Objective To explored the operation opportunity，operation skill and therapeutic effect of emergency pancreaticoduodenectomy for severe pancreaticoduodenal trauma.Methods Seven patients with severe pancreaticoduodenal trauma underwent emergency pancreatoduodenectomy，one with liver rupture repair and right hemicolectomy，and one with left  kidney and splenectomy resection.Results All the operations were successfully completed.Two patients had bile leakage after operation，recovered after the conservative treatment.No evere intraabdominal infection，pancreaticointestinal anastomotic leakage，postoperative bleeding and other complications occurred.There were no reoperations and postoperative death occurred.All patients returned to normal diet and discharged from hospital.Conclusions Emergency pancreatoduodenectomy can be considered as an effective treatment for patients with severe pancreaticoduodenal trauma which can not be cured by other methods.

Objective To investigate the risk factors study and measures of postoperative intestinal adhesion in patients with laparoscopic cholecystectomy.Methods A total of 224 patients who treatment by LC in our hospital between April 2015 and April 2018 were selected as the study subjects，and occurrence of intestinal adhesions in all subjects after LC postoperation were recorded.According to the occurrence of intestinal adhesions that the patients with after postoperation were divided as intestinal adhesions group（n=45）and without intestinal adhesions group（n=179），and useing analyzed by relevant statistical analysis software the time of anal exhaust，sex，residual infection of abdominal cavity，BMI，patients's experience in LC operation，age，indwelling drainage tube，etc were conducted by monofactor analysis，and logistic regression analysis was conducted on the meaningful indexes of univariate analysis.The 45 cases of intestinal adhesions after LC postoperation were divided into conservative treatment group（n=25）and laparoscopic enterolysis treatment group（n=20）according to the different treatment methods，and the therapeutic effect of intestinal adhesion after LC was compared between the two groups，and effective prevention and treatment measures were summarized.Results After LC，intestinal adhesion occurred in 45 cases，but not in 179 cases.Patients with intestinal adhesion were randomly divided into conservative treatment group（25 cases）and laparoscopic intestinal adhesion release（20 cases）.Group of intestinal adhesion after LC postoperation that after postoperation Indwelling drain tube，abdominal residual infection，diabetes mellitus，anal exhaust time >24h，and the proportion of LC operation ≤50 cases was significantly higher than that of no postoperative intestinal adhesion group，and there was statistical difference（P<0.05）；diabetes mellitus，abdominal residual infection after postoperation，postoperative indwelling drainage tube，LC operation of patients ≤50 cases were independent risk factors of intestinal adhesion after LC（P<0.05）；the total effective rate of laparoscopic enterolysis group was significantly higher than that of conservative treatment group，and there was statistical difference（P<0.05）.Conclusion Complicated with diabetes，postoperative abdominal residual infection，postoperative indwelling drainage tube and performer LC operation≤50 cases，which are risk factors for postoperative intestinal adhesion in patients with laparoscopic cholecystectomy.

