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.

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.

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.

Objective To investigate the effect of budesonide suspension combined with terbutaline on the ventilator-associated pneumonia (VAP) and rehabilitation in patients undergoing thoracic surgery. Methods Fifty-five patients underwent thoracic surgery from June 2006 to January 2017 in our hospital. The patients were treated with budesonide suspension combined with terbutaline atomization solution for inhalation. Forty patients with thoracic surgery were selected as the control group. Comparison of the two groups after the blood gas indicators, the incidence of VAP, mechanical ventilation and hospital stay. Results There was no significant difference in white blood cells, neutrophils and CRP between the two groups.The oxygen saturation of the observation group was higher than that of the control group, the arterial oxygen partial pressure was higher than the control group, PaCO2 was lower than the control group, the difference was statistically significant (P<0.05). The VAP of the observation group was lower than that of the control group. The time of mechanical ventilation was shorter than that of the control group. The hospitalization time was shorter than that of the control group, the difference was statistically significant (P<0.05). Conclusion The combination of budesonide suspension and terbutaline atomization can improve the postoperative effect of thoracic surgery and reduce the incidence of postoperative VAP and promote the early rehabilitation of patients.

Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency is a metabolic disease of long chain fatty acid oxidation. The clinical manifestations are heterogeneous, mainly with heart, liver, skeletal muscle and brain damage, and the onset of which can be from newborn to adult. Cardiomyopathy type is more serious with high mortality. The liver failure type and myopathy type would be potentially lethal, but generally the prognosis is relatively good. Recurrent hypoglycemia, energy metabolism disorder, liver dysfunction, cardiomyopathy and serious arrhythmia are the main causes of death. Most patients can be identified through neonatal screening, and the prognosis is usually good in patients with early diagnosis and treatment. The purpose of this consensus is to standardize the diagnosis, treatment and management of VLCAD deficiency, so as to improve the prognosis of patients and reduce death and disability.

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.

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.

Objective To discuss the effect of psychological intervention in relieving anxiety and depression of patients with ocular injuries caused by automotive air bag.Methods.34 patients with ocular injuries caused by automotive air bag were selected and divided into the intervention group and the control group with 17 patients in each group.The control group adopted routine intervention,while the intervention group was given psychological intervention,including music therapy,Beck's cognitive therapy and before-discharge education.Self-rating anxiety and self-rating depression scale were used to evaluated the psychological status of patients at admission and one day before discharge.Results Incidence of anxiety and depression significantly decreased in the intervention group after intervention.Score of anxiety and depression reduced after intervention in the intervention group,also evidently lower than that of the control group.Conclusions Psychological intervention can relieve anxiety and depression of patients with ocular injuries caused by automotive air bag.

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.

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.