Objective:To investigate the neuroprotective effect of ibuprofen, and influence of ibuprofen in hippocampal nod-like receptor protein 3 (NLRP3) inflammatome and its related products in chronic epilepsy rats models.Methods:Thirty male SD rats were randomly divided into 3 groups: control group, pentylenetetrazol (PTZ) group and PTZ+ibuprofen group ( n=10). Rats in the PTZ group were intraperitoneally injected with PTZ (35 mg/kg) once every one d, and rats in the PTZ+ibuprofen group were intraperitoneally injected with ibuprofen (30 mg/kg) once every one d 30 min before PTZ injection; rats in the control group were intraperitoneally injected with the same amount of normal saline every one d. Injection for 15 times was performed. After the last injection, the rats were observed for 10 min, and the latency, seizure level and complete ignition of the rats in each group were recorded. Electroencephalogram (EEG) was used to detect the abnormal brain discharge in rats. Four h after last injection, HE staining and Nissl staining were used to detect the proportion of damaged hippocampal neurons in each group. Immunohistochemical staining was used to detect the absorbance values of NLRP3 inflammasome, caspase-1 and interleukin (IL)-18 positive cells in the hippocampus of rats in each group; Western blotting was used to detect the protein expressions of NLRP3 inflammatome, caspase-1 and interleukin (IL)-18 in the hippocampus of each group. Results:(1) As compared with the PTZ group, rats in the PTZ+ibuprofen group had statistically lower incidence of complete ignition, significantly longer latency and significantly lower seizure level ( P<0.05). EEG showed spikes and high amplitude epileptic wave discharge in rats of the PTZ group; EEG showed low amplitude small spiny wave and slow spiny wave in rats of the PTZ+ibuprofen group. (2) As compared with the control group, the proportion of injured hippocampal neurons significantly increased in the PTZ group and PTZ+ibuprofen group ( P<0.05); and the proportion of injured hippocampal neurons in the PTZ+ibuprofen group signficantly decreased as compared with that in the PTZ group ( P<0.05). (3) As compared with those in the control group, the absorbance values of NLRP3 inflammatome, caspase-1 and IL-18 positive cells, and the protein expressions of NLRP3 inflammatome, caspase-1 and IL-18 in the hippocampus of the PTZ group and PTZ+ibuprofen group were all significantly increased ( P<0.05); as compared with the PTZ group, the the absorbance values of NLRP3 inflammatome, caspase-1 and IL-18 positive cells, and the protein expressions of NLRP3 inflammatome, caspase-1 and IL-18 in the hippocampus in the PTZ+ibuprofen group were all significantly decreased ( P<0.05). Conclusion:Ibuprofen can inhibit the expressions of NLRP3 inflammatome, caspase-1 and IL-18, reduce the intensity of seizures, and play a neuroprotective role.

Objective To validate whether the prognostic stage groups by the 8th edition of the American Joint Committee on Cancer (AJCC) staging system provides improved prognostic accuracy in T1?2N1M0 postmastectomy breast cancer patients compared to 7th edition. Methods a total of 1 823 female patients with T1?2N1M0 breast cancer who underwent mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy were analyzed and restaged according to 8th edition. Univariate analysis of prognostic factors was evaluated by using log?rank test. Multivariate analysis was estimated by using the Cox proportional hazards model. The prognostic accuracy of the two staging systems was compared using receiver operating characteristic ( ROC ) analyses and the concordance index ( C?index ). Results 5?year locoregional recurrence rate (LRR) for the whole group was 6.0%, 5?year distant metastasis (DM) rate was 11.5%, 5?year disease?free survival (DFS) was 85.0%, and 5?year overall survival (OS) was 93.1%. Cox analysis showed that 7th edition of the AJCC staging system and progesterone receptor status were independent risk factors for LRR, DM, DFS and OS (P＜0.05). Compared with stage by 7th edition, 1 278 (70.1%) were assigned to a different prognostic stage group: 1 088 ( 85.1%) to a lower stage and 190 (14.9%) to a higher stage. LRR, DM, DFS and OS were significantly different between prognostic stageⅠA,ⅠB,ⅡA,ⅡB and ⅢA according to 8th edition of the AJCC staging system(P＜0.001). Prognostic stage had significantly higher C?indexes and provided better estimation of prognosis compared to stage by 7th edition of the AJCC staging system ( P＜0.001). Conclusion The prognostic stage groups of 8th edition AJCC staging system has superior prognostic accuracy compared to 7th edition in T1?2N1M0 breast cancer, and has better clinical therapeutic guidance value.

