Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Purpose To investigate the diagnostic value of fetal echocardiography in total anomalous pulmonary venous connection (TAPVC),and to analyze the reasons ofmisdiagnosis so as to improve accuracy of prenatal diagnosis.Materials and Methods The prenatal echocardiographic data of 24 cases of TAPVC confirmed by postnatal echocardiography and prenatal MRI from October 2001 to December 2015 in Children's Hospital Affiliated to Nanjing Medical University and Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.Results In 24 cases,there were 14 fetuses of supracardiac type,7 cases of intracardiac type,2 cases of infracardiac type,and 1 case of mixed type.15 fetuses had TAPVC only,whereas 9 cases were associated with other cardiovascular anomalies,most commonly including bilateral right atria,single atrium,single ventricle,common atrioventricular valve and pulmonary stenosis.On 4-chamber views,the common sonographic sign was absent of pulmonary venous return to the left atrium in 24 cases (100.0％),and the presence of venous confluence between left atrium and descending aorta was observed in 22 cases (91.7％).In all 24 cases,1 case was missed diagnosis,and 3 cases were misdiagnosed as persistent left superior vena cava,common pulmonary vein atresia and patent left atrial cardinal vein.Conclusion TAPVC can be accurately diagnosed by fetal echocardiography,but it is prone to be misdiagnosed.

Objective To investigate the clinical value of high resolution ultrasound combined with radiological imaging in the diagnosis of Meckel′s diverticulitis (MD),and to analyze the causes of missed diagnosis as well as misdiagnosis by ultrasound.Methods The image data of 61 patients with MD were retrospectively analyzed,the essentials and the causes of missed diagnosis as well as misdiagnosis of ultrasound were summarized and compared with the results of operation,CT,gastrointestinal contrast,as well as radionuclide.Results The patients were divided into simple type(18,29.5%) and complex type(43,70.5%) according to ultrasonography.The simple type diagnostic accuracy rate was 100%,the ultrasonography showed the right lower abdominal tubular bowel shadow or cystic echo mass,and the structure of diverticulum could clearly showed by ultrasound.In another side,the complex type diagnostic accuracy rate was 55.8%,the ultrasonography showed the right lower abdominal mixed echo mass or concomitant with other alimentary tract malformation,while the diverticulum structure was difficult to be distinguished.The diagnostic accuracy rate of radionuclide imaging was 83.6%,CT was 37.0%,while gastrointestinal contrast was 30.0%.Among 19 cases of misdiagnosis by ultrasound,13 cases of MD were confirmed by radionuclide and CT examination,the diagnostic accuracy rate of ultrasound combined with radiological imaging diagnosis was 90.2%.Conclusions The sonographic features of MD are lack of specificity,especially in the complex type,while the patients with recurrent hemafecia or acute abdomen should be alert to the presence of MD.Patients who are suspected of MD by ultrasound diagnosis should also be examined by radiological imaging in order to make an early diagnosis and surgical treatment to improve the prognosis of patients.

Objective To observe clinical efficacy and explore clinical value of a modified procedure of double-stapling technique for mid-low rectal cancer.Methods Clinical data of patients undergoing laparoscopic anterior resection at the Department of General Surgery,the First Affiliated Hospital of Soochow University from February 2011 to February 2015 was analyzed retrospectively.According to the different ways in doing double-stapling technique,we divided patients into modified group (51 cases) and conventional group (74 cases).Parameters were compared between the two groups as general considerations,oncologic outcomes.Data were analyzed by SPSS 17.0 software packet,using t and x2 inspection.Results The difference of the general data of two groups was not statistically significant (P ＞ 0.05).Operation time in the modified group was longer than that of the conventional group [(169 ± 23) vs.(150 ±42)min,t =-3.150,P ＜0.05],but it had shorter drainage tube indwelling days [(7.9 ±2.9)d vs.(10.8±11.6)d,t=1.999,P＜0.05] and length of hospital stay after surgery [(10.0±3.6)d vs.(13.3 ± 13.7) d,t =1.025,P ＜ 0.05].The incidence of anastomotic leakage (2.0％ vs.18.9％,x2 =4.402,P ＜ 0.05) and tenesmus(3.9％ vs.17.6％,x2 =4.110,P ＜ 0.05) in the modified group was less than that of the conventional group.The difference in those areas was not statistically significant (P ＞ 0.05),such as intraopretive blood loss,per-anal exhaust time,consumption of liquid diet time,anastomotic bleeding,intestinal obstruction,reoperation for neostomy and infections.Conclusions Compared with traditional laparoscopic anterior resection,End-Corner anastomosis has the benefits of less postoperative anastomotic leakage and fewer low anterior resection syndrome.

Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas,analyze the reasons of missed diagnosis and misdiagnosis,and improve diagnostic accuracy of ultrasonography for this disease.Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively.Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery.Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease.Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%,1 8 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%.Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas.Five cases were missed diagnosed due to obvious intestinal cavity flatulence.Three cases were missed diagnosed due to lack of awareness of the disease.Five cases were misdiagnosed for duodenal stenosis or duodenal atresia.Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas,providing the dignostic evidences for clinical treatment.Thus it can be used as the preferred auxiliary examination of the disease.Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas,missed diagnosis and misdiagnosis occurred easily.To improve the accuracy of ultrasonic diagnosis,all causes of neonatal gastrointestinal tract obstructions should be considered during the examination.

BACKGROUND:Conditioned medium from mesenchymal stem cels (MSC-CM) may represent a promising alternative to MSCs transplantation. Previous studies have shown that inflammatory activation can strengthen the multiple biological potencies of MSCs; however, normal MSCs with insufficiency of immunocompetence and migration ability are not effective for tissue damage repair. OBJECTIVE:To investigate differential effects of MSC-CM with and without inflammatory activation on radiation-induced intestinal injury.METHODS:MSCs from the bone marrow of SD rats were separated, cultured and identified, and then co-cultured with non-irradiated IEC-6 or irradiated IEC-6 in a transwel system for 24 hours. Then, MSCs with inflammatory activation were cultured alone for another 48 hours. After that, the supernatant was colected as non-activated MSC-CM (MSC-CMNOR) and MSC-CM under radiation-induced inflammatory condition (MSC-CMIR). Rats were exposed to 14 Gy whole abdominal irradiation and randomly divided into four groups: control group, radiation injury group (DMEM/F12), MSC-CMNOR group and MSC-CMIR group. Continuous administration was givenvia tail vein and intraperitoneal implantation of Alzet microosmotic pumps. Intestinal samples were colected at 1, 3, 7 days after radiation for analysis of short circuit variation, at 3 days after radiation for analysis of intestinal epithelium ultrastructure, and at 1, 3, 5, 7, 14 days after radiation for histological observation of the intestinal epithelium using hematoxylin-eosin staining. Blood samples were colected at 1, 3, 7 days after radiation for analysis of serum xylose levels. In addition, the survival state and survival time of rats were observed and recorded. RESULTS AND CONCLUSION: The short circuit variation responding to electrical field stimulation was significantly reduced at al frequencies, but it was significantly improved in the MSC-CMIR group. Similarly, the intestinal absorption (serum xylose levels) was also significantly impaired by irradiation, but improved by delivery of MSC-CMIR (P < 0.05). At 3 days after MSC-CMIR infusion, the intestinal epithelium exhibited an increase in crypt size and vilous length (P < 0.05). Under the electron microscope, a reduction in intestinal microvili and open tight junctions in irradiated intestinal epithelium was found, and the intestine from rats treated with MSC-CMIR had more obvious tight junctions. In addition, treatment with MSC-CMIR dramaticaly improved the survival rate and mean survival time of irradiated rats as compared to those treated with DMEM/F12 or MSC-CMNOR (P < 0.05). Taken together, the present study demonstrated that MSC-CMIR , but not non-activated MSC-CM, improves the structural and functional restoration of the smal intestine after radiation-induced intestinal injury.

Objective To observe the application effect of the risk of ovarian malignancy algorithm(ROMA)in screening ovarian cancer among high risk population.Methods The human epididymis protein 4(HE4)and carbohydrate antigen 125 (CA125 )were detected in 1 753 cases of high risk for overian cancer,56 cases of ovarian cancer(positive control)and 60 healthy people,patients. Then the ROMA value was calculated in combination with the subject′s menstruation status.The detection results were analyzed and compared among groups.The high risk group for ovarian cancer devided according to the ROMA value was further performed the confirmatory test and the low risk group was monitored by follow up.The detection rates of ovarian cancer were compared be-tween the two subgroups.Results In the high risk population,the diagnostic performance of the ROMA value for ovarian cancer was superior to that of the single HE4 or CA125;the ROMA value had statistically significant difference between the high risk sub-group in the high-risk population with ovarian cancer or the healthy control group(P <0.05);in 1 753 cases of high risk popula-tion,37 cases were included in the high risk subgroup,in which 3 cases of ovarian cancer were screened out and in clinical early stage.The detection rate of ovarian cancer in the high risk subgroup was 8.1%.No case of ovarian cancer was detected out in the low risk subgroup.Conclusion The ROMA value is conducive to early screening for ovarian cancer in the high risk population, which can save the medical cost and increase the detection rate.