Objective To investigate the effect of minimally invasive neuroendoscopic surgery on patients with hypertensive cerebral hemorrhage（HICH）and its effect on nerve function.Methods Retrospective study of 110 patients with HICH in our hospital（January 2015 to February 2018）was conducted.According to the surgical method，48 patients in the minimally invasive group（neuroendoscopic surgery）and 62 patients in the craniotomy group（small bone window）were divided into craniotomy.Treatment）；Comparison between the two groups of operation time，surgical bleeding volume，hematoma clearance rate，ICU days，total hospital time，patients with different times before and after the operation National Institutes of Health stroke scale score（NIHSS），simple mental state scale（MMSE），Daily Living Activity Ability（ADL）Scale score.Results Surgery time of invasive group and craniotomy group was（140.6±22.1)min and (179.4±29.5）min，while surgical hemorrhage was（37.2±8.6)ml and( 187.5±32.0）ml，ICU time was（4.2±1.0)d and (5.9±1.5）d，total hospitalization time was（15.8±2.0)d and (19.4±2.8）d,respectively.For comparison，the minimally invasive group was lower than the craniotomy group（P<0.05）；The hematoma clearance rate in the minimally invasive group[（90.6±6.2）%] was higher than that in the craniotomy group[（86.1±5.8）%]（P<0.05）；Before the operation，there was no statistically significant difference between the two groups of NIHSS scores（P>0.05），4 weeks after surgery and 3 months after surgery，the NIHSS score was gradually reduced in both groups（P<0.05）.The NIHSS score（13.9±3.7，6.8±1.8）of the minimally invasive group was lower than that of the craniotomy group at the corresponding time（15.5±4.1，8.2±2.1）（P<0.05）；In the 3 months after surgery，the MMSE score（24.8±2.8）in the minimally invasive group was higher than that in the craniotomy group（22.5±3.6）（P<0.05）；After 4 weeks and 3 months after surgery，the ADL score（49.8±6.2，71.3±5.8）in the minimally invasive group was higher than that in the craniotomy group（46.3±5.7，67.5±6.2）（P<0.05）.Conclusion Neural endoscopic minimally invasive surgery to treat HICH smaller bone window craniotomy has better results，especially hematoma removal and the recovery of nerve function，cognitive function，and daily life activity in patients after surgery have certain advantages.

Objective To investigate the effect and feasibility of ropivacaine in local postoperative abdominal incisional pain in patients with minimally invasive esophageal cancer.Methods A retrospective analysis of 134 patients with thoracic esophageal cancer treated by thoracic and laparoscopic radical treatment at the Cardiothoracic Surgery from March 2017 to September 2018.Patients were divided into two groups.Group A（66 cases） were patients who didn’t have disposable venous infusion needle left in the abdominal incision during the surgery and didn’t take ropivacaine after the surgery while group B（68 cases）  were patients who had indwelled disposable intravenous infusion needle at the abdominal incision during the surgery and have taken ropivacaineafter the surgery.Abdominal median incision pain score，postoperative fat liquefaction，infection and other related complicationsof the two groups were compared after the surgery.Results Compared with group A patients，the median abdominal incision pain score（VAS）was lower in the group B in the first three days after the surgery,which was（4.1±0.9）VS（3.1±0.8）,（4.0±0.9）VS（2.9±0.9）,（3.7±0.8）VS（2.7±0.8）,respectively，and the difference was statistically significant（P<0.05）.Patients who had taken additional analgesic drugs（tramadol）were few[36.36%（24/66）VS 11.76（8/68） ,P＜0.05].There was no significant difference in fat liquefaction and infection between median abdominal incisions（P>0.05）.No cases of abdominal infection were found in both groups.Conclusion Ropivacaine for localized minimally invasive esophageal carcinoma is effective for the postoperative abdominal incision analgesia；meanwhile it does not increase the incidence of fat liquefaction，infection and abdominal infection in the middle abdominal incision，which is ideal method for minimally invasive esophageal cancer.

Objective To study the different position of the trocars in laparoscopic appendectomy.Methods From January 2017 to December 2018，a total of 120 appendicitis patients were randomly divided into 3 groups，40 cases in each group.In group one，trocar one was inserted through umbilicus，trocar two was inserted at McBurney's point，and trocar three was inserted above the pubic symphysis.In group two，trocar one was inserted through umbilicus，trocar two was inserted at the reverse McBurney's point，and trocar three was inserted above the pubic symphysis.In group three，trocar one was inserted through umbilicus，trocar two was inserted above the left side of the pubic symphysis，trocar three was inserted above the right side of the pubic symphysis.The operative time，the rates of complications，the inpatient stay，the postoperative ache degree and the postoperative satisfaction among the three groups were compared.Results Operative time：the first group was（51.13±20.05）min，the second group was（49.79±19.24）min and the third group was（58.00±15.14）min.There was no significant difference in the operation time between group one and group two（P>0.05），and group two was significantly less than group three（P<0.05）.Postoperative complications：there were 5 complications in the first group，2 complications in the second group and 4 complications in the third group.There was no significant difference among the three groups（P> 0.05）.The pain scores assessed by VAS at 6，12 and 24 hours were as follws：（5.54±1.45），（5.15±1.23），（4.08 ±0.92）in group one，（5.10±1.26），（4.78±1.12），（3.78±1.05）in group two and（5.35±1.67），（5.05±0.96），（4.10±1.08）in group three.Days of hospitalization：the first group was（5.89 ±2.77）days，the second group was（5.85 ±1.85）days，and the third group（5.52±1.83）days.There was no significant difference among the three groups（P>0.05）.There was no significant difference in the postoperative ache degree among the three groups（P>0.05），but the third group had the best postoperative satisfaction（P<0.05）.Conclusion These three different trocar positions are safe and feasible for appendicitis.Group three is more suitable for cosmetic results.