Objective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy,surgery combined with radiotherapy at diagnosis.Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed.All patients were pathologically diagnosed with breast cancer.They were complicated with ISLNM,without distant metastasis confirmed by pathological or imaging examinations.All patients received multi-modality therapy consisting of neoadjuvant chemotherapy,surgery and postoperative radiotherapy.KaplanMeier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test.Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment.The overall 5-year SCFR,OS and PFS rates were 9.2％,71.5％ and 49.5％,respectively.Following preoperative chemotherapy,the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS.The 5-year OS rates in patients with and without CR were 81.4％ and 53.9％ (P=O.035).The size of supraclavicular lymph node (≤ 1 cm vs.＞ 1 cm at diagnosis was a risk factor of the SCFR (0％ vs.21.0％,P=0.037) and OS rates (≤1 cm vs.＞1 cm:86.1％ vs.55.6％,P =0.001).Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.

Objective: To validate whether the prognostic stage groups by the 8th edition of the American Joint Committee on Cancer (AJCC) staging system provides improved prognostic accuracy in T1-2N1M0 postmastectomy breast cancer patients compared to 7th edition. Methods: a total of 1 823 female patients with T1-2N1M0 breast cancer who underwent mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy were analyzed and restaged according to 8th edition. Univariate analysis of prognostic factors was evaluated by using log-rank test. Multivariate analysis was estimated by using the Cox proportional hazards model. The prognostic accuracy of the two staging systems was compared using receiver operating characteristic (ROC) analyses and the concordance index (C-index). Results: 5-year locoregional recurrence rate (LRR) for the whole group was 6.0%, 5-year distant metastasis (DM) rate was 11.5%, 5-year disease-free survival (DFS) was 85.0%, and 5-year overall survival (OS) was 93.1%. Cox analysis showed that 7th edition of the AJCC staging system and progesterone receptor status were independent risk factors for LRR, DM, DFS and OS (P<0.05). Compared with stage by 7th edition, 1 278(70.1%) were assigned to a different prognostic stage group: 1 088 (85.1%) to a lower stage and 190 (14.9%) to a higher stage. LRR, DM, DFS and OS were significantly different between prognostic stage ⅠA, ⅠB, ⅡA, ⅡB and ⅢA according to 8th edition of the AJCC staging system(P<0.001). Prognostic stage had significantly higher C-indexes and provided better estimation of prognosis compared to stage by 7th edition of the AJCC staging system (P<0.001). Conclusion The prognostic stage groups of 8th edition AJCC staging system has superior prognostic accuracy compared to 7th edition in T1-2N1M0 breast cancer, and has better clinical therapeutic guidance value.

Objective To validate whether the prognostic stage groups by the 8th edition of the American Joint Committee on Cancer (AJCC) staging system provides improved prognostic accuracy in T1?2N1M0 postmastectomy breast cancer patients compared to 7th edition. Methods a total of 1 823 female patients with T1?2N1M0 breast cancer who underwent mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy were analyzed and restaged according to 8th edition. Univariate analysis of prognostic factors was evaluated by using log?rank test. Multivariate analysis was estimated by using the Cox proportional hazards model. The prognostic accuracy of the two staging systems was compared using receiver operating characteristic ( ROC ) analyses and the concordance index ( C?index ). Results 5?year locoregional recurrence rate (LRR) for the whole group was 6.0%, 5?year distant metastasis (DM) rate was 11.5%, 5?year disease?free survival (DFS) was 85.0%, and 5?year overall survival (OS) was 93.1%. Cox analysis showed that 7th edition of the AJCC staging system and progesterone receptor status were independent risk factors for LRR, DM, DFS and OS (P＜0.05). Compared with stage by 7th edition, 1 278 (70.1%) were assigned to a different prognostic stage group: 1 088 ( 85.1%) to a lower stage and 190 (14.9%) to a higher stage. LRR, DM, DFS and OS were significantly different between prognostic stageⅠA,ⅠB,ⅡA,ⅡB and ⅢA according to 8th edition of the AJCC staging system(P＜0.001). Prognostic stage had significantly higher C?indexes and provided better estimation of prognosis compared to stage by 7th edition of the AJCC staging system ( P＜0.001). Conclusion The prognostic stage groups of 8th edition AJCC staging system has superior prognostic accuracy compared to 7th edition in T1?2N1M0 breast cancer, and has better clinical therapeutic guidance value.

