Objective:To investigate the clinical characteristics, diagnosis and treatment of duodenal duplication in children.Methods:From Jan 2017 to Jun 2023, clinical data of 8 child patients complaining nonspecific intraabdominal symptoms at Department of General Surgery, Hu'nan Children's Hospital undering surgery were retrospectively analyzed.Results:Five patients had duodenal duplication resected, 3 patients underwent fenestration and mucous membraine removel.Postoperative pathology showed cyst type in 6 cases, tubular type in 2 cases,all with lining of intestinal mucosa, and smooth muscle, including 1 case with ectopic pancreas tissues, 2 cases with ectopic gastric mucosa tissues. Postoperative follow-up were 10-48 months. During the follow-up period, there was no abdominal pain, vomiting, abdominal distension, and other symptoms, and the children recovered well.Conclusions:The clinical manifestations of duodenal duplication are no specific. Definite diagnosis depends on pathology. Duodenal duplication resection or fenestration plus mucosal stripping is the treatment of choice. The prognosis is good.

Objective:To summarize the clinical traits, diagnostic and therapeutic experiences of pancreatic tumors in children.Methods:This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 35 children with primary pancreatic tumors who were treated at the Department of General Surgery, the Children′s Hospital Affiliated to Xiangya School of Medicine, Central South University were collected from January 2010 to June 2023. There were 17 male and 18 female patients, aging from 3 months to 15 years and 1 month, with a median age of 9 years and 2 months. The presenting symptoms included 16 patients who had abdominal mass, 13 had clinical symptoms of abdominal pain and vomiting, 4 cases were detected on the physical examination, and 7 cases were discovered on abdominal trauma examinations.Results:Among the 35 cases, 16 cases of tumors were located in the pancreatic head. Among them, 9 cases underwent open pancreaticoduodenal surgery, 2 cases received duodenum-preserving pancreatic cephalectomy, 4 cases underwent pancreatic tumor resection, and 1 case underwent laparotomy for pancreatic tumor biopsy. Seventeen cases had tumors located in the body and tail of the pancreas, including 13 patients who underwent laparoscopic splenic-sparing caudectomy and 4 patients who underwent pancreatic tumors resection. Two cases of von Hippel-Lindau(VHL) with diffuse cystic pancreatic degeneration were continuously observed and followed up. Postoperative pathological examinations revealed that there were 20 cases of solid pseudopapillary neoplasm(SPN), 6 cases of pancreaticoblastoma(PBL), 2 cases of insulinoma, 2 cases of serous cystadenoma, 2 cases of mature teratoma and 1 case of lipoma. Four patients with PBL were completely resected after 4 cycles of induction chemotherapy due to their large tumors. All PBL patients received standardized systematic treatment including surgery and chemotherapy. Postoperative complications included 4 cases(12.1%) of biochemical leakage, 1 case(3.0%) of grade B pancreatic fistula complicated with massive bleeding, 2 cases(6.1%) of elevated platelet count, and 2 cases(6.1%) of intestinal obstruction. One case of grade B pancreatic fistula complicated with massive bleeding underwent emergency surgery, and other cases with complications were cured through conservative treatment. Two patients with SPN recurred at 36 and 33 months and were treated with reoperation. One patient with obstructive jaundice with high-grade transformed SPN was abandoned after diagnosis, and one patient with PBL died. The follow-up period of the patients was 1 to 7 years. The tumor size of 2 VHL patients with diffuse cystic pancreatic degeneration did not change after regular visits, and tumor survival was not observed in other children.Conclusions:There are no specific clinical manifestations of pancreatic tumors in children and there are various pathological types, with the majority being SPN and PBL. Radical surgery for preservation of organ and functions is the preferred treatment for pediatric pancreatic tumors, and most have a favorable prognosis.

