Langerhans cell histiocytosis in children with refractory diarrhoea and hypoalbuminaemia as the initial presentation: two case reports and a literature review.

Langerhans cell histiocytosis (LCH) involving the gastrointestinal tract is a rare condition for which clinical experience is limited. We describe the cases of two patients who initially presented with chronic diarrhoea, hypoproteinaemia, and intermittent fever. These findings suggest that in cases of refractory diarrhoea accompanied by recurrent hypoalbuminaemia, especially with abdominal rash, LCH should be considered. Gastrointestinal endoscopy, biopsy, and imaging studies are essential for obtaining a definitive diagnosis. This approach might be helpful for the early recognition of gastrointestinal tract involvement in LCH.

Effects of extracellular ATP on local and systemic responses of bean (Phaseolus vulgaris L) leaves to wounding.

Wounding increased the extracellular Adenosine 5'-triphosphate (eATP) level of kidney bean leaves. Treatment with wounding or exogenous ATP increased the hydrogen peroxide (H2O2) content, activities of catalase and polyphenol oxidase, and malondialdehyde content in both the treated and systemic leaves. Pre-treatment with ATP-degrading enzyme, apyrase, to the wounded leaves reduced the wound-induced local and systemic increases in H2O2 content, activities of catalase and polyphenol oxidase, and malondialdehyde content. Application of dimethylthiourea (DMTU) and diphenylene iodonium (DPI) to the wounded and ATP-treated leaves, respectively, reduced the wound- and ATP-induced local and systemic increases in H2O2 content, activities of catalase and polyphenol oxidase, and malondialdehyde content. Moreover, the wound- and ATP-induced systemic increases of these physiological parameters were suppressed when DMTU or DPI applied to leaf petiole of the wounded and ATP-treated leaves. These results suggest that eATP at wounded sites could mediate the wound-induced local and systemic responses by H2O2-dependent signal transduction.

Three new sesquiterpenes from Pterocarpus santalinus.

Three new sesquiterpenes of canusesnol K (1), canusesnol L (2) and 12, 15-dihydroxycurcumene (3), along with five known ones (4-8), were isolated from the heartwood extract of Pterocarpus santalinus. Their structures were established by extensive analyses of 1D and 2D NMR spectroscopy, including 1H NMR, 13C NMR, HSQC, HMBC and NOESY, and HRESI-MS. The absolute configurations of the new compounds were established with Modified Mosher's method. The cytotoxic activities of all these compounds against HepG2 (human liver cancer), MCF-7 (human breast cancer), MDA-MB-231 (human breast cancer), and Hela (human cervical carcinoma) cancer cell lines were evaluated. Compound 1 exhibited moderate cytotoxic activity toward MDA-MB-231 cell lines.

[Intestinal absorption and metabolism of Puerariae Lobatae Radix decoction by in situ closed-loop method].

Biopharmaceutics classification system of Chinese materia medica (CMMBCS) emphasizes characteristic of the multi-component environment based on the drug solubility and permeability. In this study, the in situ closed-loop method combined with LC-MS technique was utilized to study the intestinal absorption and metabolism of Puerariae Lobatae Radix decoction (PLRD), providing selection basis for intestinal permeability components in CMMBCS. A total of 36 components were identified from PLRD. Among them, 17 components could be detected in the plasma sample, indicating that 17 components could be absorbed into blood, so these 17 components could be used as intestinal permeability evaluation components in CMMBCS. The other 19 components were not detected in the plasma sample, suggesting that they may not be absorbed or metabolized by the gut wall enzymes.

[Preparation, characterization and Calu-3 cellular uptake of three kinds of poly(b-benzyl-L-amino)block-poly(ethylene glycol) nanoparticles].

