Objective To evaluate the efficacy and toxicity of whole brain radiotherapy concurrent with capecitabine for treatment of brain mestastases from breast cancer with post-operative.Methods Fifty patients with brain mestastases from breast cancer with post-operative were randomized into two groups:25 patiens were treatend with whole brain radiotherapy concurrent with capecitabine (treatment group) and the other 25 patients were treated with whole brain radiotherapy alone (control group).Radiation dose was 40 Gy in 20 fractions over 4 weeks.Capecitabine was administered concurrently with radiotherapy in escalatiny dose from the 1st day of RT to the end day (850 mg/m2,twice/day).Results The survival rates at 1-and 2-year were 60.0 ％ (15/25) and 28.0 ％ (7/25) in treatment group,44.0 ％ (11/25) and 16.0 ％ (4/25) in control group (x2 =1.28,1.05,P ＞ 0.05).Toxicities were tolerable.Conclusion Whole brain radiotherapy concurrent with capecitabine was effective and safe in treatment for patients with breat cancer and well-tolerated toxicity.

Inorganic/polymer hybrid star polylactic acid (POSS-PLA) was obtained through ring-opening polymerization of lactide by using polyhydroxyl cage silsesquioxane (POSS-OH) as the core and tin (II) octoate as the catalyst. The star polylactic acid (POSS-PLA) was used to modify sodium alginate hydrophobically and a drug carrier was obtained. The drug release behavior was investigated by using ibuprofen as the model drug. The results showed that the drug loading rate could be improved and the release rate was postponed with an increase of POSS-PLA content in the carries. The release mechanism gradually changed from the first-order to the zero-order pattern after the modification.

BACKGROUND:Ferroferric oxide (Fe3O4) nanoparticles are a research hotspot in drug delivery system, which can transport antineoplastic drugs to the lesion under external magnetic field. Additional y, its submicrons even can reach the tumor site several centimeters far away from the magnetic source. OBJECTIVE:To investigate the histocompatibility and in vivo distribution of Fe3O4 nanoparticles and to explore its application prospect and limitations as a drug carrier in the chemotherapy of osteosarcoma. METHODS:10.0 mg/kg Fe3O4 nanoparticles were administrated into Wistar rats via tail vein, then the rats were executed at 15, 60 and 120 minutes, respectively, and the rat lung, brain, heart, liver, kidney, hind limb and skeletal muscle were removed. The ferric ion content in each tissue was determined by atomic absorption spectrometer, and the morphological changes of different tissues were observed by hematoxylin-eosin staining at each time point. RESULTS AND CONCLUSION:After administrated for 15 minutes, the concentration of Fe3O4 nanoparticles in the liver and kidney reached peak, fol owed by a decrease at 60 and 120 minutes, but stil remained a high level. The concentration of Fe3O4 nanoparticles at three time points showed significant difference compared with the control group (P<0.05), demonstrating that the nanoparticles can be quickly enriched and long-term persistent in the liver and kidney. After administrated for 15 minutes, the concentration of Fe3O4 nanoparticles in the heart, lung, skeletal muscle and bone reached peak, which had significant difference compared with the control group (P<0.05), and significantly decreased subsequently except that in the bone. This significant difference stil displayed at 60 minutes between groups (P<0.05), indicating that the nanoparticle can reach a high concentration but persist short time in the high blood perfused tissues. Compared with the control group, the concentration of Fe3O4 nanoparticles in the brain tissue showed no significant difference at each time point (P>0.05), suggesting that the blood-brain barrier can inhibit the nanoparticle penetration. No overt morphological changes were found in each tissue after hematoxylin-eosin staining. In conclusion, the distribution of Fe3O4 nanoparticles conjugate sodium oleate in organism is influenced by the blood perfusion and mononuclear phagocyte system, and they cannot penetrate the blood-brain barrier and make no significant effect on tissues, but maintain a high level in the liver kidney and bone for a long-term, thus providing a theoretical basis for the drug delivery system in the magenetic hyperthermia therapy of malignant tumors.