Objective: To investigate the overall efficacy of early breast cancer after breast-conserving treatment. To analyze risk factors affecting local regional recurrence (LRR), distant metastasis (DM) and survival. Methods: 1 791 breast cancer patients treated with breast-conserving surgery were retrospectively analyzed. The inclusion criteria were pathologic diagnosis of invasive breast cancer without supraclavicular and internal mammary node metastasis, T1-2N0-3M0, and no neoadjuvant therapy. Univariate analysis of survival was performed by Kaplan-Meier method and log rank test. Cox regression model was used for multivariate analysis. Results: The median follow-up time was 4.2 years. For all patients, the 5-year LRR, DM, disease-free survival(DFS) and overall survival(OS) rates were 3.6%, 4.6%, 93.0% and 97.4%, respectively. The LRR rates of patients with Luminal A, Luminal B1, Luminal B2, HER-2 over-expressed and triple-negative breast cancer were 2.0%, 6.1%, 5.9%, 0 and 10.0%, while the DM rates were 3.2%, 6.7%, 8.3%, 4.8% and 7.3%, respectively. Among the N0 patients, axillary dissection was performed in 689 cases and sentinel lymph node biopsy in 652 cases. The 5-year LRR rates were 3.3% and 3.2% (P=0.859), and the OS rates were 98.2% and 98.3% (P=0.311) respectively, which showed no statistically significant. There were 1 576 patients that underwent postoperative radiotherapy. Postoperative radiotherapy significantly reduced the 5-year LRR compared with surgery alone (2.5% vs 12.9%). The 5-year LRR rates of patients who received conventional fractionated radiotherapy and hypo-fractionated radiotherapy were 2.7% and 3.1%, respectively. But the difference was not statistically significant (P=0.870). Multivariate analysis showed that age, lymphovascular invasion, pathological T staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors of LRR in breast cancer patients (all P<0.05). Histological grade and pathological N staging were independent factors of DM (all P<0.05). The age, lymphovascular invasion, pathological T and N staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors for DFS (all P<0.05). Histological grade, pathological N staging, ER/PR status and endocrine therapy were factors for OS (all P<0.05). Conclusions With contemporary standard treatment, the recurrence rate of early breast cancer after breast conserving treatment is less than 10%. Node-negative patients after sentinel lymph node biopsy did not need axillary dissection. The overall utilization of radiotherapy after breast conserving surgery is satisfactory. Hypofractionated radiotherapy is as effective as conventional fractionated radiotherapy. Local regional recurrence and distant metastasis have different risk factors.

Objective To investigate the pattern of nodal recurrence after curative resection in adenocarcinoma of the gastroesophageal junction ( AGE ) , and to provide a basis for delineation of the radiation range in the high-risk lymphatic drainage area.Methods A retrospective analysis was performed in 78 patients with locally advanced AGE who were newly treated in our hospital from January 2009 to December 2013 and had complete clinical data.All patients received curative resection and were pathologically diagnosed with stage T3/T4 or N (+) AGE.Those patients were also diagnosed with SiewertⅡor Ⅲ AGE by endoscopy, upper gastroenterography, macroscopic examination during operation, and pathological specimens.None of the patients received preoperative or postoperative radiotherapy.All patients were diagnosed by imaging with postoperative nodal recurrence.The computed tomography images of those
patients were accessible and had all the recurrence sites clearly and fully displayed.Results The median time to recurrence was 10 months ( 1-48 months) , and 90%of the recurrence occurred within 2 years after surgery.The lymph nodes with the highest risk of recurrence were No.16b1( 39%) , No.16a2( 37%) , No.9 (30%), and No.11p (26%), respectively.There was no significant difference in the recurrence rate within each lymphatic drainage area between patients with SiewertⅡandⅢAGE ( P=0.090-1.000) .The lymph nodes with the most frequent recurrence were No.16b1, No.16a2, No.9, No.16b2, No.11p, and No.7 in patients with stage N3 AGE and No.11p, No.16b1, No.16a2, No.9, No.8, and No.7 in patients with stage non-N3 AGE.Patients with stage N3 AGE had a significantly higher recurrence rate in the para-aortic regions (No.16a2-b2) than those with stage non-N3 AGE (67%vs.33%, P=0.004, OR=4.00, 95% CI=1.54-10.37) .Conclusions The lymph nodes with the highest risk of recurrence are located in the celiac artery, proximal splenic artery, and retroperitoneal areas ( No.16a2 and No.16b1) in patients with SiewertⅡorⅢlocally advanced AEG.Moreover, patients with stage N3 AGE have a higher risk of retroperitoneal recurrence.The above areas should be involved in target volume delineation for postoperative radiotherapy.