Objective To analyze the effect of videoscope-assisted surgery on the symptoms and prognosis in patients with complex anal fistula.Methods Eighty patients with complex anal fistula admitted to our general surgery department from January 2017 to December 2018 were divided into observation group（n=42，minimally invasive videoscope-assisted surgery）and control group（n=38，traditional low cut high thread surgery）according to the surgical plan.The postoperative efficacy and anal dynamic changes，anal function score，pain score，recovery index，and complications before treatment were compared between the two groups.Results The efficacy of the observation group was significantly better than that of the control group（P<0.05）.After operation，the anal canal resting pressure，anal canal diastolic pressure and maximum anal canal pressure were significantly lower than those before operation；the anal canal resting pressure，anal canal diastolic pressure and maximum anal canal pressure were significantly higher in the observation group than in the control group（P<0.05）.The anus sphincter，anal morphology score and VAS score of the observation group were significantly lower than those of the control group（P<0.05）.The hospitalization time，wound healing time，wound area and scar area of  the observation group were significantly lower than those of the control group（P<0.05）.The incidence of postoperative bleeding，dysuria，anal edema and infection in the observation group was significantly lower than that in the control group（P<0.05）.Conclusions Videoscope-assisted surgery is minimally invasive and painful with highefficacy and safety，which can effectively improve the prognosis in patients with complex anal fistula.

Objective To estimate the clinical practicability and values of serum enzymology related indicators by evaluating the predictive performance of these indicators on the prognosis of colorectal cancer.Methods By referring to the medical records，the clinicopathological data of 509 colorectal cancer patients，and serum enzymatic indexes before and 1 month after surgery were collected.Cox proportional risk regression was used to analyze the associations between the serum enzymatic indicators and progression free survival（PFS）and cancer-specific survival（CSS）of colorectal cancer patients by calculating Hazard Ratio（HR）and 95% Confidence interval（CI）.Results Preoperative and postoperative high levels of alkaline phosphatase（ALP），gamma-glutamyl transpeptidase（GGT）and lactate dehydrogenase（LDH）were associated with PFS，with HRs（95% CI）of 1.41（1.02～1.92），1.45（1.05～2.02）and 3.15（2.04～4.87）for preoperative indicators，respectively，and 1.33（1.14～2.78），1.78（1.10～2.01）and 1.72（1.04～2.84）for postoperative indicators，respectively.Preoperative alanine aminotransferase（ALT），aspartate aminotransferase（AST），ALP，GGT and LDH were independent prognostic factors for CSS，with HRs（95% CIs）of 1.73（1.10～2.72），1.78（1.11～2.86），1.99（1.26～3.16），2.47（1.55～3.93）and 4.24（2.56～7.04），respectively.Patients with higher postoperative ALP，GGT and LDH levels had shorter CSS，with HRs（95% CIs）of 2.25（1.24～4.10），2.14（1.02～4.52）and 2.88（1.49～5.68），respectively.Conclusion GGT，LDH and ALP can be used as prognostic markers of colorectal cancer.