Objective:To explore the impact of the number of pathological lymph node metastasis areas on the prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) after radical surgery.Methods:The clinicopathologic data of 153 patients with ESCC treated by radical surgery at the Department of Thoracic Surgery of the Affiliated Taixing People′s Hospital of Yangzhou University from January 2012 to December 2014 were retrospectively analyzed. Among these patients, 76 had no adjuvant therapy, and 77 received adjuvant radiotherapy or chemoradiotherapy after surgery. According to the lymph node classification criteria of American Thoracic Association and the number of pathological lymph node metastasis areas, the patients were divided into non-regional lymph node metastasis group ( n=68), oligo-regional lymph node metastasis group (1-2 regional lymph node metastasis, n=54) and multi-regional lymph node metastasis group (≥3 regional lymph node metastasis, n=31). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The Cox proportional hazards model was used to analyze prognostic factors, receiver operating characteristic (ROC) curve was used to analyze the predictive value of the number of lymph node metastasis areas. Results:The median overall survival (OS) was 37.0 months for the 153 patients, and the 1-, 3- and 5-year OS rates were 97.4%, 51.0% and 30.7% respectively. In the non-regional lymph node metastasis group, the median OS was 46.0 months, and the 1-, 3- and 5-year OS rates were 97.1%, 58.8% and 39.7% separately. In the oligo-regional lymph node metastasis group, the median OS was 39.0 months, and the 1-, 3- and 5-year OS rates were 94.4%, 55.6% and 35.2% respectively. In the multi-regional lymph node metastasis group, the median OS was 26.0 months, and the 1-, 3- and 5-year OS rates were 98.1%, 25.8% and 3.2% separately. There was a statistically significant difference among the three groups ( χ2=18.257, P<0.001). Among the 76 patients without adjuvant treatment, the 1-, 3- and 5-year OS rates were 94.7%, 50.0% and 34.2% in patients with non-regional lymph node metastasis, 90.9%, 36.4% and 9.1% in patients with oligo-regional lymph node metastasis, 97.4%, 18.8% and 0 in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=8.201, P=0.017). Among the 77 patients with adjuvant therapy, the 1-, 3- and 5-year OS rates were 97.7%, 66.7% and 46.7% in patients with non-regional lymph node metastasis, 96.9%, 68.8% and 53.1% in patients with oligo-regional lymph node metastasis, 93.3%, 26.7% and 6.7% in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=18.083, P<0.001). Univariate analysis showed that age ( HR=1.534, 95% CI: 1.041-2.260, P=0.030), T stage ( HR=1.757, 95% CI: 1.197-2.579, P=0.004), N stage ( HR=1.548, 95% CI: 1.043-2.297, P=0.030), TNM stage ( HR=1.392, 95% CI: 1.114-2.459, P=0.015), adjuvant therapy ( HR=0.545, 95% CI: 0.370-0.803, P=0.002) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.385, 95% CI: 0.238-0.624, P<0.001; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.442, 95% CI: 0.269-0.726, P=0.001) were closely related to OS in patients with ESCC after operation. Multivariate analysis showed that T stage ( HR=1.699, 95% CI: 1.143-2.525, P=0.009), adjuvant therapy ( HR=0.577, 95% CI: 0.386-0.864, P=0.008) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.553, 95% CI: 0.411-0.996, P=0.011; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.550, 95% CI: 0.328-0.924, P=0.024) were independent prognostic factors for OS. The number of lymph node metastasis areas (AUC=0.648, 95% CI: 0.560-0.735, P=0.004) was better than the number of lymph node metastasis (AUC=0.595, 95% CI: 0.497-0.694, P=0.061) in predicting OS of patients with ESCC after radical surgery. Conclusion:The number of postoperative pathological lymph node metastasis areas in thoracic ESCC has important value in predicting survival prognosis, and adjuvant therapy can significantly improve the OS of patients with oligo-regional lymph node metastasis.

