Enhanced recovery after surgery (ERAS) includes preoperative education,intraoperative effective anaesthetization,analgesia,precision surgical techniques and postoperative early rehabilitation.Because of special location of the pancreas,difficulty of surgical techniques,longtime of learning and high incidence of postoperative complications,the application of ERAS in pancreatic surgery is restricted.While ERAS could reduce the stress after surgery and the incidence of complications,promote the recovery of patients,shorten the duration of hospital stay and reduce the expenses,which are confirmed by clinical practice.ERAS is the trend of the development of pancreatic surgery.How to balance the optimal prognosis and speed recovery is need to be resolved by pancreatic surgeons.

Genome-wide association study (GWAS) has been increasing rapidly worldwide in recent years, along with more attention to heredity and genetic polymorphism of diseases.The single nucleotide polymorphism (SNP) is the most common genetic variant in the human genome, which can influence gene expression, transcription, translation and modification, and has become one of the important causes of disease susceptibility.Not only is uric acid related SNP susceptible to hyperuricemia and gout, but also plays an important role in the circulation, respiration, and nervous system diseases.Therefore, the present paper reviews the relationship between uric acid related SNP and clinical diseases in order to bring a new perspective on prevention and treatment.

Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.

Objective To investigate the efficacy and safety of long-term intermittent treatment with topical corticosteroids in localized chronic eczema.Methods A total of 129 patients with localized chronic eczema were treated with triamcinolone acetonide and econazole nitrate cream (Pevisone (R)).Those who achieved a clinical cure within 4-week treatment were recruited into the following long-term study and classifled into 2 groups to be intermittently treated with triamcinolone acetonide and econazole nitrate cream or a moisturizing cream for 8 weeks.The cream was applied topically twice a day for 2 days every week.Patients were followed up on week 4 and 8 after the beginning of treatment and on week 12 after the discontinuation of treatment.The severity of eczema in patients was rated according to SCORAD (SCORing atopic dermatitis) score.Results The SCORAD score was significantly lower in patients treated with triamcinolone acetonide and econazole nitrate cream than in those with moisturizing cream on week 8 in the treatment and week 12 after the discontinuation (t=3.076,2.367,both P<0.05).A statistical decrease was also observed in the recurrence rate of eczema in patients treated with triamcinolone acetonide and econazole nitrate cream compared with moisturizing cream.treated patients at the 3 follow-up time points (x2=4.426,7.683,8.199,all P<0.05).The incidence of adverse events was 3.1% during the treatment with triamcinolone acetonide and econazole nitrate cream.No severe adverse reactions were observed.Conclusion Long-term intermittent treatment with topical corticosteroids is effective for the prevention of exacerbation and postponement of recurrence,of eczema.

Objective To investigate the clinicopathological features,treatment method and prognostic factors of the gastric neuroendocrine neoplasms (gNENs).Methods The clinical data of 80 patients with gNENs who were admitted to the Zhongshan Hospital of Fudan University from January 2002 to December 2011 were retrospectively analyzed.All the patients received gastroscopic examination.Patients with well-differentiated and diameter ≤ 2 cm gNENs received endoscopic mucosal resection or endoscopic submucosal dissection.Patients with poordifferentiated and diameter ＞ 2cm tumors received surgical resection of gNENs.Patients were followed up via phone call,mail or out-patient examination till October 31,2013.The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate.The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model.Results Fifty-eight patients had pain and discomfort in the epigastric region.Thirty-two gNENs were located at the cardia,40 at the body and 8 at the pylorus.Fortyfour gNENs were ulcerative type,25 were polypoid type,11 were protruded type.The mean diameter of the gNENs was 2.6 cm (range,0.4-7.5 cm).Twenty-seven gNENs were in grade 1,10 in grade 2 and 43 in grade 3.Forty-five gNENs were localized,34 gNENs had lymph node involvement (2 gNENs had distal metastasis),and 1 gNENs had distal metastasis.Thirty-one patients received endoscopic resection,and did not receive adjuvant therapy.Forty-nine patients (6 with gastric neuroendocrine tumor and 43 with gastric neuroendocrine carcinoma)received radical resection,including proximal subtotal gastrectomy in 16 patients,distal subtotal gastrectomy in 15 patients,total gastrectomy in 15 patients and distal subtotal gastrectomy + resection of the liver metastasis in 3 patients.Thirty-four patients received adjuvant chemotherapy and 15 did not receive adjuvant chemotherapy.Seventy-nine patients were followed up for a median time of 42.0 months (range,2.0-113.0 months).The mean time of survival was 75.6 months(range,2.8-100.8 months),and the 1-,3-,5-year overall survival rates were 91.3％,75.8％ and 66.5％,respectively.The 5-year survival rates of patients with gNENs in grade 1,grade 2 and grade 3 were 100.0％,100.0％ and 38.0％,respectively.The results of univariate analysis showed that the gender,treatment methods,adjuvant chemotherapy,types of tumor,tumor diameter,classification and staging of the tumor were correlated with the prognosis of the patients (x2=9.550,17.488,25.038,14.994,6.897,25.234,22.066,P ＜ 0.05).The results of multivariate analysis showed that the gender was the independent risk factor influencing the prognosis of the patients (RR =11.280,95％ confidence interval:5.353-19.121,P ＜ 0.05).Conclusions The clinical presentations of gNENs are often nonspecific.The main presentation of gNENs is pain in the epigastric region of the abdomen,and most of the gNENs are located at the cardia or body of the stomach.The staging and grading of the gNENs are varied,and the prognosis is related with the gender of the patients.Endoscopic or surigcal resection is the main treatment method for gNENs.Female patients have a better prognosis than male patients.

