Pancreatic cancer is a highly malignant tumor in the digestive system, and radical surgery is the only possible means to cure pancreatic cancer at present. In the past decade, pancreatic surgery has been developing rapidly, with various new technologies and concepts emerging, among which the use of minimally invasive techniques and the popularization of neoadjuvant therapy concepts are the most notable. At the same time, the surgical treatment of pancreatic cancer still has a long way to go, and many problems need to be solved urgently. This article introduces the surgical treatment of pancreatic cancer in the 2024 edition of the NCCN guidelines, focusing on minimally invasive and open surgical treatments, expanded lymph node dissection, combined vascular resection and reconstruction, surgical treatment of pancreatic neck cancer and neoadjuvant therapy, and briefly discussing the unresolved issues.

Pancreatic cancer is a highly malignant tumor in the digestive system, and radical surgery is the only possible means to cure pancreatic cancer at present. In the past decade, pancreatic surgery has been developing rapidly, with various new technologies and concepts emerging, among which the use of minimally invasive techniques and the popularization of neoadjuvant therapy concepts are the most notable. At the same time, the surgical treatment of pancreatic cancer still has a long way to go, and many problems need to be solved urgently. This article introduces the surgical treatment of pancreatic cancer in the 2024 edition of the NCCN guidelines, focusing on minimally invasive and open surgical treatments, expanded lymph node dissection, combined vascular resection and reconstruction, surgical treatment of pancreatic neck cancer and neoadjuvant therapy, and briefly discussing the unresolved issues.

Circulating tumor DNA(ctDNA) is the DNA fragment released into blood by tumor cells.Wheather it presents or not and its plasma concentration are closely related to the prognosis of patients. The common detection methods of ctDNA include digital polymerase chain reaction,second-generation sequencing,methylation detection technology and so on. Detecting specific point mutations or methylation of ctDNA can not only assist in the diagnosis of pancreatic cancer,but also be expected to identify pancreatic cancer at an early stage. Detecting ctDNA after operation can help predicting tumor recurrence and metastasis effectively,so that patients with high recurrence and metastasis risks can be intervened in advance. Accordingly,this article intends to review detection technology of ctDNA and its clinical applications in the early diagnosis of pancreatic cancer,the prediction of tumor recurrence and metastasis after surgery,and the evaluation of patient prognosis.

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Circulating tumor DNA(ctDNA) is the DNA fragment released into blood by tumor cells.Wheather it presents or not and its plasma concentration are closely related to the prognosis of patients. The common detection methods of ctDNA include digital polymerase chain reaction,second-generation sequencing,methylation detection technology and so on. Detecting specific point mutations or methylation of ctDNA can not only assist in the diagnosis of pancreatic cancer,but also be expected to identify pancreatic cancer at an early stage. Detecting ctDNA after operation can help predicting tumor recurrence and metastasis effectively,so that patients with high recurrence and metastasis risks can be intervened in advance. Accordingly,this article intends to review detection technology of ctDNA and its clinical applications in the early diagnosis of pancreatic cancer,the prediction of tumor recurrence and metastasis after surgery,and the evaluation of patient prognosis.

Objective To investigate the superinfection of human immunodeficiency virus (HIV) / hepatitis B virus (HBV) in Yining City, and to study on its prevention and control measures. Methods A total of 21 cases of HIV / HBV superinfection recorded by Yining CDC from January 2017 to October 2019 were investigated. Results In this group, the proportion of male (66.67%) was higher than that of female (33.33%), 36-60 years old and 17-35 years old (42.86% and 33.33%), junior high school and primary school and below (57.14% and 28.57%), sex workers and migrant workers (42.86% and 28.57%) were higher. The common clinical manifestations of this group were long-term fever, emaciation, general pain and so on. HIV was mainly sexually transmitted (61.90%). HBV was mainly transmitted by blood and sex (47.62% and 9.52%). The proportion of big three Yang was the highest (42.86%), followed by simple HBsAg (23.81%), small three yang (19.05%), HBsAg / anti HBC (14.29%). Conclusion In Yining City, 36-60 years old of male, junior high school and below, sex workers and migrant workers account for a relatively high proportion, and their clinical manifestations were complex, with clear features. Therefore, prevention and management should be strengthened.

With the improvement of living standards in recent years, the incidence rate of nonalcoholic fatty liver disease (NAFLD) has kept increasing, with 15%-30% in general population and 50%-90% in obese population. The "second-hit" theory has been widely recognized as the pathogenesis of NAFLD. In-depth studies have found that intestinal flora imbalance may promote the progression of NAFLD by increasing energy absorption in the body, damaging intestinal mucosal barrier, and producing large amounts of toxic metabolites, which provides a new direction for exploring the pathogenesis of NAFLD and effective therapies. This article reviews the role of intestinal flora imbalance in the development and progression of NAFLD.

Objective To understand the misreporting rate regarding the routes of transmission among the reported HIV patients in Yili prefecture of Xinjiang,since 2011.Methods An investigation focusing on the route of transmission among people living with HIV/AIDS was carried out to clarify the responsible reasons for the situation.Results The overall incorrect reporting rate on the route of transmission was 10.8％.The proportion of heterosexual transmission route was over estimated by 63.8％ to 72.0％.However,the proportion of injecting drug was underestimated by 27.5％ to 22.2％.The number of cases being confirmed as through heterosexual transmission but incorrectly reported was quite high,contributing 82.6％ of all the incorrectly reported cases.Most of the patients that incorrect reported,were moved from injecting drug use to heterosexual transmission,which contributed 79.5％ of all the total incorrectly reported cases.Results from multi-factor analysis showed that the risk related to incorrect reporting was 3.64 times in males than in females.People who anticipated to receive HIV testing were 2.23 times more than those who had not.Old-age groups were 3.511,4.053,4.415 and 6.524 times higher than those people who were aged below 16 years.Conclusions The proportion of heterosexual transmission route was over-estimated while the proportion on injecting drug use was underestimated.However,the transmission pattern had changed from injecting drug use at the early epidemic stage,to current sexual transmission mode.We recommended that more attentions should be paid to patients who were males,at older age or those who had no expectation in receiving the HIV testing,during the initial following-up stage.

