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.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

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 evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

Objective:This study aims to analyze the trends,hotspots,and interrelations in research on retroperito-neal tumors through bibliometric methods,providing the latest scientific information support for clinicians and research-ers.Methods:Data were sourced from the SCI-expanded database of the Web of Science Core Collection,covering the period from 2004 to 2023.Statistical analysis and visualization of the number of publications,total citations,average citations per article,countries,institutions,journals,and keywords were conducted using Microsoft Excel 2019,VOS-viewer,and CiteSpace.Results:A total of 6,842 relevant articles were retrieved,with a total of 113 753 citations and an average of 16.63 citations per article.The number of publications had been increasing annually,peaking in 2022.The United States,China,and Japan are the major research countries,with the United States contributing the most.Memo-rial Sloan Kettering Cancer Center and the University of Texas MD Anderson Cancer Center are the leading research in-stitutions.The journal with the most publications was the Cureus Journal of Medical Science.Gronchi Alessandro was the most prolific author.The ain keywords were"Management","Surgery",and"Tumor",and the most cited papers focus on surgery and multicenter studies.Conclusion:Research on retroperitoneal tumors is increasing annually,with hot-spots focusing on treatment methods and prognosis analysis.The United States is the main contributor to this field,with significant international collaboration.Future research should further explore the pathogenesis of retroperitoneal tumors and more effective treatment strategies.

Objective To explore the efficacy and safety of conversion therapy for advanced hepatocellular carcinoma(HCC)with macrovascular invasion.Methods A total of 149 patients with advanced HCC with macrovascular invasion who were treated at our hospital from Jul.2019 to Jun.2021 were enrolled.All patients received systemic therapy combined with local therapy,and were assigned to conversion therapy group(n=42)and non-conversion therapy group(n=107)according to whether they ultimately underwent surgical treatment.The long-term prognosis and adverse reactions of these patients after conversion therapy were analyzed.Results The median event-free survival of 149 patients was 15.5 months,and the median overall survival had not been reached.The median event-free survival in the conversion therapy and non-conversion therapy groups were 19.8 months and 10.7 months,respectively,with the median overall survival being not reached and 28.2 months,respectively.Multifactor Cox regression analysis showed that conversion therapy was a protective factor for overall survival(hazard ratio[HR]=0.125,95％confidence interval[CI]0.016-0.966),but not for event-free survival.The 1-year and 2-year overall survival rates of the conversion therapy and non-conversion therapy groups were 100.0％,96.4％and 72.1％,53.4％,respectively,and the difference in survival curves between the 2 groups was statistically significant(P=0.003).The 1-year and 2-year event-free survival rates were 77.5％,33.8％and 47.3％,31.5％,respectively.There was no significant difference in survival curves between the 2 groups(P=0.070).The differences of the overall incidences of targeted and immunotherapy-related adverse reactions in the conversion therapy group and non-conversion therapy group(66.7％[28/42]vs 72.0％[77/107],P=0.524)and the incidences of grade Ⅲ to Ⅳ adverse reactions(23.8％[10/42]vs 27.1％[29/107],P=0.681),were not statistically significant.Conclusion For patients with advanced HCC with macrovascular invasion,conversion therapy can significantly improve the prognosis without serious adverse reactions.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

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.

BACKGROUND: Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions. However, the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation (AR) has not been thoroughly investigated. This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population. METHODS: Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study, with baseline serum albumin measured at enrollment. Mortality outcomes were monitored for two years post-enrollment, employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality. RESULTS: During the 2-year follow-up period, we observed 63 all-cause deaths. The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve, indicating a mortality threshold at 35 g/L. For serum albumin levels below 35 g/L, each 1 g/L decrease was associated with a 25% higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.07-1.45). In contrast, no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L. Moreover, when serum albumin is classified as hypoproteinemia (serum albumin < 35 g/L), the higher risks of all-cause death were observed in hypoproteinemic patients (HR = 2.93, 95% CI: 1.50-5.74). More importantly, the association between serum albumin and death was significantly stronger in overweight/obese patients (≥ 24 kg/m² vs. < 24 kg/m², P _interaction = 0.006). CONCLUSIONS In elderly patients with AR, serum albumin levels showed an approximating L-shaped relationship with all-cause death, with thresholds of 35 g/L. Body mass index was significant effect modifiers of the association. These results suggest that serum albumin, as an inexpensive and readily available biochemical marker, may further improve the stratified risk of mortality in older AR patients.

BACKGROUND: Biomarkers-based prediction of long-term risk of acute coronary syndrome (ACS) is scarce. We aim to develop a risk score integrating clinical routine information (C) and plasma biomarkers (B) for predicting long-term risk of ACS patients. METHODS: We included 2729 ACS patients from the OCEA (Observation of cardiovascular events in ACS patients). The earlier admitted 1910 patients were enrolled as development cohort; and the subsequently admitted 819 subjects were treated as validation cohort. We investigated 10-year risk of cardiovascular (CV) death, myocardial infarction (MI) and all cause death in these patients. Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was derived using main part of these variables. RESULTS: During 16,110 person-years of follow-up, there were 238 CV death/MI in the development cohort. The 7 most important predictors including in the final model were NT-proBNP, D-dimer, GDF-15, peripheral artery disease (PAD), Fibrinogen, ST-segment elevated MI (STEMI), left ventricular ejection fraction (LVEF), termed as CB-ACS score. C-index of the score for predication of cardiovascular events was 0.79 (95% CI: 0.76-0.82) in development cohort and 0.77 (95% CI: 0.76-0.78) in the validation cohort (5832 person-years of follow-up), which outperformed GRACE 2.0 and ABC-ACS risk score. The CB-ACS score was also well calibrated in development and validation cohort (Greenwood-Nam-D'Agostino: P = 0.70 and P = 0.07, respectively). CONCLUSIONS CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS. This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.