Objective:To study the strategies in the diagnosis and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas in children.Methods:The clinical data of 16 children with SPN managed at the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital) from January 2015 to December 2022 were retrospectively studied. There were 9 males and 7 females, ranged from 7 years and 5 months to 13 years and 3 months, with a median age of 10 years and 7 months. The clinical performance and types of the tumor (type Ⅰ, tumor located in the tail of pancreas; Type Ⅱ, the tumor located in the pancreatic body; Type Ⅲ, tumor located in the head of the pancreas), surgical methods, complications (pancreatic fistula, intestinal obstruction, hemorrhage) were analyzed. The recurrence was followed up by outpatient review or telephone after surgery.Results:The main clinical characteristics included abdominal pain (12 cases), abdominal trauma examination findings (2 cases), and physical examination findings (2 cases). The results of abdominal ultrasound, enhanced CT and/or MRI examinations showed that 4 cases of cystic tumors, 7 cases of solid tumors, and 5 cases of cystic solid tumors. Among of all patients, 2 cases were clinical classification type Ⅰ, 8 cases were type Ⅱ, and 6 cases were type Ⅲ. Among 6 cases with tumor located in the head of the pancreas, 3 patients underwent pancreaticoduodenectomy, 1 patient underwent resection of the head of the pancreas with preservation of the duodenum, 1 patient underwent laparoscopic resection of pancreatic head tumor, 1 patient underwent biopsy of pancreatic head tumor. The other 10 cases with tumor located in the body and tail of the pancreas, 6 patients underwent laparoscopic splenic preservation pancreatic body-tail resection, 1 patient underwent laparoscopic resection of pancreatic body-tail and splenectomy, combined with autologous splenic transplantation, 1 patient underwent laparoscopic removal of the splenic venous thrombus, splenic preservation pancreatic body-tail, 1 patient underwent laparoscopic enucleation of a dorsal tumor in the middle part of the pancreas, and 1 patient underwent open resection of spleen-preserving pancreatic body-caudal. Postoperative complications included pancreatic fistula (grade B) with massive hemorrhage (1 case), biochemical leakage (1 case), post-operative pancreatitis (1 case), intestinal obstruction (1 case), and reactive thrombocytosis (1 case). The patient pancreatic fistula (grade B) with massive hemorrhage and pancreatic leakage required emergency surgery, while the remaining patients recovered with conservative treatment. All patients were followed up for 22 to 90 months (median follow-up period of 70 months), two cases relapsed and were successfully re-treated surgically at 36 months and 33 months post-surgery, respectively. One patient with high grade transformation SPN and obstructive jaundice withdrew treatment (missed follow-up), while the remaining patients without recurrence after surgery.Conclusion:Children SPN has no specific clinical features, and preoperative abdominal ultrasound, CT and/or MRI can be located and diagnosed. Surgery is the preferred treatment, and the prognosis is well.

Objective:To investigate the role of cyclooxygenase-2 (COX-2) in glycochenodeoxycholic acid (GCDC)-induced apoptosis of mouse extrahepatic biliary epithelial cells (EBECs) and clarify its possible mechanism.Methods:EBECs were cultured in vitro and infected with RNAi-COX-2 lentivirus (GCDC+ shCOX-2 group). EBECs were then treated with different concentrations (0, 25, 50, 100, 200, 400, 800 μmol/L) of GCDC (GCDC group). Cell proliferation activity was detected by cell counting kit-8 (CCK-8) assay; lactate dehydrogenase (LDH) release rate was measured by colorimetry; apoptosis was analyzed by flow cytometry; caspase-3 activity was detected by fluorescent probe method; COX-2 mRNA expression was determined by real-time quantitative polymerase chain reaction (qRT-PCR); protein levels of COX-2, autophagy-related proteins LC3, p62, Beclin-1, and apoptosis-related proteins Bax, Bcl-2, cleaved caspase-3 were evaluated by Western blot.Results:Compared with the 0 μmol/L GCDC group, the apoptosis level, LDH release rate, and caspase-3 activity in the 50, 100, and 200 μmol/L GCDC groups gradually increased (all P<0.05) in a concentration-dependent manner. After RNAi-COX-2 lentivirus infection, COX-2 mRNA and protein expression levels in EBECs significantly decreased (all P<0.05). Compared with the GCDC group, the apoptosis rate of EBECs in the GCDC+ shCOX-2 group significantly decreased ( P<0.05). The GCDC+ shCOX-2 group showed increased cell proliferation activity, downregulated protein expressions of Bax, cleaved caspase-3, and p62, and upregulated protein expressions of Bcl-2, LC3 II/I, and Beclin-1 (all P<0.05). Conclusions:Inhibition of COX-2 improves GCDC-induced apoptosis of EBECs, and the mechanism may be related to the activation of the autophagy pathway.