Objective To analyze the relationship between age and the prognosis of patients with pancreatic neuroendocrine tumors (pNETs).Methods The clinical data of 102 patients with pNETs who were admitted to the Zhongshan Hospital of Fudan University from January 1999 to December 2010 were retrospectively analyzed.The properties of the tumors were determined by morphology and immunohistochemical staining of chromogranin A,synaptophysin and neuron-specific enolase.Preoperative grading of the tumors was done by mitotic count and Ki67 proliferation index,and the staging of the tumors was done by ENETS TNM system.All patients were divided into younger group (age≤60 years,77 patients) and older group (age ＞ 60 years,25 patients).The survival of the patients was estimated using the life table,and the survival curve was drawn by the Kaplan-Meier method.The survival of the 2 groups was compared using the Log-rank test.Multivariate analysis was performed with the COX proportional hazards model.Results The median survival time was 139.8 months.The overall 1-,2-,5-,and 10-year survival rates were 96％,93％,90％ and 80％,respectively.The postoperative survival time of patients in the younger group was significantly longer than that in the older group (x2 =4.717,P ＜ 0.05 ).The prognosis of patients with higher tumor grades ( G2,G3) and higher TNM stages ( Ⅲ,Ⅳ ) in the older group was significantly poorer than those in the younger group ( x2 =11.158,5.375,P ＜ 0.05 ).The results of multivariate analysis showed that age and major vascular invasion were the independent predictors for survival (RR =8.626,12.795,P ＜0.05 ).Conclusions Age above 60 years is an important independent factor influencing the prognosis of pNETs patients.Tumor grading and TNM staging are highly correlated with the prognosis of the pNETs patients.

Objective To evaluate the effect of EMS through ureteroscope per urethra for the treatment of infant bladder and urethral stone with acute urinary retention. Methods Ten cases (9 boys, 1 girl)of infant bladder and urethral stone with acute urinary retention were treated by EMS through ureteroscope per urethra. Mean age of the patients was 9 months. Two cases suffered from bladder stones while the other 8 cases suffered from urethral stones. The size of stones varied from 0.5-1.1 cm with the average of 0.8 cm. All 10 cases underwent EMS through ureteroseope per ure-thra after general anaesthesia by using ketamine in vein. Wolf F8/9. 8 ureteroscope was used and mo-nitored by television. The EMS probe of ultrasound lithotripsy was sticked through operating passway of ureteroscope to shatter and eliminate bladder and urethral stone. During operation, 50-- 100 ml li-quid pressure was retained in the urinary bladder. The pressure of perfusion pump varied between 160 and 210 kPa(average, 180 kPa). The energy of ultrasound lithotripsy was 40%--60% with a ratio of 30%--70%. F8 type of 2 cavity aerocyst urethral catheter was indwelled after operation. Results The average operation time was 25 min. Urethral stones were rinsed into bladder. Stones were elimi-nated at one time by ureteroscope. Urethral catheters were removed after the patients revived from anesthesia and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. Conclusions Low urinary obstruction could be relieved immediately after EMS through ureteroscope per urethra in patients of infant bladder and urethral stone with acute urinary retention. This operation is safe, high-efficient with less lesion, and would be the first option for the patients of infant bladder and urethral stone with acute urinary re-tention.