Objective To investigate the defecation status and quality of life of patients after anterior resection of rectal cancer，and to analyze the related factors of anterior resection syndrome.Methods From May 2010 to May 2016，a total of 100 cases of patients with rectal cancer who underwent anterior rectal resection in Nanjing Hospital of TCM were followed up.Patients were asked to fill in LARS score form and EORTC qlq-c30（V3.0）quality of life scale.A total of 85 cases of complete data were obtained.According to LARS score table，patients were divided into two groups，major anterior resection syndrome and no/minor anterior resection syndrome，to compare the quality of life of two groups and analyze relevant factors.Results A total of 45/85 patients（52.9%）with anterior resection syndrome were diagnosed.These included 30/85 patients with major anterior resection syndrome（35.3%）and 15/85 patients with minor anterior resection syndrome（17.6%）.The incidence rate of each symptom of preoperative resection syndrome was tenesmus（69.4%）> urgency of defecation（57.7%）> incontinence of gas（52.9%）> frequency of defecation（42.4%）> incontinence of liquid（38.8%）>  constipation（11.7%）.Compare major anterior resection syndrome，no/minor anterior resection syndrome in patients with EORTC QLQ C30-score：in the overall level of health，all the function dimension，physical function，role function，emotional function，cognitive function，social function，fatigue，diarrhea differences statistically significant（P<0.05），quality of life of patients with major anterior resection syndrome significantly worse.Age，the distance between the lower margin of the tumor and the anal margin，and radiotherapy were risk factors for major anterior resection syndrome after anterior resection of rectal cancer（P<0.05），but none of them were independent risk factors（P>0.05）.Conclusion The quality of life of patients after anterior resection is closely related to the occurrence of anterior resection syndrome，and the quality of life of patients with major anterior resection syndrome is poor.Patients with advanced age，low anastomotic site and radiation therapy are more likely to develop major anterior resection syndrome.

Objective Exploration and analysis of the clinical application of computer-aided design combined with 3D printing technology in cervical spine fracture and dislocation of cervical spine fracture.Methods The clinical data of 70 patients with cervical spine fractures and dislocations who were treated in our hospital were collected and divided into two groups according to different treatment methods：The observation group（35 cases）was treated with computer-aided design combined with 3D printing technology，and the control group（35 cases）was treated with conventional CT-assisted surgery.The parameters of the operation time，intraoperative blood loss，and exhaust time of the two groups were recorded and analyzed，and the position of the postoperative screw was set.Analysis and evaluation of JOA score and VAS before and after treatment.Statistics and analysis of the occurrence of postoperative adverse reactions in patients.Results The operation time（95.2±10.4）min，the amount of bleeding（148.9±8.2）ml and the exhaust time（2.5±1.1）d in the observation group were better than the control group[（108.3±7.6）min，（208.8±9.1）ml，（3.1±0.6）d]（P<0.05）.The success rate of postoperative fixation（85.71%）in the observation group was higher than that in the control group（68.57%）（P<0.05）.The JOA scores of the two groups were higher than those before treatment.The JOA score of the observation group（15.64±1.48）was higher than that of the control group（14.73±1.51）（P<0.05）.The VAS scores of the two groups were lower than before treatment.The VAS score of the patients（3.16±0.46）was lower than that of the control group （3.42±0.33）（P<0.05）.The incidence of adverse reactions in the observation group（8.57%）was lower than that in the control group（17.14%），the difference was not statistically significant（P>0.05）.Conclusion Cervical spine fractures and cervical dislocation patients with computer-aided design combined with 3D printing technology for treatment，with short operation time，low damage，good therapeutic effect and high safety，it is worthy of clinical application.

