AIM　To establish innovational triangular phase diagrams for preparation of pharmaceutical microemulsion (ME) with low toxicity as a result of reducing the amount of the emulsifiers. METHODS Lecithin and polyoxyethylene octyl phenyl ether (OP) were used as emulsifiers (E), absolute alcohol and n-octyl alcohol as assistant emulsifiers (A), ethyl oleate and olive oil as the oil phase (O). For the innovational triangular phase diagrams, lecithin-ethyl oleate-water and absolute alcohol (optimized ratio W/A=0.6)system, and OP(olive oil and n-octyl alcohol (O/A=0.34)-water system were used for preparation of the ME. While for the traditional triangular phase diagrams, OP and n-octyl alcohol (E/A=Km=1.5)-olive oil-water system, lecithin and absolute alcohol (E/A=Km=1.12)-ethyl oleate-water system were used. Then, the corresponding amounts of the emulsifiers used in both methods were compared. RESULTS　In the ME of lecithin systems by the innovational and the traditional methods, the amounts of emulsifier are 6%-28% and 28%-29.6%, respectively. In the ME of OP systems by the innovational and the traditional methods, the amounts of emulsifier are 23%-40% and 27.6%-49.8%, respectively. CONCLUSION　The method of innovational triangular phase diagram for preparation of ME is superior to the traditional method in finding out the lower amounts of emulsifiers for ME, and is a feasible method with guiding significance for preparing ME.

Wnt/β-catenin signaling pathway regulates cell proliferation,differentiation,and takes part in the process of gene expression and cell migration.The recent researches have shown that abnormal Wnt/β-catenin signal is closely related to the development of breast cancer and other tumors.Elucidation of the relationship between Wnt/β-catenin and breast cancer can help to reveal its mechanisms and provide a new insight into breast cancer prevention and treatment.Here,we summarize the latest advances about components and mechanism of Wnt/β-catenin pathway in breast cancer as below.

Targeted therapies of breast cancer offer a possibility of effective and individualized therapy based on the molecular profile of the tumor.Currently there are three main types of targeted therapeutic drugs for breast cancer,the first category is the monoclonal antibody against the human epidermal growth factor receptor 2 (HER2) including trastuzumab,pertuzumab,lapatinib,T-DM1.The second is targeting VEGF such as bevacizumab.The last one everolimus is a mammalian target of rapamycin (mTOR) inhibitors.A number of trials suggest that the addition of targeted therapy to chemotherapy or endocrine therapy significantly improved PFS and OS in patients with breast cancer.

Objective To analyze the clinical outcomes after different treatments for the Monteggia's fracture in children. Methods From January 1991 to December 2001, a total of 128 children with Monteggia's fracture were reviewed, there were 91 males and 37 females, the average age was 7.4 years (range, 2-14 years). According to the Bado classification system: 73 of typeⅠ( extension type) accounted for 57.0%; 20 of type Ⅱ (flexion type), 15.6%; 33 of type Ⅲ (adduction type), 25.8%; 2 of type Ⅳ, 1.6%. 50 patients received conservative treatment, all belonged to the fresh fractures (within 1 week after injury); the other 78 patients were operated, including 30 fresh fractures after failure of closed reduction and 48 old fractures. The conservative patients received manipulation and plaster immobilization. In the operative group, 45 patients (16 fresh and 29 old fractures) were fixed with single Kirschner wire after reduction of the radiohumeral joints, and the ulnas were free of fixation; 33 children (14 fresh and 19 old fractures) were fixed with double wire both for the radiohumeral joints and fractured ulnas. In the fresh Monteggia's fractures, the annular ligament was repaired simply without reconstruction, but in the old fractures, neither reparation nor reconstruction was needed. The plaster was kept for 4-6 weeks postoperatively. Results All patients were available at the final follow up with a mean of 5.6 years (range, 1-10 years). According to the Lihan Ming's scoring system for the motion function in children: the conservative patients were classified as 42 excellent, 4 good, 2 fair and 2 poor, the excellent and good rate was 92%; and in the single wire group, there were 31 excellent, 5 good, 2 fair and 1 poor, the excellent and good rate was 93.3%; finally in the double wire group, 22 excellent, 7 good, 2 fair and 2 poor, the excellent and good rate was 87.9%. Conclusion The closed reduction should be selected first for the fresh Monteggia's fracture in children, the operation is only indicated for the special fresh or old fractures, in which neither the anatomic reduction was satisfactory nor the reduction can be kept without internal fixation. The operative technique, including the open reduction of the radiohumeral joint and fixation both with Kirschner wire and plaster,is reliable to improve the clinical results.