Objective:To investigate the role of cyclooxygenase-2 (COX-2) in glycochenodeoxycholic acid (GCDC)-induced apoptosis of mouse extrahepatic biliary epithelial cells (EBECs) and clarify its possible mechanism.Methods:EBECs were cultured in vitro and infected with RNAi-COX-2 lentivirus (GCDC+ shCOX-2 group). EBECs were then treated with different concentrations (0, 25, 50, 100, 200, 400, 800 μmol/L) of GCDC (GCDC group). Cell proliferation activity was detected by cell counting kit-8 (CCK-8) assay; lactate dehydrogenase (LDH) release rate was measured by colorimetry; apoptosis was analyzed by flow cytometry; caspase-3 activity was detected by fluorescent probe method; COX-2 mRNA expression was determined by real-time quantitative polymerase chain reaction (qRT-PCR); protein levels of COX-2, autophagy-related proteins LC3, p62, Beclin-1, and apoptosis-related proteins Bax, Bcl-2, cleaved caspase-3 were evaluated by Western blot.Results:Compared with the 0 μmol/L GCDC group, the apoptosis level, LDH release rate, and caspase-3 activity in the 50, 100, and 200 μmol/L GCDC groups gradually increased (all P<0.05) in a concentration-dependent manner. After RNAi-COX-2 lentivirus infection, COX-2 mRNA and protein expression levels in EBECs significantly decreased (all P<0.05). Compared with the GCDC group, the apoptosis rate of EBECs in the GCDC+ shCOX-2 group significantly decreased ( P<0.05). The GCDC+ shCOX-2 group showed increased cell proliferation activity, downregulated protein expressions of Bax, cleaved caspase-3, and p62, and upregulated protein expressions of Bcl-2, LC3 II/I, and Beclin-1 (all P<0.05). Conclusions:Inhibition of COX-2 improves GCDC-induced apoptosis of EBECs, and the mechanism may be related to the activation of the autophagy pathway.