Objective To evaluate the risk of locoregional recurrence ( LRR ) and role of radiotherapy for patients with estrogen receptor?negative and human epidermal growth factor receptor 2?overexpressed ( Rec?/HER?2+) locally advanced breast cancer ( LABC ) . Methods A retrospective analysis was performed on the clinical data of 294 patients with Rec?/HER?2+LABC from 1999 to 2011. All patients were treated with modified radical mastectomy ( MRM ) . Of them, 239 patients received postmastectomy radiotherapy and 55 patients did not. Locoregional recurrence?free survival ( LRRFS) and overall survival ( OS) , as well as LRR, were compared between the two groups. The Kaplan?Meier method was used to estimate survival and recurrence rates, and the log?rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate prognostic analysis was performed using the Cox regression model. Results The 5?year sample size was 162. Fifty?six patients developed LRR. The 5?year LRRFS and OS rates were 79. 7% and 70. 0%, respectively. Postmastectomy radiotherapy significantly increased the 5?year LRRFS rate ( 85. 1% vs. 56. 0%, P=0. 000) , but did not significantly increase the 5?year OS rate ( 71. 3% vs. 64. 2%, P= 0. 441 ) . Multivariate analysis indicated that postmastectomy radiotherapy was the only independent prognostic factor associated with increased LRRFS ( RR=0. 303, 95% CI:0. 166?0. 554, P=0. 000). Conclusions Patients with Rec?/HER?2+ LABC treated with MRM alone appear to be at a significantly increased risk of LRR compared with those treated with MRM followed by radiotherapy.

Objective To investigate the clinical characteristics and long-term outcome of patients with mucosa-associated lymphoid tissue ( MALT) lymphoma of Waldeyer's ring. Methods Ten patients were retrospectively analyzed. Seven patients had stage ⅠE and 3 patients had stage ⅡE disease. All patients received radiation therapy with a median dose of 40 Gy, and 7 patients also received 1 t0 4 cycles of CHOP-based chemotherapy before radiation. Results The ratio of male to　female was 1∶9. The median age was 58 years. No patient had B symptoms. One patient had elevated LDH level. The complete response rate after treatment was 100％. With median follow-up periods of 90 months, 1 patient died from rectal cancer. One patient developed brain metastasis and was salvaged by radiotherapy. The 5-year overall survival, cancer specific survival and progression-free survival rates were 90％ , 100％ and 80％ , respectively. Conclusions The clinical characteristics of Waldeyer's ring MALT lymphoma were similar to that of nongastric MALT lymphoma. For patients with Waldeyer's ring MALT lymphoma, primary radiotherapy can result in excellent long-term survival.

ObjectiveTo evaluate the current practice of breast-conserving radiotherapy (BCR) in mainland China.MethodsA questionnaire on the details of treatment pattern of BCR for early breast cancer was mailed twice to all radiotherapy centers in mainland China in 2009.The responding data were collected and analyzed.ResultsOf the 952 surveyed centers,396 responded (41.6％) and 328 performed BCR.The median interval between surgery and radiotherapy was 9 weeks.Of the 328 centers with BCR,whole breast was the most common irradiation target (319 centers,97.3％ ),followed by supraclavicular region (273 centers,83.2％ ),axilla (138 centers,43.3％ ),and internal mammary chain (85 centers,26.8％ ).In 97.5％ of centers (310/319),whole breast was irradiated in all candidates.Supraclavicular region and axilla irradiation was performed for lymph-node positive patients in 41.8％ (114/273) and 26.8％(37/138) centers,and for ≥4 positive lymph-nodes in 31.5％ (86/273) and 29.0％ (/138)centers,respectively. Internal mammary chain was irradiated for tumors located in the center or inner quadrant in 72.9％ ( 56/85 ) centers.Conformal radiotherapy for the whole breast was used in 51.8％centers.The median total dose was 50 Gy,all using conventional fractionations.ConclusionsA consensus has been reached that radiotherapy is needed for patients receiving breast-conserving surgery and that irradiation to whole breast is necessary.However,establishment and widespread use of guidelines for BCR should be strengthened.