Objective Thermal burns of the anterior chest disfigure the female breast, and the postburn breast deformity is a sequela of severe scar contraction of the burned chest. For deformities that affected the mammary development, museulocutaneous flaps were used. Here we introduce our experience in using the latissimus dorsi myocutaneous island flap in burned breast reconstruction. Methods During the past 7 years, 7 female patients with such deformities required reconstruction, the expanded or unex-panded latissimus dorsi musculocutaneous island flaps were used in the partial reconstruction of burned breast. In the mild deformities group (2 cases), unexpanded latissimus dorsi musculocutaneous island flaps were used. For patients with undeveloped mammary glands (5 cases), expanded latissimus dorsi musculocutaneous island flaps were used. Results The procedure was performed in 7 patients and all the flaps were alive, with significant improvement of breast appearance. The complication rate was low. There were no deformity and dysfuction in the donor site. Conclusions The technique has many advanta-ges: beautiful contour of breast, good blood supply of the flap, no donor site morbidity. It provides the plastic surgeon with an excellent, safe and consistently successful method for burned breast reconstrue-tion. This experience has led to development of surgical principles and techniques tailored to this particu-larly difficult problem.

AIM:To observe the situation of rat retinal tissue DNA damage at early diabetic period, discuss the role of the blood glucose fluctuations, and provide a new method for studying the pathogenesis of diabetic retinopathy ( DR) .
METHODS: SD rats were randomly divided into four groups:normal control group (NC), normal fluctuation group ( NF ) , diabetes group ( DM ) and diabetes fluctuation group ( DF ) . Diabetic models were established through intraperitoneal injection of STZ. A certain amount of glucose was injected in the rats of group NF and DF in an intraperitoneal mode three times a day after the model was established, thereby causing blood glucose fluctuations. Rats were killed and the retinal tissues were taken in the 8th week. Single cell gel electrophoresis ( SCGE ) technique was adopted for detecting DNA injury extent in the retina tissue.
RESULTS:Groups NF and DF showed significant and regular fluctuations. The curve of blood glucose fluctuations was relatively stable. All values of MBG, SDBG, LAGE and M were significantly increased compared with group NC. Group DF was increased more significantly. It was statistically significant (P<0. 01). SCGE showed that there were DNA damages in different levels in the cells of group NF, DM and DF. Indicators of cells such as TL, TDNA %, TM, OTM were higher than that in group NC. It was statistically significant ( P<0-01). The comparison difference between two groups was also significant (P<0. 01).
CONCLUSION: Rat retinal tissues have DNA injury during early diabetic period. DNA injury is gradually aggravated with blood glucose fluctuation. It indicates that high blood glucose and blood glucose fluctuation are involved in the mechanism of cell DNA injury, and they may be one of DR early event, have played a certain role in the incidence of DR.

Background Mesenchymal stem cells (MSCs) have been applied in basic and clinical researches of organ transplantation.Our previous study showed that intravenous injection of MSCs prolonged corneal allograft survival in rat.However,the effect of local administration of MSCs on corneal allograft rejection remains unclear.Objective The aim of this study was to investigate the effect of subconjunctival injection of MSCs on corneal allograft rejection in rat model of keratoplasty.Methods MSCs were isolated and cultured from femur and tibia bone marrow of clean Wistar rats,and then the cells were identified by induced differentiation of osteoblast and adipocyte.The third generation of MSCs was used in subsequent experiment.Allogenic penetrating keratoplasty was performed with the bilateral corneas of 20 Wistar rats as donor grafts and the right eyes of 40 Lewis rats as recipients.PBS 0.1 ml containing 2 × 106 MSCs and 0.1 ml PBS only was subconjunctivally injected immediately and postoperative 3 days respectively in randomized two groups,and another 6 normal Lewis rats served as the normal control group.Corneal rejection response was evaluated under the slit lamp after surgery based corneal opacity,edema and neovascularization,and the grafts were scored according to the criteria of Larkin.The corneal samples were extracted from 12 rats of the PBS control group and the MSCs group separately 10 days after surgery.The relative expressions of Th1 cytokines (interferon-γ [IFN-γ] mRNA and interleukin-2 [IL-2] mRNA) and Th2 cytokines (IL-4 mRNA and IL-10 mRNA) were detected by real-time quantitative PCR.Protein levels of IL-4 and IL-10 proteins in the corneas were assayed by ELISA.All experimental protocols involving rats were approved by the laboratory animal care and use committee of the Tianjin Medical University and treated with the ARVO statement for the use of animals in ophthalmic and vision research.Results The cells grew well with the orange stain for alizarin red in differentiated the osteoblasts and red stain for Oil red O in differentiated adipocytes.The survival time of corneal graft in the MSCs group was (11.8±1.6) days,it was significantly longer than (9.6±1.4) days in the PBS control group (P=0.004).The levels of IL-4 mRNA and IL-10 mRNA in the MSCs group were significantly higher than those in the PBS control group (both at P =0.00);while the levels of IFN-γ mRNA and IL-2 mRNA were not significantly different between the groups (both at P＞0.05).The IL-10 protein contents were (22.74 ±7.06),(68.40±12.83) and (215.41 ±44.66)pg/ml in the normal control group,PBS control group and MSCs group,showing significant difference among the three groups (F =55.06,P =0.00) and a significant increase in the MSCs group compared with the PBS control group and the normal control group (both at P ＜ 0.05).Conclusions Subconjunctival injection of MSCs prolongs the survival time of cornea allograft in penetrating keratoplasty probably by modulating the balance between Th1 and Th2 cytokines,especially by up-regulating Th2 cytokines.

