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.

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.

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.

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.

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.

Objective To evaluate the feasibility of endoscopic transoral-transpharyngeal approach to the upper cervical. Methods Anatomic characteristics were observed and measured in the anterior column of 50 dry atlas and axis specimens. Conventional and endoscopic methods to decompress the spinal cord and excise the cartilage surface of the atlantoaxial joint by transoral-transpharyngeal approach were taken respectively in two groups of cadaveric heads and necks. All the cadaveric specimens were then open dissected to evaluate endoscopic operation methods, decompression size and the "safe zone". Results The anterior arch of atlas was of a length of (19.8?2.3) mm, the height of odontoid was (15.9?1.9) mm, the width (10.5?0.6) mm, and the thickness (11.5?1.9) mm; the maximal transverse diameter of superior facet of axis was (15.1?1.6) mm, and the anteroposterior one was (17.7?1.3) mm. The anterior tubercle of the atlas could be acted as landmark leading to the endoscopic atlantoaxis surgery. The arch could be drilled either from the tubercle to the lateral side or broken from the junction to the lateral mass. Endoscopic odontoid dissection should begin at the apex of the odontoid, and proceed inferiorly. It was necessary to move or slope the working tube to explore atlantoaxial lateral joint and dissect its cartilage, but the width and depth of cartilage dissection should be limited to 12 mm and 10 mm in order to avoid damage to vertebral artery and spinal cord. Measurements after postoperative open dissection showed that endoscopic decompression size were not significantly different from that of conventional method. There was a "safe zone" in the front of atlantoaxis of transoral-transpharyngeal approach, with (45.9?3.6) mm wide and (29.4?2.5) mm high. Conclusion Endoscopic transoral-transpharyngeal approach to the upper cervical is technically feasible, which had a good exploration and could get the same decompressing size with conventional transoral-transpharyngeal approach.

Objective To investigate the clinicopathological features of thymic neuroendocrine carcinoma and its differential diagnosis. Methods Clinicopathologic analysis and immunohistochemical staining were performed in 5 cases of TNC. Results For 5 cases TNC, 3 cases occurred in men, 2 cases occurred in women. The average age was 46.8 years. They were with chest symptoms before operation. 3 cases were Ⅱ and 2 cases were Ⅲ by clinic stages. Grossly , the tumors were gray in color with areas of hemorrhage and necrosis. Histopathology of well differentiated 2 cases and poorly differentiated 3 cases. Immunohistochemically, the tumor cells were positive for CK, NSE, SyN and CgA. 3 cases were positive for PCNA, Ki67, p53. Conclusions TNC has a pleomorphic appearance of histological features with well, moderate and poorly-differentiated areas. Immunohistochemical staining is helpful in the differential diagnosis of TNC from other tumors derived from the thymus. Neither grading as neuroendocrine carcinomas nor any individual histologic parameter showed a significant association with prognosis. Initial aggressive treatment, including complete surgical excision and adjuvant radiotherapy, appears to offer the best hope for prolonged survival. Adjuvant chemotherapy also should be considered, because the incidence of distant relapse is high.

Objective:To evaluate the nasal safety of gastrodin nasal temperature-sensitive in situ gel through the studies on cilia toxicity in toads and mucosal irritation in rats. Methods:The toads were randomly divided into four groups, saline group, gastrodin in situ gel group, blank gel matrix group and sodium deoxycholate group, and the cilia toxicity was observed in vivo by a toad palate meth-od. The rats were randomly divided into three groups, saline group, gastrodin in situ gel group and blank gel matrix group, and the mucosal irritation was studied in rats through the observation of nasal mucosal pathological changes and behavioral indices. Results:Compared with the saline group, gastrodin in situ and blank gel matrix showed no notable effect on the cilia movement function in toads, and the effect on cilia movement of sodium deoxycholate showed statistically significant difference when compared with that of sa-line, gastrodin in situ gel and blank gel matrix (P<0. 01). During and after the treatment, no sneezing appeared in the rats. Com-pared with that in the saline group, the number of scratching nose in the gastrodin in situ gel group and blank gel matrix group in-creased (P<0. 05) without difference between the groups (P>0. 05), and after the 2-day withdrawal, that in the gastrodin in situ gel group and blank gel matrix group decreased significantly when compared with that at the last administration (P<0. 05) and showed no notable difference when compared with that in the saline group (P>0. 05). The number of inflammatory cells in the nasal mucosa in the gastrodin in situ gel group and blank gel matrix group increased complicated with congestion and cilia falling off, and after the with-drawal, the mucosal morphology in the three groups showed no significant difference. Conclusion:The local application of gastrodin in situ gel has high security, which is valuable to be studied further.

Objective To explore the effect of lysolecithin choline (LPC) on blood-brain barrier(BBB) permeability in rats with acute pancreatitis. Methods Acute pancreatitis rat model was produced and rats were randomly divided into:(1)Test group-AP, rats received LPC by tail vein injection; (2)control group I, AP rats were given normal saline by tail vein injection; (3)control group II, sham operation without AP, but LPC was given by tail vein injection.Horseradish peroxidase(HRP) was used as a tracer to determine BBB permeability 7~10 days later.Results The test group showed local extravascular effusion of HRP, indicating that BBB permeability was markedly increased,while both control groups showed no apparent increase of BBB permeability,which were statistically significant(P