Objective:To study the strategies in the diagnosis and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas in children.Methods:The clinical data of 16 children with SPN managed at the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital) from January 2015 to December 2022 were retrospectively studied. There were 9 males and 7 females, ranged from 7 years and 5 months to 13 years and 3 months, with a median age of 10 years and 7 months. The clinical performance and types of the tumor (type Ⅰ, tumor located in the tail of pancreas; Type Ⅱ, the tumor located in the pancreatic body; Type Ⅲ, tumor located in the head of the pancreas), surgical methods, complications (pancreatic fistula, intestinal obstruction, hemorrhage) were analyzed. The recurrence was followed up by outpatient review or telephone after surgery.Results:The main clinical characteristics included abdominal pain (12 cases), abdominal trauma examination findings (2 cases), and physical examination findings (2 cases). The results of abdominal ultrasound, enhanced CT and/or MRI examinations showed that 4 cases of cystic tumors, 7 cases of solid tumors, and 5 cases of cystic solid tumors. Among of all patients, 2 cases were clinical classification type Ⅰ, 8 cases were type Ⅱ, and 6 cases were type Ⅲ. Among 6 cases with tumor located in the head of the pancreas, 3 patients underwent pancreaticoduodenectomy, 1 patient underwent resection of the head of the pancreas with preservation of the duodenum, 1 patient underwent laparoscopic resection of pancreatic head tumor, 1 patient underwent biopsy of pancreatic head tumor. The other 10 cases with tumor located in the body and tail of the pancreas, 6 patients underwent laparoscopic splenic preservation pancreatic body-tail resection, 1 patient underwent laparoscopic resection of pancreatic body-tail and splenectomy, combined with autologous splenic transplantation, 1 patient underwent laparoscopic removal of the splenic venous thrombus, splenic preservation pancreatic body-tail, 1 patient underwent laparoscopic enucleation of a dorsal tumor in the middle part of the pancreas, and 1 patient underwent open resection of spleen-preserving pancreatic body-caudal. Postoperative complications included pancreatic fistula (grade B) with massive hemorrhage (1 case), biochemical leakage (1 case), post-operative pancreatitis (1 case), intestinal obstruction (1 case), and reactive thrombocytosis (1 case). The patient pancreatic fistula (grade B) with massive hemorrhage and pancreatic leakage required emergency surgery, while the remaining patients recovered with conservative treatment. All patients were followed up for 22 to 90 months (median follow-up period of 70 months), two cases relapsed and were successfully re-treated surgically at 36 months and 33 months post-surgery, respectively. One patient with high grade transformation SPN and obstructive jaundice withdrew treatment (missed follow-up), while the remaining patients without recurrence after surgery.Conclusion:Children SPN has no specific clinical features, and preoperative abdominal ultrasound, CT and/or MRI can be located and diagnosed. Surgery is the preferred treatment, and the prognosis is well.

Objective:To investigate the clinical characteristics, diagnosis and treatment of duodenal duplication in children.Methods:From Jan 2017 to Jun 2023, clinical data of 8 child patients complaining nonspecific intraabdominal symptoms at Department of General Surgery, Hu'nan Children's Hospital undering surgery were retrospectively analyzed.Results:Five patients had duodenal duplication resected, 3 patients underwent fenestration and mucous membraine removel.Postoperative pathology showed cyst type in 6 cases, tubular type in 2 cases,all with lining of intestinal mucosa, and smooth muscle, including 1 case with ectopic pancreas tissues, 2 cases with ectopic gastric mucosa tissues. Postoperative follow-up were 10-48 months. During the follow-up period, there was no abdominal pain, vomiting, abdominal distension, and other symptoms, and the children recovered well.Conclusions:The clinical manifestations of duodenal duplication are no specific. Definite diagnosis depends on pathology. Duodenal duplication resection or fenestration plus mucosal stripping is the treatment of choice. The prognosis is good.