Objective To up-regulate the expression of Glil gene in periodontal ligament stem cells ( PDLSCs) and to explore the effect of Glil gene on PDLSCs proliferation and osteogenesis differentiation by establishing Glil gene adenovirus vectors. Methods Subcloned Glil to viral backbone vector Adtrack-CMV and transfered the established vector to 293T cells, which was to acquire the virus particles. Trans-fected aim cells,namely PDLSCs,with these virus. Detected its effect on PDLSCs proliferation with CCK-8 assay, and detected the expression of Glil and the bone-related markers ALP and Runx2 through Western blot. Results An adenovirus vector, which were over expressed Glil gene, was successfully constructed and transfected to PDLSCs. Compared with the empty vector group and normal group, the over expressed one had a much slower proliferation rate in CCK-8 assay (P=0. 003). Western blot showed that ALP and Runx2 can be overexpressing os-teogenic differentiated after PDLSCs successfully transfected with the Glil gene. Conclusion Over expressing Glil gene would lead to a much slower proliferation rate in the PDLSCs and an increase of the bone-related markers. It is concluded that Glil can enhance the osteogenic dif-ferentiation capacity in PDLSCs.

Objective To evaluate the effects of the size of lymph node metastasis (LNM) on the chemoradiotherapy efficacy and prognosis for the patients after resection of thoracic esophageal squamous cell carcinoma (ESCC).Methods Between 2011 and 2014,a total of 75 esophageal squamous carcinoma patients with secondary LNM after resection of ESCC were recruited in this retrospective study.They were treated with curative radiotherapy only or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University.Thc LNM volume and maximum diameters were measured by the Monaco treatment planning system.The enrolled patients were grouped according to the median values of LNM volume and maximum diameters.The relationship between the responsiveness to treatment and these markers was analyzed by univariate and multivariate logistic analysis.The Kaplan-Meier method and Log-rank test were adopted to calculate and compare the overall survival (OS) rates with these markers.The Cox proportional hazards model was used to carry out univariate and multivariate analyses.Results The overall effective rate was 69.3％ for all enrolled patients.The response rates were 81.6％ with LNM volume ＜57 cm3 and 56.8％ with LNM volume ≥57 cm3.The response rates were 83.8％ with LNM maximum diameter ＜ 5 cm and 55.3％ with LNM maximum diameter ≥5 cm.The responses to treatment were highly associated with treatment method (OR =1.825,95％ CI:1.134-3.658,P =0.017),LNM volume (OR =4.183,95％ CI:1.416-12.354,P =0.010) and maximum diameter (OR =3.374,95％ CI:1.185-9.611,P =0.023) by univariate logistic regression analysis.Multivariate logistic regression analysis showed that therapeutic method (OR =1.225,95％ CI:1.085-2.837,P =0.038) and LNM volume (OR =1.614,95％ CI:1.003-3.025,P =0.048) were independent risk factors for tumor response.The median OS time of this cohort was 14 months,and the 1,2 and 3 year OS rates were 60.7％,25.3％ and 20.1％,respectively.Kaplan-Meier survival analysis revealed that TNM stage (HR =2.039,95 ％ CI:1.234-3.370,P =0.005),treatment methods (HR =1.858,95 ％ CI:1.385-2.958,P =0.013),LNM volume (HR =2.642,95％ CI:1.552-4.497,P ＜ 0.001) and LNM maximum diameter (HR =3.399,95 ％ CI:1.939-5.958,P ＜ 0.001) were significantly associated with OS.Furthermore,multivariate Cox proportional hazard regression model analysis for OS was performed and the results showed that TNM stage (HR =2.023,95 ％ CI:1.149-3.560,P =0.015),LNM volume (HR =2.055,95 ％ CI:1.041-4.055,P =0.038) and maximum diameter (HR =1.910,95％ CI:1.137-3.895,P =0.045) were considered as independent prognostic risk factors for OS.Conclusion LNM volume in ESCC patients with secondary LNM after esophagectomy has great values for predictive therapeutic effects and survival outcomes,and LNM maximum diameter has significant value for survival outcomes.

