Insulinoma (islet β-cell tumor) is one of the most common pancreatic endocrine tumors. It has a typical clinical manifestation called Whipple's triad. And so far, surgical treatment is the only curative method. But the localization diagnosis of insulinoma is difficult. Recently, with advances in diagnostic tech-niques, the localization diagnosis of insulinoma accuracy has markedly improved. This paper makes a brief overview of the progress in diagnosis and treatment of insulinoma.

Pancreatic resection is the treatment choice for pancreatic malignancy and cer-tain benign pancreatic disorders. Althogh, pancreatic resection requires high techndogy whereas current mortality after a pancreaticoduodenectomy has dropped to below 3 % in expe-rienced high-volume centers and post-operative morbidity is still as high as 50%. At pres-ent, the single most significant cause of morbidity and mortality after pancreatectomy is the development of pancreatic leakage and fistula (PF). The occurrence of a PF increases the length of hospital stay and the cost of treatment, requires additional investigations and proce-dures, and can result in life-threatening complications. Early recognition of a PF and prompt institution of appropriate treatment is critical to the prevention of potentially devastating con-sequences; however there is no universally accepted definition of PF that would allow stand-ardized reporting and proper comparison of outcomes between different centers. The present article reviews the conlept evolution of PF and discusses the current preventive strategies.

NF-κB is a nuclear transcription factor with multiple adjustion. The activation of NF-κB can occur by three different mechanisms. The multiple NF-κB activation pathways are important due to the large number of genes that are regulated by NF-κB and their effects on cancer cells. These gene products can promote growth and tumori-genesis, inhibit apoptosis, allow metastasis and invasion, promote angingenesis, and cause chemoresistance. All of these roles in pancreatic cancer make NF-κB a promising target in treatment. Therefore, inhibiting the activity of NF-κB becomes a hot spot and novel idea of preventing and treating pancreatic cancer.

Objective To summarize the experience in the diagnosis and treatment of adenosquamous carcinoma of the pancreas to better our understanding of this rare exocrine pancreatic neoplasm. Methods The clinical data of five cases of adenosquamous carcinoma of pancreas admitted between July 2002 and June 2008 were analyzed retrospectively, and relevant literature was reviewed and discussed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 2 women with a mean age of 64 ± 18 years old. Tumor was located in the head of pancreas in 2 patients, body and tail in 3 cases. One patient was submitted to pancreaticoduodenectomy, three patients underwent distal pancreatectomy and splenectomy and one had cholecystojejunostomy and gastric bypass surgery, as well as 1251 implantation. The mean size of the tumor was 4.5 cm. One patient had posterior stomach wall, descending duodenum, portal vein involvement; spleen was invaded in 2 cases; neural and vessel invasion was present in 2 cases. Lymph node metastasis was present in 1 case. Pathologically primary tumor and liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. In all 5 patients with complete follow up, 3 died of tumor recurrence or liver metastasis with a mean postoperative survival time of 11.2 momths (8.5 ~ 13.5 months). The other 2 cases survived for 6 and 56 months , respectively. Conclusions Pancreatic adenosquamous carcinoma was likely to be found in patients in their 60s, and confirmative diagnosis was difficult. The prognosis of this rare tumor appeared to be dismal due to the high degree of malignancy.

Pancreaticoduodenectomy,which is also known as Whipple surgery,is a complex of high-risk surgery,while the majority of patients have postoperative complications.As a serious complication,pancreatic fistula has been prevented and treated by a variety of methods.Currently,the main methods include improved surgical methods,somatostatin analogues,the use of support tube and medical adhesive,and so on.However,prevention and treatment of pancreatic fistula remains to be controversial.Here,the author will review the research progress of pancreatic fistula.

Objective To sum up the clinical experience of treating thoracolumbar fractures with Scofix system and transpedicular bone graft. Methods 62 consecutive patients with thoracolumbar fracture were treated operatively with reduction and stabilization by Scofix system combined with vertebral fusion via transpedicular bone grafting. Results 62 patients were followed up. Their postoperative radiographs and CT scans showed that more than 90%of the cases gained reduction, the effective diameters of vertebral canal became normal and the mean time of vertebral fusion was about 3 months. Conclusions Scofix system is effective in reduction and fixation for thoracolumbar fractures, and transpedicular bone graft is helpful in restoring the height of vertebral body and increasing vertebral fusion. The procedure also has advantages of preventing vertebral collapse, reducing nerve injury and facilitating functional recovery.

MicroRNA (miRNA) plays a regulating function in translation stage of gene expression.MiRNA has been found directly involving in the occurrence and development of pancreatic cancer,and its abnormal expression is closely related to early diagnosis of pancreatic cancer and may provide new therapeutic target for pancreatic cancer patients.MiRNA detection will have good application prospect in on the diagnosis and treatment of pancreatic cancer.

Background and purpose: The incidence of Hashimoto's disease (HD) coexistent with thyroid carcinoma is 0.5%-38%, and it is increased significantly in recent years. Therefore, we investigated the clinical characteristics and surgical experiences in patients with HD coexistent with thyroid neoplasm. Methods: The clinical data in 417 cases of HD coexistent with thyroid nodules including 93 cases of HD coexistent with thyroid carcinoma treated surgically and confirmed pathologically from Jun. 1985 to Dec. 2007 were analyzed. Results: The coexistent rate of HD with thyroid carcinoma (TC) was 22.3% respectively. The coexistent rate of HD with TC was 9.2% before 1995, and it went up to 24.7% after that year (P<0.05). Among those HD coexistent with TC patients, 66 cases were papillary carcinoma, 15 cases were follicular carcinoma, 9 cases were mixture and 3 cases were lymphoma. There were 43 cases of micro-foci thyroid carcinoma, which accounted for 46.2% of the malignancy. Unilateral or bilateral, total, subtotal or partial thyroidectomy and biopsy were the main operative procedures for the disease. Conclusion: There is a high incidence of thyroid carcinoma in patients with HD coexistent with thyroid nodules, and it is rising up recently. In the clinical treatment of HD, we should be aware of the coexistent thyroid tumors and micro-foci thyroid carcinoma.

Objective To explore the possible causes that result in serum-resistance of patients with syphilis. Methods Cerebrospinal fluid(CSF) routine and biochemistry, RPR, TPPA, and immunological function in 25 patients with syphilis serum-resistance were detected after giving the standard therapy, and radiographic examination of multiple internal organs was performed as well. All patients were treated with 24 million units of Penicillin G per day by intravenous drip for 14 days followed by muscle injection of Bicillin 2.4 million units weekly for 3 weeks after leaving hospital. Blood serum RPR was reexamined 3 and 6 months after treatment, respectively. Results Among 25 patients CSF-TPPA was positive in 11 cases, all patients' CSF-RPR were negative, CSF-WBC and CSF-Pr increased in 7 patients, serum IgM level increased and C3 decreased in 10 cases (40%), and CD_3+CD_8+ cell count increased and NK cell count decreased in 21 cases (84%). The regurgitation of bicuspid valve, tricuspid valve and aortic value was found in 3 patients. The RPR titers in all patients did not decrease after treatment according to neurosyphlis. Conclusion Asymptomatic neurosyphilis and immune disorder may be causes of serum-resistance of syphilis.