Objective:To summarize the clinical traits, diagnostic and therapeutic experiences of pancreatic tumors in children.Methods:This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 35 children with primary pancreatic tumors who were treated at the Department of General Surgery, the Children′s Hospital Affiliated to Xiangya School of Medicine, Central South University were collected from January 2010 to June 2023. There were 17 male and 18 female patients, aging from 3 months to 15 years and 1 month, with a median age of 9 years and 2 months. The presenting symptoms included 16 patients who had abdominal mass, 13 had clinical symptoms of abdominal pain and vomiting, 4 cases were detected on the physical examination, and 7 cases were discovered on abdominal trauma examinations.Results:Among the 35 cases, 16 cases of tumors were located in the pancreatic head. Among them, 9 cases underwent open pancreaticoduodenal surgery, 2 cases received duodenum-preserving pancreatic cephalectomy, 4 cases underwent pancreatic tumor resection, and 1 case underwent laparotomy for pancreatic tumor biopsy. Seventeen cases had tumors located in the body and tail of the pancreas, including 13 patients who underwent laparoscopic splenic-sparing caudectomy and 4 patients who underwent pancreatic tumors resection. Two cases of von Hippel-Lindau(VHL) with diffuse cystic pancreatic degeneration were continuously observed and followed up. Postoperative pathological examinations revealed that there were 20 cases of solid pseudopapillary neoplasm(SPN), 6 cases of pancreaticoblastoma(PBL), 2 cases of insulinoma, 2 cases of serous cystadenoma, 2 cases of mature teratoma and 1 case of lipoma. Four patients with PBL were completely resected after 4 cycles of induction chemotherapy due to their large tumors. All PBL patients received standardized systematic treatment including surgery and chemotherapy. Postoperative complications included 4 cases(12.1%) of biochemical leakage, 1 case(3.0%) of grade B pancreatic fistula complicated with massive bleeding, 2 cases(6.1%) of elevated platelet count, and 2 cases(6.1%) of intestinal obstruction. One case of grade B pancreatic fistula complicated with massive bleeding underwent emergency surgery, and other cases with complications were cured through conservative treatment. Two patients with SPN recurred at 36 and 33 months and were treated with reoperation. One patient with obstructive jaundice with high-grade transformed SPN was abandoned after diagnosis, and one patient with PBL died. The follow-up period of the patients was 1 to 7 years. The tumor size of 2 VHL patients with diffuse cystic pancreatic degeneration did not change after regular visits, and tumor survival was not observed in other children.Conclusions:There are no specific clinical manifestations of pancreatic tumors in children and there are various pathological types, with the majority being SPN and PBL. Radical surgery for preservation of organ and functions is the preferred treatment for pediatric pancreatic tumors, and most have a favorable prognosis.

Objective To investigate the correlation between antiphospholipid antibody syndrome and the early onset of preeclampsia. Methods From May 2010 to July 2013, one hundred and threecases in-patient treatment of the early onset preeclampsia were enrolled in this study. The maternal serum anticardiolipin antibodies(ACA)and anti-β2-glycoproteinⅠantibody (Aβ2-GPⅠ) were detected by ELISA method. 58 cases of pregnant women were randomly divided into the routine treatment group (30 cases) and the anticoagulant therapy group (28 cases). Results ACA positive predictive value of the early onset preeclampsia value was 3.9%. No significant difference was found in the prolonged anticoagulation of early onset preeclampsia time between the control group and the treatment group. Conclusion ACA may not be used to predict the early onset preeclampsia. Anticoagulation therapy can′t extend the early onset preeclampsia time and improve the outcome of pregnancy.

Objective To investigate the effect of cyanidin-3-glucopyranoside extracted from Chinese bayberry on proliferation and apoptosis of human gastric cell line SGC7901.Methods After cocultured with C3G on different concentrations,cell proliferation was determined by MTT assay; morphology of apoptosis were observed by laser confocal microscopy; TUNEL assay was applied to measure the apoptoic rate; The expression of Bcl-2,Bax,Caspase-3,ICAD protein were observed by Western blot assay.Results C3G significantly inhibited the proliferation of SGC7901 cells in a concentration-and timedependent manner as measured by MTT method(P ＜ 0.01).After cells were treated with C3G,the presence of typical morphological changes of apoptosis was confirmed with laser confocal microscopy after Hoechst 33258 fluorescence staining.TUNEL assay indicated that the number of apoptotic cells in C3G-treated group was greater than that in the gastric cancer cells group(P ＜ 0.01).The expression level of Bcl-2 was down-regulated while the expression level of Bax was up-regulated by C3G,the ratio of Bcl-2 protein and Bax protein decreased.C3G may accelerate the activation of procaspase-3 and down-regulate the expression of ICAD(P ＜ 0.01).Conclusions C3G inhibits SGC7901 cell growth and induces apoptosis in a concentraion-and time-dependent manner.This action may be mediated by down-regulating Bcl-2/Bax,resulting in Caspase-3 activition and decreased ICAD protein expression.