DNA methylation is one of the most important epigenetic mechanism and molecular biological basis in tumor suppressor gene silencing.It is now well recognized that solid malignant tumors can release a significant amount of genomic DNA into systemic circulation,and with more than 90％ of this total circulating cell-free DNA derived from tumor tissue,which can reflect the overall cell heterogeneity of the tumor itself.In breast cancer,the presence of abnormally high DNA concentrations in plasma has been reported,and changes in the levels of these circulating DNA associated with tumor burden and progression have been confirmed repeatedly.Accumulating data strongly suggested that DNA methylation patterns found in circulating cell free DNA were similarly with the primary tumor,and could be a useful biomarker in early diagnosis,prognosis assessment,and recurrence monitoring for breast cancer patients.Here,we summarize the latest advances in this research field.

Long non-coding RNAs are RNA transcripts longer than 200 nt without any function of coding protein,and gradually become a new focus of cancer research because of their important roles in regulating genes expression at the epigenetic,transcriptional and post-transcriptional levels.Recently,more researches show that are closely related to the occurrence of breast cancer and other tumors.Therefore,in this review,we summarize the developing understanding of LncRNAs associated with breast cancer.

Objective To investigate the expression of OPN, α-SMA, E-cadherin and their correlation in the chronic allograft nephropathy (CAN) rat model, and to explore the possible role of OPN in CAN.Methods Orthotopic renal-transplantation using Fisher rats as donors and Lewis rats as recipients was done to establish CAN group, and Lewis to Lewis rats as control group. Rats in each group were sacrificed 12 weeks after the surgery. Blood and urine were collected for further test. Allograft samples were collected and sectioned for HE, Sirus-red staining, immunohistochemistry and Western blot.Results There were CAN morphological changes of the allograft in CAN group. As compared with control group, immunohistochemistry and Western blot revealed that the expression of OPN and α-SMA in CAN group was significantly increased, and that of E-Cadherin reduced. Its trend was correlated with the inflammatory response and the EMT of tubule epithelial cells.Conclusions OPN expression in rat CAN model is significantly up-regulated. OPN may play a role in CAN. OPN might affect the CAN by promoting EMT of tubule epithelial cells.

BACKGROUND: Adequate preparation of donors and recipients prior to living-related donor renal transplantation, short warm and cold ischemia time for donor kidney, good histocompatibility of human leukocyte antigen match, and low postoperative rejection incidence provide feasibility for use of low-dose immunosuppressive agents after living-related donor renal transplantation. OBJECTIVE: To investigate the safety and effectiveness of low-dose calcineurin inhibitors (CNI), an immunosuppressive agent, in living-related donor renal transplantation. METHODS: A total of 38 recipients who underwent living-related donor renal transplantation at the Center of Renal Transplantation of the First Affiliated Hospital of Nanjing Medical University from January 2006 to June 2008 were randomized for treatment with mycophenolate mofetil (750 mg twice a day), prednisone, and either standard-dose CNI (n=18) or low-dose CNI (n=20) during 12 months post-transplantation. Ciclosporin A was given orally (starting dose, 6 and 4 mg/kg per day, respectively) in two divided doses to achieve the 12-hour whole blood concentration as measured by fluorescence polarization immunoassay. The starting dose of tacrolimus was 0.12 and 0.08 mg/kg per day respectively, and its whole blood concentration was measured by enzyme-multiplied immunoassay technique. After transplantation, patients were followed up. Renal function, pulmonary infection, liver dysfunction, and CNI nephrotoxicity at different time periods were compared between different regimens. RESULTS AND CONCLUSION: During 12 months post-transplantation, patient death occurred in one of 18 patients (5.6%) in the CNI standard-dose group and none of 20 patients (0%) in the CNI low-dose group. There was no significant difference in renal function and acute rejection between CNI standard-dose and CNI low-dose groups (P > 0.05). The incidence of liver dysfunction and CNI nephrotoxicity was significantly lower in the CNI low-dose group than in the CNI standard-dose group (P < 0.05). In addition, a low-dose CNI regimen helped recipients to lessen the economic burdens. These findings indicate that it is effective, safe and economical to use a low-dose CNI regimen in living-related donor renal transplantation.