The aim of this paper is to compare the cytotoxicity and cellular uptake efficiency of three kinds of poly(b-benzyl-L-amino) block-poly(ethylene glycol) nanoparticles (PXA-PEG-NPs) using Calu-3 cells, and select one as a nasal drug delivery vector for curcumin (Cur). Poly(gamma-benzyl-L-glutamate) block-poly(ethylene glycol) nanoparticles (PBLG-PEG-NPs), poly(gamma-benzyl-L-lysine) block-poly(ethyleneglycol) nanoparticles (PZLL-PEG-NPs) and poly(gamma-benzyl-L-aspartate) block-poly(ethylene glycol) nanoparticles (PBLA-PEG-NPs) were prepared by emulsion-solvent evaporation method. MTT assays were used to evaluate the cytotoxicity of PXA-PEG-NPs against Calu-3 cells. The cellular uptake of nanoparticles was visualized by an inverted fluorescence microscope and quantified by a flow cytometer. The results indicated that even at high concentration of 2 mg x mL(-1) the three nanoparticles had no cytotoxicity on Calu-3 cells. Compared to the curcumin solution, the three curcumin-loaded PXA-PEG-NPs showed significantly higher cellular uptake efficiency on Calu-3 cells (at equal concentration of curcumin with 5 microg x mL(-1) Cur solution), PBLG-PEG-NPs group was the highest. The cellular uptake increased with incubation time, and has positive correlation with nanoparticle concentration. In brief, PXA-PEG-NPs are conducive to delivery Cur into cells, and PBLG-PEG-NPs might be provided as a good nasal drug delivery carrier.

[Analysis of cataract surgical rate and its influencing factors in Shanghai, China].

OBJECTIVE: To explore the cataract surgical rate (CSR) of Shanghai from 2006 to 2012 and examine its influencing factors. METHODS: As of 2003, a cataract surgery registration form had been filled by physicians after every cataract surgery in Shanghai. The local eye disease prevention team then entered the relevant information into the Shanghai Cataract Operations Database. Based upon this database, CSR of Shanghai was calculated. And the number of cataract surgeries was compared between Shanghai urban and suburban districts as well as among different medical institutions. RESULTS: The overall CSR in Shanghai increased from 1741 in 2006 to 2313 in 2012. In 2012, CSR in urban districts reached 6013 while it stood at 460 and 584 in inner and outer suburb districts respectively. The number of hospitals performing cataract surgery in urban districts was much more than that in suburbs. And the average number of cataract surgeries per hospital per year in suburbs was only one third of that (748 cases) in urban areas. The number of cataract surgeries at in private hospitals increased rapidly during the past 7 years. The number of 1921 cases was nearly twice as many as that at tertiary hospitals in 2012. Phacoemulsification surgery was the most popular surgical choice for cataract removal, accounting for 98.40% of total cataract surgeries in 2012. CONCLUSION: Until 2012, CSR in Shanghai dropped below the target of World Health Organization (WHO). A low level of CSR in suburbs is a major influencing factor for the overall level of CSR in Shanghai.

[Therapeutic effects of Fuzhenghuayu decoction in a CCl4-induced liver cirrhosis rat model and on hepatic stellate cell activation].

