coronary artery lesions(103 cases) and the group with severe coronary artery lesions (83 cases).The ABI and hs-CRP were detected.The relationship between ABI,hs-CRP and cartotid artery intima-media thickness(IMT) were analyzed.Results The ABI and hs-CRP of the group with mild coronary artery lesions or with severe coronary artery lesions were lower than that of the group without coronary artery lesions(P ＜0.05 or P ＜0.01).The ABI and hs-CRP of the group with mild coronary artery lesions were lower than that of the group with severe coronary artery lesions(all P ＜ 0.05).The IMT was (1.37 ± 0.29) mm in the group with coronary artery lesions,which had a negative correlation with A BI (r =-0.2195,P ＜ 0.05) and a positive correlation with hs-CRP(r =0.3946,P ＜ 0.05).Conclusion The detection of ABI combined with hs-CRP can be used to evaluate diabetic patients with coronary artery disease.

The cardinal features of Turner syndrome(TS) are short stature,congenital abnormalities,gonadal dysgenesis.The sex hormone insufficiency lead to infertility and lack of proper development of secondary sex characteristics,it also involves in the frequent osteoporosis and increased cardiovascular risk,state of physical fitness,insulin resistance,body composition,and may play a role in the increased incidence of autoimmunity.Recent researches emphasize the TS patients need for proper sex hormone replacement therapy to improve their quality of life.This review summarizes the effects of estrogen and androgen insufficiency as well as the effects of sex hormone replacement therapy on the whole body of Turner syndrome.

About 20％-30％ of pancreatic neuroendocrine neoplasms (pNENs) are resectable after the initial diagnosis,and about 70％-80％ of pNENs are locally advanced or metastatic tumors.For resectable pNENs,primary and metastatic lesions are suggested to be resected,and for locally advanced or metastatic functional tumors,debulking surgery is encouraged for controlling the symptoms and alleviating the life quality; debulking surgery could not improve the overall survival of patients with non-functional neuroendocrine tumors,unless there are lifethreatening complications such as bleeding or obstruction.For type Ⅰ liver metastasis,simultaneous resection of primary and metastatic lesions is advised; while for type Ⅱ liver metastasis,systemic treatment combined with local treatment (radio-frequency ablation,transcatheter arterial chemoembolization and transartery embolization) is effective; for type Ⅲ liver metastasis,target therapy such as Sunitinib,Everolimus combined with long acting Sandostatin is effective.No adjuvant therapy is needed after radical resection of pNENs,while following therapy is suggested for patients after metastatic pNENs resection.

Pancreatic neuroendocrine tumor (pNET) accounts for about 2％ of all malignant pancreatic tumors.According to presence or absence of specific hormone related symptoms,pNET is classified as functional and non-functional.About 75％ of pNET is non-functional.Surgery is the only potential treatment that cures pNET.Before operation,localization of primary tumor is very important.For localized lesions,pancreaticoduodenectomy,segmental pancreatectomy,distal pancreatectomy or enucleation could be chosen according to the site of primary tumor.For metastatic pNET,if the primary lesion and metastatic lesions could be resected simultaneously,aggressive approach is an optimal choice and better clinical outcome could be achieved.For those with big multiple metastatic lesions,especially in the liver,debulking operation should be considered when more than 90％ metastatic lesions could be resected,for debulking operation could improve the survival and quality of life of those patients.Liver transplantation should be reserved to patients with no extra-hepatic metastasis and tumor is stable with low grade,while R0 resection could be achieved for primary lesion.

The incidence of pancreatic neuroendocrine tumors is increasing in recent years. Scientific treatment strategy will improve the prognosis of patients. Surgical resection is the main treatment for pancreatic neuroendocrine tumors, especially for localized tumors. At present, there are still controversies about the treatment of pancreatic neuroendocrine tumors at home and abroad. Based on the literature and clinical practice, the author combs the related controversies and suggests that the age, physical condition, tumor location, staging, grading and functional status of the patients should be taken into consideration when making the surgical plan. The individualized treatment of pancreatic neuroendocrine tumor should be realized according to the specific situation of the patients and the evidence-based medicine.

ObjectiveTo investigate the effects on QT dispersion in patients who received maintenance hemodialysis by dialysate with different concentration of potassium. MethodsTook 57 patients who received maintenance hemodialysis as dialysis group, took another 30 healthy subjects as control group, patients in dialysis group alternatively received hemodialysis by dialysate with potassium concentration of 2.0mmol/L and 3.0mmol/L once. QT interval of both groups were recorded by 12-lead synchronized ECG and then QT dispersion and QTcd were calculated. ResultsQTd and QTcd of dialysis group were(52.7 ±8.2) and(63.2 ±9.0)ms respectively and which were significantly higher than control group, the difference between groups was statistically significant( t =2. 638,2. 750, both P ＜ 0.05 ) ; QTd, QTcd and the incidence of arrhythmia of 2.0mmol/L K + group were ( 63.5 ± 7.6), ( 72.3 ± 8.0)ms and 22.8％ ( 13/57)respectively and which were all significantly higher than 3.0mmol/L K + group,the differences between groups were statistically significant ( t =2. 245,2.351, x2 =5. 599, all P ＜ 0.05 ). ConclusionQT dispersion reflectsed the heterogeneity of ventricular repolarization and electrical instability,and the use of dialysate with potassium concentration of 3.0mmol/L could shorten QT interval and reduce the incidence of arthythmia.

The incidence and prevalence of pancreatic cancer have been steadily increasing globally and domestically. The common risk factors of pancreatic cancer include diabetes mellitus, chronic panereatitis, cigarette smoking, family history of pancreatic cancer, and alcoholism. There is no specific symptom and early diagnostic marker of pancreatic cancer. CA19-9 is the most commonly used serum marker for the detection and follow-up of pancreatic cancer. However, its sensitivity and specificity precluded its use in screening of the disease. Enhanced spiral CT scan is the routine radiological modality for the diagnosis and staging of pancreatic cancer. Newly developed diagnostic modality such as ultrasound contrast imaging, endoscopic ultrasound, PET/CT scan further improved the sensitivity and specificity of diagnosis. Preoperative fine needle aspiration (FNA) is not recommended for patients with resectable pancreatic cancer. Pathological confirmation by FNA is necessary for patients who will be treated by chemotherapy or chemoradiotherapy. Preoperative staging laparoscopy can rule out the patients with abdominal seeding, so that unnecessary open surgery is avoided. In order to achieve better survival, every effort should be made to achieve R_0 resection for patients with stage Ⅰ or Ⅱ disease.