Objective To investigate the prognostic values of systemic inflammatory markers,including preoperative neutrophil-to-lymphocyte ratio (NLR),platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR),in patients with esophageal squamous cell carcinoma (ESCC) by curative esophagectomy.Methods A total of 117 patients with ESCC from January 2010 to December 2012 in Affiliated Taixing People's Hospital of Yangzhou University were retrospectively analyzed.They were treated with standard curative esophagectomy.These patients were divided into NLR≥2.8 group and NLR ＜2.8 group,PLR≥127.3 group and PLR ＜127.3 group,LMR≥3.8 group and LMR ＜3.8 group for comparing the patients' general survival conditions and analyzing the influence on the progression-free survival (PFS) and overall survival (OS) rates according to the median values 2.8,127.3,3.8 of NLR,PLR and LMR,respectively.The COX proportional hazards models of NLR,PLR and LMR were used to carry out univariate and multivariate analyses for PFS and OS.The evaluation of prognostic values of NLR,PLR and LMR were carried by receiver operating characteristic (ROC) curve.Results For 117 patients,the median PFS time was 17 months,and the PFS rates at the 1-,3-and 5-year period were 66.7％,21.4％ and 17.9％,respectively;the median OS time was 36 months,and the OS rates at the 1-,3-and 5-year time were 94.9％,46.2％ and 28.2％,separately.In addition,a close relationship was identified between high NLR,high PLR,low LMR and tumor relapse (all P ＜0.05).Furthermore,in the NLR ＜2.8 group,the median PFS time was 24 months (95％ CI:19.788-28.212),and the 1-,3-,5-year PFS rates were 78.9％,35.1％ and 31.6％ separately,while in the NLR≥2.8 group,the median PFS time was 13 months (95％CI:10.153-15.847),and the 1-,3-,5-year PFS rates were 55.0％,8.3％ and 5.0％,respectively (x2 =15.601,P ＜ 0.001).In the PLR ＜ 127.3 group,the median PFS time was 24 months (95％ CI:19.891-28.109),and the 1-,3-,5-year PFS rates were 78.0％,30.5％ and 27.1％.In the PLR≥ 127.3 group,the median PFS time was 15 months (95％CI:11.832-18.168),and the 1-,3-,5-year PFS rates were 55.2％,12.1％ and 8.6％ (x2 =7.621,P =0.006).In the LMR ＜3.8 group,the median PFS time was 14 months (95％ CI:11.534-16.466),and the 1-,3-,5-year PFS rates were 57.9％,8.8％ and 5.3％,whilein the LMR≥3.8 group,the median PFS time was 21 months (95％ CI:16.783-25.217),and the 1-,3-,5-year PFS rates were 75.0％,33.3％ and 30.0％ (x2 =10.201,P =0.001).Correspondingly,the median OS time was 42 months (95％ CI:29.188-48.282) and the 1-,3-,5-year OS rates were 98.2％,56.1％ and 47.4％ in the NLR ＜2.8 group.While the median OS time was 27 months (95％ CI:20.358-33.642) and the 1-,3-,5-year OS rates were 91.7％,36.7％ and 10.0％ in the NLR ≥2.8 group (x2 =19.161,P ＜ 0.001).Themedian OS time was 38 months (95％ CI:31.310-44.690) and the 1-,3-,5-year OS rates were 94.9％,54.2％ and 37.3 ％ in the PLR ＜ 127.3 group and the median OS time was 27 months (95 ％ CI:19.537-34.463) and the 1-,3-,5-year OS rates were 93.1％,37.9％ and 19.6％ in the PLR≥127.3 group (x2 =7.019,P =0.008).The median OS time was 30 months (95％ CI:23.659-36.341) and the 1-,3-,5-year OS rates were 91.2％,36.8％ and 12.3％ in the LMR ＜ 3.8 group.While the median OS