OBJECTIVE: To evaluate the influence of Fuzhenghuayu decoction on fibrotic liver tissue and activated hepatic stellate cells (HSCs) using a carbon tetrachloride (CCl4)-induced liver cirrhosis rat model system. METHODS: Sixty-four Sprague-Dawley rats were randomly divided into the following groups: normal (non-model, non-drug intervention), CCl4 liver fibrosis model, and CCl4 liver fibrosis model Fuzhenghuayu drug intervention at low dose (0.75 g/kg/d) and high dose (1.5 g/kg/d). The drug intervention was administered via oral-gastric irrigation once daily for 6 times per week over a 6-week period. Four rats from each group were sacrificed at the end of week 2, 4, and 6 for serum and liver tissue collection. Liver fibrosis was evaluated by histology, and expression of a-smooth muscle actin (a-SMA) was determined by immunohistochemistry. Liver function was assessed by measuring levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil). Between-group comparisons were made by completely random design and ANOVA with Bonferroni correction. RESULTS: At the end of weeks 2, 4 and 6, all four groups showed significantly different levels of ALT, AST, and TBil; in addition, the model group and drug intervention groups had significantly higher levels of ALT, AST, and TBil than the control group, the drug intervention groups showed significantly lower levels of ALT, AST, and TBil than the model group (P less than 0.01 or less than 0.05), and the differences between the low dose and high dose groups reached statistical significance (P less than 0.01 or less than 0.05). At the end of weeks 2, 4 and 6, the model group and drug intervention groups had significantly higher area ratio of liver fibrosis than the normal group (F = model: 18.68, low dose: 49.95, high dose: 82.44, P less than 0.01), but the two drug intervention groups had significantly less area ratio of liver fibrosis than the model group (P less than 0.05) and the high dose group showed the most robust decrease. In addition, the model group and drug intervention groups showed higher expression of a-SMA than the normal group (F = model: 18.68, low dose: 49.95, high dose: 82.44, P less than 0.01), but two drug intervention groups had significantly less a-SMA than the model group (F = model: 46.32, low dose: 40.30, high dose: 58.42, P less than 0.05) and the high dose group showed the most robust decrease. CONCLUSION: The Fuzhenghuayu decoction reduces the numbers of activated HSCs, thereby leading to down-regulated a-SMA expression and reduced degree of liver fibrosis; these effects may represent the mechanism by which this drug suppresses hepatic fibrosis.

Changes and related factors of blood CCN1 levels in diabetic patients.

Objective: To study the differences in blood cellular communication network factor 1 (CCN1) levels between patients with diabetes mellitus (DM) and healthy individuals and to explore the relationship between CCN1 and diabetic retinopathy (DR). Methods: Plasma CCN1 levels were detected using ELISA in 50 healthy controls, 74 patients with diabetes without diabetic retinopathy (DM group), and 69 patients with diabetic retinopathy (DR group). Correlations between CCN1 levels and age, body mass index, mean arterial pressure, hemoglobin A1c, and other factors were analyzed. The relationship between CCN1 expression and DR was explored using logistic regression after adjusting for confounding factors. Blood mRNA sequencing analysis was performed for all subjects, and the molecular changes that may be related to CCN1 were explored. The retinal vasculature of streptozotocin-induced diabetic rats was examined using fundus fluorescein angiography; in addition, retinal protein expression was examined using western blotting. Results: Plasma CCN1 levels in patients with DR were significantly higher than in the control and DM groups; however, no significant differences were observed between healthy controls and patients with DM. CCN1 levels negatively correlated with body mass index and positively correlated with the duration of diabetes and urea levels. It was observed that high (OR 4.72, 95% CI: 1.10-20.25) and very high (OR 8.54, 95% CI: 2.00-36.51) levels of CCN1 were risk factors for DR. Blood mRNA sequencing analysis revealed that CCN1-related pathways were significantly altered in the DR group. The expression of hypoxia-, oxidative stress-, and dephosphorylation-related proteins were elevated, while that of tight junction proteins were reduced in the retinas of diabetic rats. Conclusion: Blood CCN1 levels are significantly elevated in patients with DR. High and very high levels of plasma CCN1 are risk factors for DR. Blood CCN1 level may be a potential biomarker for diagnosis of DR. The effects of CCN1 on DR may be related to hypoxia, oxidative stress, and dephosphorylation.

[Serum changes of adiponectin, insulin resistance and their correlation in endometrial cancer patients].

OBJECTIVE: To explore changes of serum adiponectin and insulin resistance in patients with endometrial cancer and to evaluate the clinical significance and correlation. METHODS: The serum levels of adiponectin and fasting insulin were determined by ELISA, electro-chemilluminometry and radioimmunoassay in 35 patients with endometrial cancer [all patients divided into two groups, A1 group belonged to without postmenopausal when first visiting (n = 20), A2 group belonged to postmenopausal when first visiting (n = 15)] and 30 cases of health control. The result of homeostasis model assessment-insulin resistance (HOMA-IR) index was calculated. RESULTS: The levels of adiponectin in A1 group was lower than that of health control group [(6.7 ± 1.1) versus (10.0 ± 1.4) ng/L, P < 0.05], and HOMA-IR was higher than that of health control group (3.5 ± 1.8 versus 1.1 ± 0.7, P < 0.05). While there were not significant difference between A2 group and health control group (P > 0.05). Adiponectin and insulin resistance was negatively correlated (r = -0.389, P < 0.05). CONCLUSION: Adiponectin reducing and insulin resistance in reproductive age patients may be the independent factors to promote endometrial cancers.

