Objective: To investigate the effects of macrophage colony-stimulating factor (M-CSF) on the polarization and infiltration of M2 macrophages and the invasion and metastasis of tumor cells in ovarian cancer microenvironment. Methods: A co-culture system consisting of ovarian cancer cells (A2780 and SKOV3) and THP-1 derived macrophages was established in vitro. The M-CSF levels in culture medium and M-CSF mRNA levels in cancer cells and macrophages were detected by ELISA and qRT-PCR, respectively. The proportion of CD68+CD163+ M2 macrophages (polarization cells) was determined by flow cytometry. The invasive and metastatic ability of A2780 and SKOV3 cells after co-culturing with M2 macrophages were analyzed using Transwell assay. The expression levels of M-CSF, CD68+, CD163+ and E-cad in paraffin sections of 52 patients with ovarian cancer and 18 patients with benign ovarian tumor were detected by the immunohistochemistry staining, and their correlations and the relationship between M-CSF and clinicopathological features of ovarian cancer patients were analyzed. Results: The M-CSF levels in culture medium of the co-culture group (A2780 and SKOV3 cells co-cultured with M2 macrophages) were significantly higher than that of A2780 and SKOV3 cells alone (t=14.315 and 12.338, P＜0.01). Fluorescence quantitative PCR results showed that the increased M-CSF originated from the secretion of co-cultured ovarian cancer cells (t=29.915 and 36.826, P＜0.01). The proportions of CD68+CD163+ M2 macrophages in the A2780 cells co-cultured with M2 macrophages group and SKOV3 cells co-cultured with M2 macrophages group were (6.14±0.50)% and (7.32±0.67)%, respectively, which were significantly higher than that in the M2 macrophages alone group ([1.82±0.34]%, t=12.289 and 12.711, P＜0.01). Transwell assay showed that the co-culture environment enhanced the invasion of A2780 and SKOV3 cells (24.00±4.81 vs 75.20±6.42, t=11.058; 18.40±2.31 vs 61.60±9.66, t=7.537, P＜0.01). The expression levels of M-CSF in ovarian cancer tissues were positively correlated with the number of CD68+ cells and CD163+ cells (r=0.690 and 0.596, P＜0.01), and negatively with the expression levels of E-cad (r=-0.566, P＜0.01). Moreover, the expression levels of M-CSF and the number of CD68+ cells and CD163+ cells in ovarian cancer tissues were significantly higher than that in benign ovarian tumor tissues, however, the expression levels of E-cad were on the contrary. The expression levels of M-CSF in ovarian cancer tissues were significantly correlated with tumor stage, differentiation and lymphatic node metastasis (χ2=6.240, 6.612 and 4.544, respectively, P＜0.05). Conclusion The increased expression of M-CSF in ovarian cancer microenvironment may induce the polarization and infiltration of CD68+CD163+ M2 macrophages, and then promote the invasion and metastasis of ovarian cancer cells.

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.

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 characteristics of the newly discovered tricuspid injury during the fol-low -up of the patients with interventional transcatheter closure for perimembranous ventricular septal defect (VSD). Methods A retrospective analysis of clinical data was performed in the successful completion of membranous VSD in-tervention from March 2003 to April 2015,and 11 cases of serious tricuspid injury in children were found during the fol-low -up.Results Among 11 children,10 cases underwent surgery again,and in 7 cases of them with pseudoaneurysm of perimembranous septum,the occluders were deviated toward the right ventricul which caused valvular inadequacy for plate winding closures,extrusion and wear of tricuspid chordae and /or leaflet by right ventricul(RV)disc.Among them,1 case was caused by leaflet fusion tear and tricuspid valve insufficiency;3 cases without pseudoaneurysm were caused by a spindle like RV disc recovery structure protruding into the right ventricle,and then the disc squeezed the tricuspid tendinous cord or leaflet and the right ventricular disc nut wrapped tendon of tricuspid valve finally leading to tricuspid valve insufficiency.There was a small amount of tricuspid regurgitation after surgery;the cardiac size and car-diac function returned to normal.One case did not receive surgery,and at present the right atrium and right ventricle were significantly enlarged,and the activity was limited.Conclusions Tricuspid injury discovered newly after perimem-branous VSD interventional therapy is more common in pseudoaneurysm with large tumor occluding the right ventricular disc resulting in poor formation,and it is important to consider these factors in choosing the size of the occluder and the operation.Long term follow -up mechanism should be established for the treatment of VSD after interventional therapy.