Objective To explore the ultrasound imaging and the clinical analysis of eosinophilic cystitis in children and to improve the understanding of this very rare clinical disease.Methods The ultrasound imaging of 9 patients who were diagnosed as eosinophilic cystitis in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Jul.2007 to May 2013 were analyzed retrospectively,and the relevant literatures were reviewed.Results The ultrasound imaging of the 9 patients were described as follows:4 cases showed a diffuse thickening bladder wall,2 cases showed a localized mass-like thickening bladder wall,and 3 cases showed a markedly thickening anterior bladder wall and bilateral bladder wall.Laboratory studies showed that all the patients were presented with eosinophilia.Six patients underwent cystoscopy that showed an erythematous,and velvety appearance of the bladder mucosa.Histopathology disclosed a bladder mucosal tissue with dense interstitial eosinophilic infiltration consistent with eosinophilic cystitis.Three patients had clinical resolution under the treatment of anti-infections and urine alkalinization.Other 6 patients received prednisone at 0.5-1.0 mg/kg and an antihistamine treatment.Prednisone was eventually tapered off after 2-week reemission.Regular follow-up by urinary bladder ultrasound and urine routine did not show any disease recurrence in 9 children.Conclusions The combination of bladder wall thickening and peripheral eosinophilia may suggest the likely diagnosis of eosinophilic cystitis.Cystoscopy with bladder biopsy is the most important step in the diagnosis of eosinophilic cystitis.Anti-histamines and corticosteroids can be used as the primary management and have good results.

OBJECTIVETo explore whether docetaxel-resistant cells (MCF-7/Doc) and doxorubicin-resistant cells (MCF-7/ADM) can secrete Exosomes and their potential role in cell-cell drug-resistance transfer.

METHODSExosomes were extracted from the cell culture supernatants of MCF-7/Doc and MCF-7/ADM cells by fractionation ultracentrifugation, and were identified by transmission electron microscopy and Western blot analysis. GFP-MCF-7/S, a breast cancer parental sensitive cell line stably expressing green fluorescent protein (GFP), was constructed by recombinant lentiviral vector with GFP. Then the resistance experiment of cells and the experiment of resistance transfer by exosomes were designed to observe the phenomenon of cell-to-cell drug-resistance transfer.

RESULTSSimilar to the breast cancer parental sensitive cells (MCF-7/S), the breast cancer resistant sublines could secrete exosomes, which exhibited round or elliptic shape ranging from 30 to 100 nm in diameter with intact membrane, and only expressed the protein marker of exosomes, Tsg101, did not express the endoplasmic reticulum marker calnexin. After MCF-7/S, MCF-7/DOC and MCF-7/ADM cells we cocultured with GFP-MCF-7/S cells for 72 h, there were no significant differences in the expression of fluorescence-labeled cells among the four groups. When treated by the drug ADM or DOC for 24 hours, the MCF-7/DOC+GFP-MCF-7/S group was in favor of a significant higher survival rate of fluorescence-labeled cells compared with the MCF-7/S+GFP-MCF-7/S group (65.5% vs. 25.5%, P < 0.001), and so did the MCF-7/ADM+GFP-MCF-7/S group (53.6% vs. 25.4%, P < 0.001). The exosomes extracted from MCF-7/S, MCF-7/DOC and MCF-7/ADM cells were cultured with the GFP-MCF-7/S cells for 48 h. Among these groups, no significant differences in the expression of fluorescence-labeled cells were found. After treated by the drug ADM or DOC for 24 hours, the exosomes extracted from MCF-7/DOC+GFP-MCF-7/S group was associated with a significant higher survival rate of fluorescence-labeled cells compared with the exosomes extracted from MCF-7/S+GFP-MCF-7/S group (59.9% vs. 32.4%, P < 0.001), and so did the exosomes extracted from the MCF-7/ADM)+GFP-MCF-7/S group (58.3% vs. 27.2%, P < 0.001).

CONCLUSIONOur results suggest that drug-resistance can be transferred between breast cancer cells, and exosomes are probably the transporter of the drug resistance.

Antibiotics, Antineoplastic ; pharmacology ; Antineoplastic Agents ; pharmacology ; Cell Survival ; Coculture Techniques ; DNA-Binding Proteins ; metabolism ; Doxorubicin ; pharmacology ; Drug Resistance, Neoplasm ; Endosomal Sorting Complexes Required for Transport ; metabolism ; Exosomes ; metabolism ; pathology ; Green Fluorescent Proteins ; metabolism ; Humans ; MCF-7 Cells ; pathology ; Taxoids ; pharmacology ; Transcription Factors ; metabolism