time was 38 months (95％ CI:27.878-48.121) and the 1-,3-,5-year OS rates were 95.0％,55.3％ and 43.3％ in the LMR≥3.8 group (x2 =10.201,P=0.001).In univariate analysis,the following factors were significantly associated with poor PFS:T stage (HR =1.292,95％ CI:1.077-2.211,P =0.048),N stage(HR =1.773,95％ CI:1.186-2.651,P =0.005),TNM stage (HR =1.768,95 ％ CI:1.181-2.645,P =0.006),NLR (HR =2.193,95 ％ CI:1.450-3.316,P＜0.001),PLR(HR =1.722,95％CI:1.149-2.581,P =0.009) and LMR (HR =0.531,95％CI:0.353-0.799,P =0.002).The univariate analysis further revealed that T stage (HR =1.982,95％ CI:1.162-3.383,P=0.012),N stage (HR =1.910,95％ CI:1.243-2.934,P =0.003),TNM stage (HR =2.115,95％ CI:1.375-3.252,P =0.001),NLR (HR =2.599,95％ CI:1.657-4.078,P ＜ 0.001),PLR (HR =1.764,95％CI:1.145-2.717,P =0.010) and LMR (HR =0.470,95％ CI:0.303-0.728,P =0.001) were also significantly associated with poor OS.Furthermore,multivariate COX regression analysis showed that TNM stage (HR=1.608,95％CI:1.057-2.445,P =0.026) and NLR (HR =1.886,95％CI:1.133-3.138,P=0.015) were independent prognostic factors for PFS in patients with ESCC after surgery.Correspondingly,TNM stage (HR =1.867,95 ％ CI:1.190-2.928,P =0.007) and NLR (HR =2.226,95 ％ CI:1.292-3.835,P =0.004) were also independent prognostic factors for OS in ESCC patients following surgery.Finally,ROC curves of NLR,PLR and LMR for PFS predictive values were as follows:the area under the curve (AUC) for NLR,PLR and LMR were 0.725 (95％ CI:0.615-0.835,P =0.001),0.657 (95％ CI:0.533-0.781,P =0.025) and 0.290 (95％ CI:0.178-0.402,P =0.003),respectively.ROC curve analysis of NLR,PLR and LMR in diagnostic value of OS indicated that the AUC was 0.731 (95％ CI:0.632-0.829,P ＜ 0.001) for NLR,0.613 (95％ CI:0.501-0.726,P =0.057) for PLR and 0.308 (95％ CI:0.205-0.412,P =0.053) for LMR.Conclusion NLR is superior to PLR.and LMR in predicting the survival outcome of patients with ESCC,and NLR is of great value in predicting the survival and prognosis of patients with thoracic ESCC after operation.

Objective To evaluate the efficacy of capecitabine and nedaplatin combined with chemoradiotherapy in the treatment of the elderly patients with esophageal cancer.Methods 87 patients were randomly divided into concurrent chemoradiotherapy group(42 patients)and radio-therapy group(45 patients).The chemoradiotherapy group was treated with concurrent radiothera-py combined with chemotherapy while the radiotherapy group was treated with radiotherapy only. Results The overall efficacy (CR+PR)rates of concurrent chemoradiotherapy group and control group were 92.9% and 77.8,the difference was significant between the two groups(P <0.05). The survival rate of concurrent group after 1 year and 2 years was higher than that in the control group (85.7%,59.5% in 1 year vs 66.7%,37.8% in 2 years respectively).And the difference in toxicity was significant between the two groups with higher toxicity in the concurrent chemoradio-therapy group than in the control group (P <0.05).Conclusion The concurrent chemoradiother-apy in the treatment of the elderly with esophageal cancer can improve the overall efficacy rates and 1,2 year survival rates,but the toxicity was significantly higher.