Objective To analyze and compar the characteristics of fracture and dislocation of type B and type C cervical 7/thoracic1 by  pedicle screw combined locking plate short segment fixation and pedicle screw long segment fixation.Methods Twenty-four patients with cervical 7/ thoracic 1 fracture and dislocation were divided into group A(13 cases) and group B(11 cases) according to the inclusion criteria.Group A was treated with pedicle screw combined with locking plate for short segment fixation，while group B was treated with pedicle screw for long segment fixation.The operation time，blood loss and complications were counted.CT scan was used to observe the accuracy of pedicle screw placement.JOA score was used to evaluate the improvement of spinal cord function after surgery.NDI was used to evaluate postoperative cervical function.Independent sample t-test was used to compare the observation results of the two surgical methods.Results A case of anterior cervical hematoma was found in group A，which had been absorbed 3 months later.One case of fat liquefaction at the back of neck occurred in group A and group B，which was healed after dressing change and debridement.A total of 70 cervical and thoracic pedicle screws were placed.CT scan 1 week after surgery showed that 3 cervical 7 pedicle screws，2 cervical 5 pedicle screws and 2 cervical 6 pedicle screws，partial thread perforation of the lateral wall of the pedicle，no nerve root or vertebral artery injury.The operation time was（194.62±29.89）min and blood loss was（188.85±67.89）ml in group A，the operation time was（163.64±32.02）min and the blood loss was（244.55±42.51）ml in group B ,which were statistically significant（P＜0.05）.The improvement degree of JOA was（0.27±0.18）% in group A and（0.27±0.11）% in group B at 1week after the operation;（0.35±0.20）% in group A and（0.40±0.17）% in group B at 3 months after the operation;（0.40±0.22）% in group A and（0.42±0.16）% in group B at the last follow-up.There was no statistical significance at each time point（P＞0.05）.The NDI scores were（0.17±0.04）in group A and（0.30±0.07）in group B at 3 months after the operation;（0.09±0.03）in group A and（0.18±0.07）% in group B at the last follow-up.There was significant differences in the two time points（P＜0.05）.Conclusion Pedicle screw combined locking plate short segment fixation is complicated and traumatic，but it is conducive to postoperative limb function recovery.Pedicle screw fixation with long segments is less invasive，but it increases the risk of screw placement and has a great impact on postoperative cervical vertebral function.The anterior and posterior combined short segment fixation is preferred when the patient's physical condition is tolerable.

Objective To investigate the early clinical effects of posterior cervical single-door laminoplasty plus centerpiece titanium plate fixation for multi-segmental cervical spondylotic myelopathy.Methods 35 patients suffering from cervical spondylotic myelopathy who underwent C3-C7 single-door centerpiece titanium plate fixation were reviewed retrospectively.The neurofunction was evaluated by comparing Japan Orthopaedic Association（JOA）score measured before and 12 months after surgery.X-ray，CT and MRI were performed before operation，7 days after operation，6 months after operation and 12 months after operation.The sagittal diameter of C5 spinal canal on the CT was measured before operation and 12 months after operation respectively，and the expansion rate of C5 spinal canal was calculated.The C2-C7 Cobb angle were measured to evaluate cervical curvature by means of X-ray measured before and 12 months after surgery.Results All patients were followed up for 12～24 months.Radiographic findings at follow-up period showed spinal canal enlarged perfectly，and no door closing or instrument failure.The average JOA score for preoperation was （8.43±1.09）and （13.94±1.66）at 12 months after operation，with the improvement rate of（65.68±16.15）%.The mean sagittal diameter of C5 spinal canal was （9.49±1.30）mm before operation and （16.70±1.97）mm at 12 months，with the improvement rate of （76.88±14.66）% .The C2-C7 Cobb angle had a decreasing trend at the 12 months follow-up compared with preoperative values，and there was significant difference（P<0.05）.Conclusion Posterior cervical single-door laminoplasty plus centerpiece titanium plate fixation is reliable，nerve therapeutic effect and early clinical efficacy is satisfactory.