Currently,heart failure is one common disease causing serious damage to children's health and life which has high missed diagnosis rate and mortality.Accurate and effective evaluation of pediatric cardiac function is of great importance in the treatment,surveillance and prognosis of disease.Tei index was first presen-ted by Japanese scholars as a new comprehensive indicator of global (combined systolic and diastolic)myocar-dial function.It was defined as a ratio between the sum of isovolumic times (ICT and IRT)and ejection time (ET).This index can be measured by a simple,reproducible and non-invasive method regardless of changes in the heart rate or ventricular shape and other external factors.The sensitivity for ventricular dysfunction could be high.Tei index has been used more and more often in the clinical evaluation of cardiac function especially in children.This paper reviews the measurement methods,related factors and pediatric clinical application progress of Tei index.

Ultrasonography has grown rapidly and gained widespread acceptance in various fields.It has become a favored diagnostic imaging tool for its non-invasive,non-ionizing radiation,fast,convenient and portable.This article described briefly the application of ultrasound in vascular and its related diseases.

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.

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.

Objective To study hematotoxic effect of formaldehyde in mice.Methods Sixty healthy KM mice were randomly divided into a control group and three formaldehyde treated groups named a low level group,a moderate level group and high level group.Themice in the experimental groups were exposed to formaldehyde by intraperitoneal injection,once a day,for three weeks at the dose of 0.2,2.0 and 20 mg/kg bw respectively.Five mice were sacrificed at the 1st,2nd,3rd week of formaldehyde treatment and the blood samples were collected.The red blood cell counts,white blood cell counts and the hemoglobin content in the blood in mice were determined.Results During the experimental period,the body weight of mice in low level group at the 1st and 3rd week decreased significantly compared with the control group.The organ coefficient of the kidney in the moderate level group,high level group at the 1st week were higher than that of control group.The organ coefficient of the spleen in moderate level group at the 2nd week,in all three formaldehyde treated groups at the 3rd week was lower than that of control group.The organ coefficient of the heart in high level group at the 3rd week also decreased markedly in comparison to that of control group.The hemoglobin content in high level group at the 3rd week was lower than that of the control group.The red blood cell counts in three experiment groups at the 1st week and in high level group at the 2nd week decreased markedly compared with the control group.The white blood cell counts were seen much lower in low level group at the first two weeks,in moderate level group at the 1st week and in high level group in the experimental period compared with the control group.Conclusion Formaldehyde exposure has some hematotoxic effects in mice.

Objective: To study the protective effect in CCl4-induced liver injury by organoselenium from Se-enriched lactobacillus. Methods: (1) In the first series, forty-five animals were randomly divided into control (C) group, CCl4 group, CCl4 plus organoselenium group (CCl4-Se group). The liver injury was induced by abdominal injection of CCl4 every other day for 4 w. Changes of GSH-Px, CAT and SOD activities as well as MDA content in liver were estimated in the 2nd and 4th week after CCl4 injection respectively. (2) In the second series, forty-eight mice were randomly divided into C group, CCl4 group, CCl4 plus low dose organoselenium group (CCl4-LSe group) and CCl4 plus high dose organoselenium group (CCl4-HSe group). Changes of hepatocyte [Ca2+]i in animals in every group were investigated by means of confocal laser microscope on the 4th and 8th day after CCl4 injection respectively. Results: During the entire experimental period, liver MDA of CCl4 group was markedly superior to that of C and CCl4-Se groups, and the level of latter two groups was very close. The GSH-Px and CAT activities were higher in CCl4-Se group than in CCl4 group,but lower than that of C group. There were higher SOD activities in C and CCl4-Se groups compared to that in CCl4 group though without obvious difference. Average fluorescence pixels of hepatocyte [Ca2+]i in CCl4 group was 2.8 and 5.5 times higher than that of group C in the 4th and 8th day respectively,while those in CCl4-Se groups were significantly lower than those of CCl4 group, and close to C group. Conclusions: Organoselenium from Se-enriched lactobacillus, can protect hepatocyte [Ca2+]i homeostasis by reducing lipid peroxidation after CCl4 exposure.