Objective To evaluate the efficacy of capecitabine and nedaplatin combined with chemoradiotherapy in the treatment of the elderly patients with esophageal cancer.Methods 87 patients were randomly divided into concurrent chemoradiotherapy group(42 patients)and radio-therapy group(45 patients).The chemoradiotherapy group was treated with concurrent radiothera-py combined with chemotherapy while the radiotherapy group was treated with radiotherapy only. Results The overall efficacy (CR+PR)rates of concurrent chemoradiotherapy group and control group were 92.9% and 77.8,the difference was significant between the two groups(P <0.05). The survival rate of concurrent group after 1 year and 2 years was higher than that in the control group (85.7%,59.5% in 1 year vs 66.7%,37.8% in 2 years respectively).And the difference in toxicity was significant between the two groups with higher toxicity in the concurrent chemoradio-therapy group than in the control group (P <0.05).Conclusion The concurrent chemoradiother-apy in the treatment of the elderly with esophageal cancer can improve the overall efficacy rates and 1,2 year survival rates,but the toxicity was significantly higher.

Objective The purpose of this study was to investigate the influence of pre-treatment inflammatory markers on the therapeutic effect and survival outcome in patients with esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or radiotherapy (RT) alone.Methods A total of 107 patients who were diagnosed with ESCC were retrospectively analysed.They were treated with radical radiotherapy alone or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University between January 2013 and December 2014.According to the median values of neutrophil-lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR) and CRP/Alb ratio before treatment,the patients were divided into NLR＜3.06 group (54 cases) and NLR≥3.06 group (53 cases),PLR＜145.26 group (54 cases) and PLR≥ 145.26 (53 cases),CRP/Alb＜0.13 group (52 cases) and CRP/Alb≥0.13 (55 cases),respectively.The relationships between the response to treatment and these markers were analysed by univariate and multivariate logistic analyses.The Kaplan-Meier method and logrank test were adopted to calculate and compare associations of the progression-free survival (PFS) rates with these blood markers.Cox proportional hazards models were used for the univariate and multivariate analyses.Results The therapeutic effects of chemoradiotherapy,NLR＜3.06,PLR＜ 145.26 and CRP/ Alb＜ 0.13 were better than those of radiotherapy alone,NLR≥ 3.06,PLR≥ 145.26 and CRP/Alb ≥ 0.13,respectively,and the differences were statistically significant (HR=2.118,4.138,2.297,3.784,P＜0.05).Further analysis showed that chemoradiotherapy (HR =1.342,95％ CI 1.023 ～ 2.467,P＜ 0.05) and CRP/Alb ratio＜ 0.13 (HR =7.004,95％ CI 2.088 ～ 23.496,P＜0.05) were independent risk factors for good tumour response.In addition,TNM stage,treatment modality,NLR,PLR and CRP/Alb ratio were significantly associated with PFS by the univariate analysis (P＜0.05 for all).Furthermore,the multivariate Cox proportional hazard regression model analysis showed that only TNM stage (HR =1.326,95％ CI 1.070-1.833 P＜0.05),treatment modality (HR =0.400,95％ CI 0.230-0.694,P＜0.05) and CRP/Alb ratio (HR=3.518,95％ CI 1.975-6.266,P＜ 0.05) were considered independent prognostic factors for PFS.And according to TNM staging and treatment subgroup analysis,CRP/Alb＜0.13 had better progression-free survival time than CRP/Alb≥ 0.13 ESCC patients.Finally,the ROC curve also confirmed that CRP/Alb was superior to NLR and PLR in predicting short-term efficacy and progression-free survival in ESCC patients receiving chemoradiotherapy.Conclusions Our study demonstrated that CRP/Alb ratio was promising as a predictive marker for the therapeutic effect and survival outcome in ESCC patients receiving CRT or RT alone.