Objective To identify interleukin (IL)-17-producing T cells and Foxp3 positive CD4 positive T ceils from patients with rheumatoid arthritis (RA), and investigate their cytokine levels as well as their correlations. Methods Flow cytometry was used to analyze the subsets of T cells in peripheral blood from 39 RA patients and 40 healthy donors. IL-17, IL-6, IL-23 and transforming growth factor (TGF)-beta levels in sera of these subjects were tested by ELISA. Results IL-17+CD4+ T cells increased significantly and IL-17, IL-6 and IL-23 elevated markedly in peripheral blood of RA patients compared to healthy donors (P< 0.01 ). However,Foxp3+CD4+T cells decreased evidently (P<0.01) and TGF-beta did not increase in RA pati-ents when compared to healthy donors (P>0.05). Conclusion This study suggests that Th17 cells predomin-ance coupled with relatively insufficient CD4+ regulatory T cells in RA is mainly caused by alterations of rela-ted cytokines.

Objective To investigate the mechanism of liposome PGE1 on the survival of the expanded flap.Methods The minipigs were set up as an animal model.They were divided into 2 groups.The expanded flaps (8 cm ×2 cm) were designed and elevated on the back of an minipig.An image analysis technology was used to evaluate the survival rate of the expanded flap,while realtimePCR technique was used to investigate the molecular mechanism.Results The survival area of the expanded flap in the Lipo PGE1 group was significantly enlarged (P＜0.01) compared with the control group.The VEGF,iNOS and Ang-1 gene expression decreased,but TGF-β1 gene expression increased.But there was no significant difference between two groups (P＞0.05).Conclusions The Lipo PGE1 could promote survival rate of the expanded flap,but the mechanism does not involve the regulation of VEGF,iNOS,Ang-1 and TGF-β1 gene expression.

Objective To investigate the expression of microRNA (miRNA)-3620 in the plasma of patients with anti-tuberculosis drug-induced hepatotoxicity (ATDH).Methods A total of 35 patients with ATDH and 35 non-ATDH paired individuals were included in this study.Plasma miRNA-3620 levels were detected using real-time Polymerase chain reaction.Comparison between two groups was done with t test.Receiver operation characteristic (ROC) curve analysis was performed to determine the diagnostic value of miRNA-3620 in ATDH.Results The relative expression of plasma miRNA-3620 of patients with ATDH and non-ATDH were 1.65±1.43 and 0.71±0.45, respectively, with significantly statistical difference (t=3.703, P<0.01).The cut off value of miRNA-3620 expression was 1.15 and the area under ROC curve were 0.71(95% CI: 0.43-1.45).Based on this cutoff value, the sensitivity and specificity of miRNA-3620 in diagnosing ATDH were 60.0% and 82.9%, respectively;the positive predictive value was 77.8% and the negative predictive value was 67.4%.Twenty-one ATDH cases and 29 non-ATDH cases was correctly diagnosed, with the accuracy of 71.4%.Conclusion The expression of miRNA-3620 in plasma is significantly increased in ATDH patients.