Objective To investigate the clinical application of ureteroseope in the treatment of infant renal calculus with acute post-renal failure. Methods Thirteen cases of infant renal calculus with acute post-renal failure included 11 males and 2 females aging from 5 months to 1 years with a mean age of 9 months. Five cases showed bilateral renal calculi with hydronephrosis, 3 cases showed one side renal calculus with eontralateral uretal calculus incarceration, 3 cases showed bilateral uretal calculus incarceration, 2 cases showed bilateral renal calculi and hydronephrosis with urinary calculi. Anuria appeared in 11 cases for 1-3 d while oliguria appeared in 2 cases for 5-10 d. BUN and SCr were higher than normal level in all cases. Hyperuricemia was found in 8 cases, hyperkaliemia was found in 9 cases, pH values in urine of all infants were less than 6. 5(mean, 5. 5). Radiopague stone was not found in all cases by KUB. Hydronephrosis was found in 13 cases, and the diameter of hydro-nephrosis in 9 cases was more than 2.5 cm by B ultrasound. All cases were diagnosed as urinary stones with the diameter from 0.5 to 1.5 cm by CT. All cases were inserted with double J stents un-der ureteroscope for internal drainage, crushing, rinsing and eliminating stones. Results Hyperdi-uresis emerged within 24 h after operation in 13 patients. The duration of hyperdiuresis was from 24 h to 72 h. Urine volume revived gradually 48-96 h after operation while BUN and SCr revived 1-5 dafter operation. Serum uric acid revived 1-7 d after operation in 8 cases of hyperuricacidemia. Serum potassium revived 1-3 d after operation in 9 cases of hyperpotassaemia. Double J tubes were detained for 2-4 weeks. Renal calculus in 10 cases were found by B ultrasound to be discharged and conse-quently double J tubes were pulled out. Renal calculi in 2 cases became smaller and lighter. Conclu-sions For infant renal calculus with acute post-renal failure, upper urinary obstruction could be re-lieved immediately with revived urination and improved renal function by dissolution and crushing of calculus, and the placement of double J tube for internal drainage under ureteroscope. This operation is safe, high-efficient with less lesion, and would be the first option to relieve obstruction for infant re-nal calculus with acute post-renal failure.

Objective To analyze the clinical characteristics of glenoid labral tear combined with rotator cuff tear so as to provide references for arthroscopic surgery.Methods A total of 50 patients (28 males and 22 females)at mean age of 45 years old(ranged from 30 to 58 years)were enrolled in the study.Clinical data including the mechanism and time of injury,symptoms,results of physical examination,X-ray and MRI were collected.Location and degree of rotator cuff and glenoid labral tears found during arthroscopic surgery were also recorded.There were 37 patients with anterior labral tears,eight with superior labrum tears and five with posterior labral tears.The rotator cuff tear was slight in 36 patients,moderate in 10 and severe in three.One patient had extra-large tear.Anterior part of rotator cuff was found torn in 21 patients,middle part in 16 and posterior part in 13.MRI of glenoid labral tears manifested disappearance of triangular appearance and enlarged joint capsule.MRI manifestations of rotator cuff tear were high signal in torn part and continuity loss.Results All patients were followed up for average 36 months(6-72 months),which showed satisfactory results.UCLA score was(15±3)points preoperatively and(32±3)points postoperatively(P＜0.01).Conclusions More attention should be paid to glenoid labral tear to avoid misdiagnosis and delayed treatment,for it is usually combined with rotator cuff tear.Location of rotator cuff tear has some relation to the range of glenoid labral tear,ie,the larger range of glenoid labral tear may induce more posterior part of rotator cuff torn.

Objective To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic acinar cell carcinoma.Methods A retrospective review of 10 patients with pancreatic acinar cell carcinoma treated in our hospital from 1999 to 2008 was conducted and the clinical features,imaging changes,pathologic feature,treatment course and follow-up data were collected.Results There were 9 men and 1 woman with a mean age of (62±8) years old.Tumors were located in the uncinate process in 1 patient,head of pancreas in 7,body and tail in 2.The median size of these tumors was 4.5 cm×4.7 cm;common bile duct and intrahepatic bile duct,pancreatic duct dilation was detected in 7 cases,and superior mesenteric vein was invaded in 2 cases.Of the 10 patients,8 received pancreaticoduodenectomy,among these 8 patients,3 had extended lymph node dissection,2 had portal vein resection and replacement;2received resection of pancreatic body and tail as well as splenectomy.Histologically,the size of these tumors were 4.0 cm×3.3 cm×3.4 cm.Macrescopically,duodenum was invaded in 5 patients,superior mesenteric vein was invaded in 2 patients and neural invasion was present in 7 cases.Lymph node metastasis was noted in 6 cases.Follow-up data was available in 9 patients and 1 patient was lost in follow-up.The survival ranged from 3 to 51 months with a median survival 18 months,and 9 patients died of tumor recurrence and metastasis after operation.Conclusions Pancreatic acinar cell carcinoma should be recognized as a distinct tumor entity and it may not be sensitive to radiotherapy or chemotherapy.The biological features of pancreatic acinar cell carcinoma should be investigated further.