Catheter-related bloodstream infections in children with intestinal failure: a 6-year review from an intestinal rehabilitation center in China.

BACKGROUND: Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF. METHODS: This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China. Clinical data were collected, including data of temperature and gastrointestinal symptoms. Blood/catheter culture, fecal tests, and calculation of inflammatory index were performed, which were obtained within 1 week since CRBSI onset. RESULTS: Fifty children with 87 CRBSIs were identified, of which there were 17 suspected and 70 confirmed cases. Seventy-two pathogens were cultured from 70 positive blood cultures: 63% were Gram-positive organisms, 23% were Gram-negative organisms, and 11% were fungal organisms. Overall, 48.6% were enteric organisms; 47.2% of bacterial pathogens were consistent between fecal and blood cultures. Moreover, 46.3% fecal routines showed abnormalities including increased white blood cells, occult blood positive and the presence of fat droplets. The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output, abdominal distension, or both. C-reactive protein (CRP) and procalcitonin (PCT) were elevated, i.e., 16.5 mg/L [interquartile range (IQR) 8.7-44.7] and 0.48 ng/mL (IQR 0.2-1.76), respectively. CONCLUSIONS: IF children had a high rate of CRBSIs, of which larger proportions were due to Gram-positive and enteric organisms. Fever and/or gastrointestinal symptoms, combined with elevated CRP and PCT, is conducive to the early diagnosis of CRBSIs in IF patients.

A new benzofuran glucoside from Ficus tikoua Bur.

From the water-soluble portion of the methanol extract of stems of Ficus tikoua Bur., a new benzofuran glucoside, named 6-carboxyethyl-5-hydroxybenzofuran 5-O-ß-d-glucopyranoside (1), together with one known benzofuran glucoside (2) were isolated. Their structures were elucidated by 1D and 2D ((1)H-(1)H COSY, HMQC, and HMBC) NMR spectroscopy and HRMS techniques. The antioxidant activities of the isolated compounds were assayed based on the scavenging activities of DPPH free radical. Compounds 1 and 2 exhibited moderate antioxidant activities, and the IC(50) values were 242.8 µg·mL(-1) and 324.9 µg·mL(-1), respectively.

Comparison and recent progress of molecular imprinting technology and dummy template molecular imprinting technology.

Molecular imprinting technology for the preparation of polymers with specific molecular recognition function had become one of the current research hotspots. It has been widely applied in chromatographic separation, antibody and receptor mimetics, solid-phase extraction, bio-sensors, and other fields in the last decades. In this study, molecular imprinting technology was summarized from the points of templates and dummy templates, and four typical target analytes were selected to compare the differences between templates and dummy templates. The current status and prospects of molecular imprinting technology were also proposed.

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai.

AIM: To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR. METHODS: This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors. RESULTS: In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors. CONCLUSION: The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.

[Clinical observation on electroacupuncture combined with moxibustion for treatment of urinary incontinence after stroke due to deficiency of kidney-yang].