Objective To analyze the sex specific mortality in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART) and risk factors in Xinjiang Uyghur autonomous region (Xinjiang),and provide evidence for the evaluation of the effect of HAART.Methods A retrospective analysis was conducted on the mortality and survival of 8 061 male cases and 6 001 female cases of HIV infection,who received HAART during July 2004-June 2013 in Xinjiang.The information of the cases were downloaded from national antiretroviral therapy reporting sub-system in national HIV/AIDS reporting system.Cox proportional hazard model was used to identify the risk factors of deaths.Results The male cases were older and had lower CD4 value at baseline compared with the female cases.The major transmission route was injecting drug use in males,but sexual contact in females.The overall mortality of the male cases was higher than that of the females,which was 10.87/100 person-years during the first three month after receiving HAART,and 7.00/100 person-years two years later in males,but 4.77/100 person-years during the first three month and 3.00/100 person-years two years later in females.The results from Cox analysis showed that the risk factors were the CD4 value at baseline and transmission route.Compared with the cases who had lower CD4 value (CD4＜200 cells/μl) at baseline,the HR for the cases who had higher CD4 value (CD4 ≥ 350 cells/μl) was 4.08 (95％ CI:2.96-5.62) in males and 5.11 (95％CI:3.16-8.35) in females.Compared with sexual transmission,the HR for IDUs was 1.99 (95％CI:1.66-2.40) in males and 1.77 (95％ CI:1.24-2.52) in females.The results of cumulative survival analysis showed that in conventional treatment group (CD4＜350 cells/μl),the five year survival rates were 81％ and 87％ for the males and females infected through sexual contact and 66％ and 75％ for the males and females infected through injecting drug use,and in early treatment group (CD4≥350 cells/μl),the five year survival rates were 97％ and 98％ for the males and females infected through sexual contact and 86％ and 97％ for the males and females infected through injecting drug use.Conclusion In Xinjiang,the higher mortality in male HIV infection cases receiving HAART was related with lower CD4 value at baseline and higher infection rate through injecting drug use.Besides the weak intention for treatment and poor compliancy would be the deeper risk factors.

Objective To evaluate the role of neuron-restrictive silencer factor (NRSF) in the spinal cord in remifentanil-induced hyperalgesia in a mouse model of incisional pain (IP) .Methods Fifty-six male Kunming mice were randomly divided into 7 groups (n=8 each):control group (group C) ,IP group (group I) ,IP +remifentanil group (group IR ) , NRSF antisense oligonucleotide group (NAS group ) , IP + NRSF antisense oligonucleotide group (I+NAS group ) ,IP + remifentanil + NRSF mismatch oligonucleotide group (IR+NMS group) , and IP + remifentanil + NRSF antisense oligonucleotide group (IR + NAS group ) . Artificial cerebrospinal fluid 5 μl was injected intrathecally once a day for 3 consecutive days in C ,I and IR groups .NRSF antisense oligonucleotide NAS 10μg was injected intrathecally once a day for 3 consecutive days in NAS ,I+NAS and IR + NAS groups . NRSF mismatch oligonucleotide 10 μg was injected intrathecally once a day for 3 consecutive days in IR+NMS group .A 1-cm longitudinal incision was made through skin ,fascia and muscle of the plantar aspect of the right hindpaw to establish the model of incisional pain in sevoflurane-anesthetized rats .At 30 min after the last injection ,normal saline 0.4 ml was infused subcutaneously in C and NAS groups ,the model was established and normal saline 0.4 ml was subcutaneously infused simultaneously in I and I+NAS groups ,and the model was established and remifentanil 0.04 mg/kg was subcutaneously infused simultaneously in IR ,IR+NMS and IR+NAS groups .At 3 days before operation (T0 ) ,4 h before operation (T1 ) and 4 ,12 ,24 and 48 h after operation (T1-5 ) ,mechanical paw withdrawal threshold to von Frey stimuli (PMWT ) and paw withdrawal latency to thermal nociceptive stimulus (PTWL ) were measured .Results Compared with C group ,the PWMT and PWTL were significantly decreased at T2-5 in I ,IR ,I+NAS ,IR+NMS and IR+NAS groups ( P<0.05) ,and no significant change was found in the PWMT and PWTL at each time point in NAS group ( P>0.05 ) .Compared with I group ,the PWMT and PWTL were significantly decreased at T2-5 in IR and IR+NMS groups ( P<0.05) , and no significant change was found in the PWMT and PWTL at each time point in I +NAS group ( P>0.05) . Compared with IR group ,no significant change was found in the PWMT and PWTL at each time point in IR+NMS group ( P>0.05) ,and the PWMT and PWTL were significantly increased at T2-5 in IR+NAS group ( P<0.05) . Conclusion NRSF in the spinal cord is involved in the development and maintenance of hyperalgesia induced by remifentanil in a mouse model of IP .