Objective To investigate the effect of  pararectus approach in the operation of pelvic extraperitoneal soft tissue tumors.Methods A retrospective analysis of pelvic peritoneum in our hospital from January 2012 to January 2017， the application of lateral rectus approach in the 19 patients’ treatment of soft tissue tumors.Single rectus approach was performed in 5 cases， pararectus approach+extended approach in 8 cases，pararectus approach combined with posterior K-L approach in 6 cases.Results 19 cases of pelvic retroperitoneal soft tissue tumors were completely resected，incision length 9～23cm，operation time 90～210min，bleeding 420～1240ml，there were no nerve injury，pelvic organ injury，deep vein thrombosis or other complications，2 cases had femoral vein injury and intraoperative timely repair，postoperative VAS score（3.4±0.8）was significantly lower than the preoperative VAS score（7.3±1.6）.19 patients were followed up，the follow-up time was 8～58 months[（26.0±5.8）months]，14 patients without recurrence，2 cases of local tumor recurrence，and again underwent surgical resection，3 cases of malignant tumor patients with distant metastasis and death.Conclusion The pararectus approach can quickly enter the pelvic retroperitoneal space.Compared with other surgical approaches of the pelvis，the palpable anatomical structure is more extensive，and it is suitable for the resection of pelvic retroperitoneal soft tissue tumors.

Objective To evaluate the efficacy and safety of ureteral occlusion device used in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi.Methods 120 patients with upper ureteral calculi were randomly divided into two groups：60 patients were treated  with ureteral occlusion device（test group），and 60 patients were treated without ureteral occlusion device（control group），and the efficacy and safety were observed.Results The primary calculus elimination rate，the length of stay hospital and post-operative stone-free-rate in test group were significantly better than those in control group：93.3% vs.78.3%，（2.5±0.4)d vs.(3.7±0.6)d，96.7% vs.86.7%，and there were significant differences（P<0.05）.There was no significant difference in surgical complications between the two groups（P＞0.05）.Conclusion The blocking catheter combined with holmium laser lithotripsy under ureteroscopy can reduce the drift of upper ureteral calculi, improve the clearance rate of calculi and shorten the hospital stay.

Objective To compare the clinical effects of continuous negative pressure drainage system and conventional compression dressing with free skin grafting.Methods Ninety-eight patients with acute and chronic wounds from March to September 2018 who requiring skin grafting were randomly divided into two groups according to the different methods of intraoperative skin banding.The control group（n=49 cases）was used free skin grafting with conventional compression dressing.The observation group（n=49 cases）was treated with free skin grafting and continuous negative pressure drainage system.The surgical outcomes，such as the excellent rate of surgery，satisfaction，operation time，and wound healing time，and the incidence of postoperative complications such as hematoma，infection，and skin failure were compared.Results The excellent and good rate of surgery（95.92%）and satisfaction（97.96%）were significantly better in the observation group than in the control group（71.43%，73.46%）（P<0.05）.The operation time of the observation group was significantly shorter than that of the control group（P<0.05）.The wound healing time was also significantly faster than the control group（P<0.05）；the incidence of postoperative complications（6.12%）in the observation group was significantly lower than that of the control group（22.45%）（P<0.05）.Conclusion The application of continuous negative pressure drainage system in conventional skin grafting can significantly improve the surgical outcome and postoperative patient satisfaction，promote wound healing and reduce the incidence of postoperative complications.