Objective To summarize the clinical characteristics of 15 cases of Poland's syndrome and to explore the suitable treatment strategies. Methods A retrospective study of 15 adult patients with Poland's syndrome was conducted and the related literature was reviewed. According to the development of pectoralis muscles and breast, chest deformities were classified into 2 grades: mild and severe. Mild form was limited to absence of partial pectoralis major muscle, with variable hypoplasia of other minor components (such as the size of breast and the size and position of the nipple-areola complex), leading to a mild chest wall asymmetry. Severe form was characterized by absence or severe hypoplasia of the pectoralis major muscle and mammary gland with an evident chest wall asymmetry. Combined with gender, adult patients were divided into 4 types: female mild, female severe, male mild, and male severe. Each type had its own treatment strategies based on its anatomic features: silicone implant insertion for female mild type;latissimus dorsi muscular flap transposition and silicone implant insertion for female severe type;fat injection for male mild type;latissimus dorsi muscular flap transposition for male severe type of the patients. From 2003 to 2008, 15 adult cases were admitted to our ward, aged from 16 to 34 years.The case number of each type was 6, 6, 2 and 1, respectively. One severe female patients rejected any surgical interventions;the others were all treated as the above. Results Follow-up periods ranged from 6 months to 4 years. This series had got satisfactory results with good breast symmetry and natural texture. All the latissimus dorsi muscular flaps survived well. No postoperative complications, such as implant capsular contracture or implant displacement, were observed. Conclusion The manifestations of Poland's syndrome are extremely varied. This classification method is simple but useful, which could effectively direct the individualized treatment for the complete and adequate rehabilitation. Latissimus dorsi muscular flap, pedicled or free transplanted, pulsing silicone implant in females, are the first choices for severe chest deformations of this syndrome.

Objective:To study the clinicopathologic characteristics and the prognostic factors of triple negative breast cancer,and to study the correlation between clinicopathologic features and EGFR expression.Methods:Clinical characteristics and prognosis of 200 breast cancer patients diagnosed between 1997 and 2004 were reviewed.The paraffin embedded tissues were selected and tissue microarray blocks were made.Immunohistochemical staining was used to evaluate the expression of ER,PR and HER2 for breast cancer molecular type.EGFR expression was evaluated to analyze its correlation with the clinical characteristics and prognosis.Results:Fourty-two cases(21%)of 200 were triple negative breast cancer(TNBC).There was no significant difference between TNBC and non-TNBC in clinicopathologic parameters such as age,tumor size,clinical stage,and lymph node status.However,there was significant difference in histological category and menostasis status between the two groups(P<0.05).Among TNBC,17 0f 42 died during the follow-up(the overall suivival rate was 59.52%),while 26 0f 158 non-TNBC died(the overall survival rate was 83.54%).EGFR was significantly overexpressed in TNBC(69.05%)and it was associated with lymph node status and histological category.Conclusion:Although the incidence of TNBC is low,it has a poorer prognosis than other subtypes.EGFR is highly expressed in TNBC and may serve as a prognostic index and an important therapatic target for breast cancer.

Objective To optimize extraction process of flavonoids from Toosendan Fructus.Methods Three parameters that significantly affect the extraction rate of flavonoids, ratio of material to water, extraction time and ethanol concentration, were taken into consideration for extraction ratio of flavonoids from Toosendan Fructus. Based on the results of single-factor experiment, the extraction parameters of flavonoids from Toosendan Fructus were optimized by Box-Behnken of response surface methodology (RSM).Results The optimum extraction conditions were as follow: material to water ratio was 1:35; extraction time should be 3 h; ethanol concentration was 70%. The extraction ratio was up to 0.587 3% in the optimum extraction conditions.Conclusion The actual value is highly matching the theoretically value of RSM model. The results indicated that this method can rationally optimize extraction process of flavonoids from Toosendan Fructus.

Objective To detect v raf murine sarcoma viral oncogene homologue B1 (BRAF) in the synovial fluid of rheumatoid arthritis (RA) and to investigate its clinical significance in RA.Methods Synovial fluid samples were obtained from patients with RA and osteoarthritis (OA).Serum samples were obtained from patients with RA,OA and heathy controls.The presence of BRAF in the synovial fluid and sera were examined by enzyme-linked immunosorbent assay (ELISA).Western blotting was used to detect the expression of BRAF protein in the synovial tissue of RA and OA.The associations between the BRAF and the clinical features and laboratory parameters of RA were evaluated.Data analysis were performed using t test and Spearman's association analysis.Results ① The level of BRAF in the synovial fluid of RA [(84±59) ng/ml] was significantly higher than OA [(38±41) ng/ml] (t=3.290,P=0.002).② The level of BRAF in the sera of RA patients [(22.0±12.5) ng/ml] was also higher than OA [(6.8±7.5) ng/ml,t=3.882,P＜0.01] and healthy controls [(4.8±2.2) ng/ml,t=6.766,P＜0.01].③ In RA patients,the BRAF protein level in the synovial fluid [(102±52) ng/ml] was significantly higher than that in the serum [(21±12) ng/ml] (t=-4.316,P=0.003).④The expression level of BRAF in the synovial tissue of RA (0.284±0.045) was higher than that in OA patients (0.191±0.013,t=3.169,P=0.034).⑤ The level of BRAF in the synovial fluid had a negative correlation with disease duration (r=-0.40,P=0.019) and a positive correlation with rheumatoid factor (RF) levels (r=0.37,P=0.03).Conclusion The presence of BRAF in the synovial fluid and synovium of RA indicates that BRAF may play a role in the pathogenesis of RA,especially in the early stage.