OBJECTIVE: To observe the clinical effect of electroacupuncture combined with moxibustion in the treatment of urinary incontinence after stroke due to deficiency of kidney-yang. METHODS: Sixty patients with urinary incontinence after stroke due to kidney-yang deficiency were randomly divided into a control group and an observation group，with 30 cases in each group. The patients in the control group were given oral administration of Jingui Shenqi pills and Suoquan capsules. On the basis of the treatment in the control group, the patients in the observation group were given electroacupuncture treatment at the Foot Motor sensory Area on the head, Shenshu(BL23) and Huiyang(BL35), together with moxibustion at Guanyuan(CV4) and Qihai(CV6) once daily. The treatment was conducted 6 times per week and for 2 successive weeks. The average number of daily urinary incontinence and night urinary incontinence, maximum bladder volume, residual bladder urine volume, degree of urinary incontinence and clinical symptoms score of the two groups before and after treatment were observed. And the clinical efficacy of the two groups were compared. RESULTS: After the treatment, compared with those before the treatment, the average numbers of daily and night urinary incontinence of the two groups were significantly reduced (P<0.01), the maximum bladder volume was significantly increased (P<0.05), and the residual urine volume of the bladder was significantly reduced (P<0.05). The number of cases with urinary incontinence degree Ⅰ and Ⅱ increased (P<0.05), and the score of clinical symptoms of urinary incontinence was significantly reduced (P<0.05). After the treatment, compared with the control group, the number of daily and night urinary incontinence in the observation group decreased (P<0.05), the maximum bladder volume increased (P<0.05), the residual bladder urine volume decreased (P<0.05), and the number of cases with urinary incontinence degree Ⅰ and Ⅱ increased (P<0.05), the clinical symptom score of urinary incontinence was significantly reduced (P<0.05). The total effective rates of the control group and the observation group were 73.3% (22/30) and 93.3% (28/30) respectively, and the effective rate of the observation group was higher than that of the control group (P<0.05). CONCLUSION: The combination of electroacupuncture, moxibustion and traditional Chinese medicine is effective in treating urinary incontinence after stroke due to deficiency of kidney-yang.

Partial S substitution activates NiMoO4 for efficient and stable electrocatalytic urea oxidation.

Achieving a profound understanding of the reaction kinetics of a catalyst by modulating its electronic structure is significant. Herein, we present a scalable approach to achieving a spatially partial substitution of S into NiMoO4. The increase in active components in a true Ni3+ oxidation state as a result of optimizing the coordination environment greatly improved urea oxidation activity.

[Design of a volume-rendering toolkit using GPU-based ray-casting].

This paper presents an approach to GPU-based ray-casting of a shader model 3.0 compatible graphics card. In addition, a software toolkit is designed using the proposed algorithm to make the full benefit of GPU by extending VTK. Experimental results suggest that remarkable speedups are observed using GPU-based algorithm, and high-quality renderings can be achieved at interactive framerates above 60 fps. The toolkit designed provides a high level of usability and extendibility.

[Inducing liver-derived dendritic cell proliferation by plasmid-IL-3 and CD40L genes in mice in vivo].

OBJECTIVES: Try to induce liver-derived dendritic cells proliferation by plasmid-IL-3 and CD40L genes in mice in vivo. METHODS: Rapid tail-vein injection of large amounts of plasmid-carrying genes was performed to transfect genes in mice livers. Liver nonparenchymal cells were isolated by Percoll gradient centrifugation. Dendritic cell markers were detected and dendritic cells were sorted out by flow cytometry. Morphology of dendritic cells was studied microscopically (with Giemsa staining) and under scanning electron microscopy. RESULTS: Liver nonparenchymal cells dramatically increased in the liver lobules, portal and periportal areas in the treated group, but not in the control group. B220+/DEC205+ dendritic cells were detected and sorted by flow cytometry. There were more B220+/DEC205+ dendritic cells (16.0%) in the experiment group than those in the control group (1.1%). Morphologically, the sorted B220+/DEC205+ cells showed irregular shaped nuclei, paucity of cytoplasmic granules and extensive cytoplasmic processes. CONCLUSION: B220+/DEC205+ dendritic cells were expanded in vivo in mice livers by rapid tail-vein injection of plasmid-carrying genes encoding IL-3 and CD40L in a large amount. Inducing liver dendritic cell proliferation in vivo provides a more convenient way for studying the biology of these cells.

Expression of Iron Transporters and Pathological Hallmarks of Parkinson's and Alzheimer's Diseases in the Brain of Young, Adult, and Aged Rats.