Objective To observe the effects of perineural and intravenous dexmedetomidine injection combined with scalp nerve block on perioperative hemodynamics and stress response.Methods Elective intracranial aneurysm surgery for 50 patients，which were randomly divided into two groups（n=25）：DEX 1ug/kg intravenous injection group（group A）and DEX 1ug/kg mixed with ropivacaine perineural group（group B）.Patients in both groups were treated with bilateral scalp nerve block guided by ultrasound.Endotracheal intubation was performed after general anesthesia induction.Mean arterial pressure（MAP）and heart rate（HR）at pre-induction（T0），5min after intubation（T1），incision（T2），sawing skulls（T3）and the end of surgery（T4）were recorded，blood cortisol levels at T0，T2 and 6h after surgery（T5）were recorded.Intraoperative propofol and remifentanil consumption、duration of analgesia and number of patients requiring rescue analgesia were recorded.Results The MAP of T1 ~ T4 in both groups was lower than that at T0.In group A，HR at all time points from T1 to T4 decreased compared with that at T0，HR in group B was only lower than T0 at T1 and T4（P<0.05）.MAP at T1，T2 and HR at T1，T2，T3 in group B were statistically different from those in group A（P<0.05）.Blood cortisol level at T5 in group B（378.6nmol/L）was significantly decreased compared with group A（429.4nmol/L）（P<0.05）.Duration of postoperative analgesia in group B（736.4min）was prolonged compared with group A（652.8min），while only one patient in group B needed relief compared with group A.（both P<0.05）.Conclusion Compared with intravenous administration，perineural dexmedetomidine combined with scalp nerve block can stabilize hemodynamics，prolong postoperative analgesia duration and reduce perioperative stress response.

Pancreatic fistula is the most common and serious complication after distal pancreatectomy.How to effectively reduce the occurrence of pancreatic fistula and timely treatment after the occurrence of pancreatic fistula is an urgent clinical problem to be solved.In this article，the current status and progress of research on the risk factors of pancreatic fistula after distal pancreatectomy and the prevention and treatment of pancreatic fistula are reviewed.

Pancreatic neuroendocrine Neoplasms（pNENs）are a class of heterogeneous pancreatic tumors that originate from the pancreatic neuroendocrine cells.Most of them are sporadic，and the etiology and specific pathogenesis are still unclear.The incidence rate has gradually increased in recent years.According to whether it is accompanied by systemic endocrine symptoms，it can be divided into functional and nonfunctional.Most pNENs are non-functional，and often take the space-occupying change of abdominal organs as the first symptom.The liver is the most common metastatic site.Accurate pathological grading and staging are critical to determining the appropriate treatment.Surgery is the only cure，and systemic treatments such as radiotherapy，targeted therapy，and immunotherapy play an increasingly important role.For patients with distant metastases or advanced patients，the goal of treatment is to improve symptoms and prolong survival，which often requires multidisciplinary collaboration to determine the optimal treatment.This article describes the gradual recognition of pNENs as a rare tumor and the evolution of comprehensive diagnosis and treatment methods.

Pancreatic cancer has a high degree of invasion，and local lymph nodes and distant metastases are diagnosed at the first diagnosis.Long-chain non-coding RNAs（1ncRNAs）were originally thought to be the “noise” of the gene transcriptome and were not taken seriously.However，with the deepening of research，scholars have found that 1ncRNAsaregenerally transcribed in the human genome and play  important regulatory roles，which is closely related to tumor development and metastasis.There are a large number of dysregulated 1ncRNAs in pancreatic cancer，which play different biological regulation mechanisms in pancreatic cancer metastasis according to their subcellular localization and structure，involving EMT，autophagy，tumor metabolism，and key drive genes and many other aspects.Further research on the relationship between lncRNAs and tumor metastasis may provide new strategies for pancreatic cancer prevention，diagnosis and treatment.This article summarizes the recent advances in the study oflncRNA in pancreatic cancer metastasis.

The elderly are the main suffer population of degenerative diseases of bone and joint，and knee osteoarthritis is the most common degenerative diseases.The clinical manifestations of knee osteoarthritis are different levels of knee pain，limited knee movement and joint deformity，which seriously affect the life quality of patients.In clinic，the treatment goal，methods and rehabilitation strategies of the elderly patients with knee osteoarthritis are different from normal.Therefore，this consensus is based on the pathogenesis and epidemiology of knee osteoarthritis，combined with the latest evidence-based medicine and clinical experience，and aim to elaborate the clinical treatment and rehabilitation strategies，especially the use of personalized intelligent orthoses for rehabilitation，of knee osteoarthritis in the elderly.We are devoted to improve the prognosis and life quality of elderly patients through popularizing this consensus of experts.