Objective To study the effect of tranilast on cyclosporine A (CsA)-induced epithelial-to-mesenchymal transition in human renal tubular epithelial cells, and investigate the mechanism of its antifibrotic effect. Methods Cultured HK-2 cells were divided into four groups: (1)In the control group, cells were treated without any medicine; (2) The cell were treated with CsA (4. 2μmol/L) for 72 h; (3) The cells were treated with a combination of CsA (4. 2 μmol/L) and tranilast (100μmol/L); (4) The cells were treated with tranilast (100 μmol/L) alone for 72 h.Morphological changes of the cells were assessed by phase-contrast microscopy. The immunofluorescence and Western blotting were adopted to detect the expression of E-cadherin, α-SMA and OPN mRNA and proteins respectively. Results Tranilast could markedly ameliorate the morphological changes of HK-2 cells stimulated by CsA. The irmmunofluorescence staining revealed the expression of E-cadherin was markedly decreased in HK-2 cells stimulated with CsA for 72 as compared with the control group, while the expression of α-SMA and OPN was significantly higher in CsA group than the control group. The expression of E-cadherin in the CsA + Tranilast group was higher than the CsA group, while the expression of α-SMA and OPN in the CsA + Tranilast group was lower than the CsA group. Western blotting showed that protein expression level of E-cadherin in CsA group was dramatically lower than that in the control group (P＜0. 05), while that of α-SMA and OPN in CsA group was significantly higher than in the control group (P＜0.05). The protein expression level of E-cadherin in HK-2 cells in the CsA + Tranilast group was markedly higher than in the CsA group (P＜0.05), and that of α-SMA and OPN in CsA + Tranilast group was significantly lower than in the CsA group (P＜0. 05). Conclusion Tranilast can block the CsA-induced epithelialto-mesenchymal transition in HK-2 cells probably by suppressing the expression of OPN.

Objective To evaluate the effectiveness of regional electrocardiographic consultation network for primary medical institutions.Methods A distance electrocardiographic ( ECG ) consultation center was established in Yuyao People′s Hospital in September 2012, which was connected to 56 regional primary medical through internet.The online consultation was provided by ECG specialists in the center for general practitioners in regional primary health care institutions.Additionally, the ECG training course was also conducted monthly for general practitioners.The 2-year data of ECG consultation were retrospectively reviewed and the effectiveness of the consultation network was evaluated.Results During the past two years, 86 593 electrocardiograms were uploaded by primary medical institutions, in which 3 976 were required for consultation. The monthly number of electrocardiograms sent by general practitioners was increased from 3 269 ±290 in the first year to 3 947 ±376 in the second year ( P<0.01 ) .However, the requirements of ECG consultation were not significantly different between two years.Compared to the first year, the rates of consultation requirements, misdiagnosis and missed diagnosis for ECGs of atrial and ventricular premature beats, atrial fibrillation, supraventricular tachycardia, left and right bundle branch blocks,ⅠandⅡdegree atrioventricular blocks and myocardial infarction were significantly decreased ( all P<0.05) in the second year;meanwhile there was a tendency towards the reduction for ECGs of atrial flutter and Ⅲ degree atrioventricular block in the second year.Conclusion The regional electrocardiographic consultation network is effective to improve the capability of primary medical institutions in electrocardiographic diagnosis.