Iron accumulates progressively in the brain with age; however, the cause is unknown. We hypothesized that iron accumulation may be associated with the age-induced changes in the expression of iron metabolism proteins in the brain. Here, we systematically investigated iron content and the expression of two major iron importers, transferrin receptor 1 (TfR1) and divalent metal transporter (DMT1), two iron exporters, ferroportin 1 (Fpn1) and ceruloplasmin (CP), and hepcidin, along with the pathological hallmarks of Parkinson's (PD) and Alzheimer's diseases (AD) in the brain of young (3 months), adult (12 months), and aged (24 months) rats. We demonstrated that age has a region-specific effect on iron transport proteins along with iron content in the cortex, striatum, hippocampus, and substantia nigra. We also found an age-dependent increase in hyperphosphorylated tau, total beta-amyloid, and neurotoxic oligomeric aggregates in the cortex and hippocampus as well as an increase in α-synuclein and a decrease in tyrosine hydroxylase positive neurons in the substantia nigra. Our findings suggest that the age-dependent increase in brain iron may be partly due to the age-induced increase in DMT1 expression, rather than TfR1 and Fpn1 expression, and also imply that the increased brain iron is associated with expression of the pathological hallmarks of AD and PD.

Altered systemic bile acid homeostasis contributes to liver disease in pediatric patients with intestinal failure.

Intestinal failure (IF)-associated liver disease (IFALD), as a major complication, contributes to significant morbidity in pediatric IF patients. However, the pathogenesis of IFALD is still uncertain. We here investigate the roles of bile acid (BA) dysmetabolism in the unclear pathogenesis of IFALD. It found that the histological evidence of pediatric IF patients exhibited liver injury, which was characterized by liver bile duct proliferation, inflammatory infiltration, hepatocyte apoptosis and different stages of fibrosis. The BA compositions were altered in serum and liver of pediatric IF patients, as reflected by a primary BA dominant composition. In IF patients, the serum FGF19 levels decreased significantly, and were conversely correlated with ileal inflammation grades (r = -0.50, p < 0.05). In ileum, the inflammation grades were inversely associated with farnesoid X receptor (FXR) expression (r = -0.55, p < 0.05). In liver, the expression of induction of the rate-limiting enzyme in bile salt synthesis, cytochrome P450 7a1 (CYP7A1) increased evidently. In conclusion, ileum inflammation decreases FXR expression corresponding to reduce serum FGF19 concentration, along with increased hepatic bile acid synthesis, leading to liver damages in IF patients.

Hereditary pancreatitis of 3 Chinese children: Case report and literature review.

BACKGROUND: Hereditary pancreatitis (HP) is quite rare and is distinguished by incomplete penetrance presentation as early-onset relapsing pancreatitis, usually beginning in childhood. HP is now known to be commonly relevant to mutations in the PRSS1 (gene-encoding cationic trypsinogen), SPINK1 (serine protease inhibitor, Kazal type 1), CFTR (cystic fibrosis), carboxypeptidase A1 (CPA1), and chymotrypsin C (CTRC) genes as reported in some Caucasian studies. HP has a variable spectrum of severity and may develop complications. METHODS & RESULTS: We describe the clinical course of 3 preschool children, hospitalized with postprandial abdominal pain, whose laboratory tests showed high serum amylase. Similar episodes of abdominal pain led to readmission, and the patients recovered quickly after using symptomatic therapy. The condition of the first boy, who developed a pancreatic tail pseudocyst and splenic infarction, was especially complicated. The boy underwent 2 endoscopic retrograde cholangiopancreatographies and stenting, along with a surgical procedure that completely relieved his symptoms for 3 months. The 3 patients and their parents were given genetic testing. All of the patients carried 1 or more gene mutations inherited from their mothers, fathers, or both parents; however, none of the parents were affected. CONCLUSION: For children with repeated pancreatitis, clinicians should consider HP in the differential diagnosis. It is reliable to perform gene sequencing on suspicious patients and their parents. Multidisciplinary and comprehensive treatment should be recommended to manage HP and its complications. Cholangiopancreatography and stenting is a relatively minimally invasive approach when compared with surgery and can be tried as an early intervention. Surgical procedures should be reserved for patients with complications.