[Objective]To evaluate the effectiveness of biopsy of bone lesions.The factors that might effect on the clinical utility were analyzed in order to find out the independent factor for clinical effectiveness.Also we evaluated the effects of these factors on the open biopsy with needle biopsy previously done.[Method]We retrospectively reviewed 206 cases performed at our institute between June 2003 and Oct 2006,including percutaneous core-needle biopsy or open biopsy.The biopsy result was classified as correct,nondiagnostic,or incorrect.The biopsy results were considered clinical useful if they were correct and not useful if they were nondiagnostic or incorrect.We identified the independent risk factor by analyzing whether the characteristics including biopsy methods,lesion position,myxoid,lesion type reduced the effect on the clinical utility and increased the probability of proceeding to subsequent open biopsy.[Result]In 206 patients,one hundred and forty-seven cases(71.4%)underwent core-needle biopsy.Forty-seven cases(22.8%)underwent open biopsy and twelve cases(5.8%)had open biopsy with needle biopsy first.One hundred and seventy-six cases(85.4%)patients had clinical useful results.Eighteen cases(8.7%)were nondiagnostic,and twelve cases(5.8%)were incorrect.Myxoid histology was identified of independent risk factor on the clinical utility by logistic regression(P=0.02).[Conclusion]Most cases of bone lesions can be diagnosed by core-needle biopsy or open biopsy.The myxoid histology is associated with decrease clinical accuracy;No single characteristic cause increase probability of open biopsy.Correct diagnose of bone lesions requires combining biopsy,radiology and clinical data.

[Objective]To retrospectively analyze 39 cases of surgical treatment of fibrous dysplasia of proximal femur,in order to propose a partition method which can be used to guide the surgical treatment,and probe the surgical treatment strategy according to the partition method of fibrous dysplasia of proximal femur. [Methods]The data on 39 cases of fibrous dysplasia of proximal femoral from 1998 to 2009 were retrospectively analyzed.The study determined extent of the lesion according to preoperative X-ray film and proposed partitioning method in accordance with the scope of proximal femoral involvement,analyzed the relation of partition type and surgical treatment,and evaluated the effect of surgical treatment through the postoperative localized lesions control and functional score(MSTS 93).[Results]According to the scope of 39 cases of lesions,combined with characteristics of proximal femoral anatomy,proximal femur was divided into four zones: area I,femoral shaft(below small protuberance);area II,intertrochanteric(small rotor to the neck base division);area III,femoral neck;area IV,the femoral head.Based on the above partition,lesions were divided into 7 types,type I,type II,type III,type I + II,type II + III,type II + III + IV,type I + II + III,type I + II + III + IV.Surgical treatment was performed mainly with curettage of bone lesions,bone grafting and fixation.Internal fixation included DHS,intramedullary nails,and artificial joint replacement,DHS was most common in area II involvement(57.58%),followed by area III involvement(24.24%).Intramedullary nail was most common in area I involvement(64.70%) and area II involvement(35.30%).For lesions involving ≥3 zones,joint replacement was carried out.The patients were all followed up,with a median time of 6.3 years(0.5-11 years).Local recurrence rate was12.82%(5 / 39),local deformity was not found deterious.The followed up results were satisfactory.The selected treatment was reasonable.[Conclusion]When making a surgical treatment regimen for fibrous dysplasia of the proximal femur,Surgeons should consider lesion characteristics,and choose a reasonable internal fixation to achieve better surgical results.Partition method proposed in this paper can be formulated as one of preoperative surgical treatment options.

Objective To evaluate the surgical procedures and both oncological and functional outcome in patients with bone tumors of the shoulder girdle.Methods Seventy-one patients including 61.pts with malignant tumor and 10 pts with giant cell tumors of the shoulder girdle treated in our department from July 1998 to July 2006 were studied retrospectively.According to the location,there were 15 pts with scapula tumor and 56 pts with proximal humeral tumor.Forty-two male pts and 29 female pts were included in this study with an average age of 36.5 years old ranging from 11.to 62 years old.Surgical procedures:forequarter amputation in 10 pts;Scapulectomy in 3 pts;Scapulectomy and artificial scapular replacement in 3pts;partial scapulectomy and proximal humerus resection with prosthetic reconstruction in 8 pts;proximal humerus resection and prosthesis replacement in 47 pts.Results Due to adequate soft tissue was preserved,the mean functional score was 28 for the pts with giant cell tumor according to MSTS functional scoring system,compared with the functional score 23 for the pts with malignant tumor because the deltoid muscle insertion was resected in the latter group.Among the thirty-seven patients with osteosarcoma,local recurrence occurred in four cases(10.8%),lung metastasis in five and bone metastasis in two.The seven patients died of disease.One patient iagnosed of malignancy in giant cell tumor died after distal metastasis.thtee patients with Ewing sarcoma died of the disease.No recurrence Wag observed in both five humeral chondrosarcoma and five scapular chondrosarcoma.Conclusion Tumot resection and proximal humeral prostbesis replacement is the optimal method for the sarcoma of shoulder girdle in term of preservation of elbow and hand function.Preservation of abductor insertion is necessary for good abduction function.The metastatic rate of proximal humeral osteosarcoma was lower than that of lower extremities.also the prognosis of oncological outcome.Intra-articular and extra-atticular tumor resection produced similar local recurrence rate in the present study,which suggested intra-articular resection may be an altemafive procedure.

Objective To detect the expression of the tryptase in the plasma,and study the meaning in brain traumatic patients.Methods There were two groups:the brain traumatic group(40 patients)and the control group (20 health people).The content of plasma tryptase was determined by fluorescence enzyme immunoassay..Results The level of plasma tryptase had no statistical significance in control group(2.97 ±1.05)μg/L compared with the brain traumatic group(3.03 ±1.39)μg/L,however there had statistical significance comparing with sever brain traumatic patients(3.84 ±0.52μg/L)(t =3.32,P <0.05).4 cases of death in patients with severe head injury group content of tryptase (5.85 ±1.05)μg/L,which was significantly higher than the group of 16 cases of injury in severe head injury after 2 months still alive with the content of serum tryptase (2.49 ±0.52)μg/L,the difference was statistically significant (t =8.13,P <0.01).Conclusion The plasma tryptase level in sever brain traumatic patients increased significantly,and might be of importance for treatment strategies and prognosis.

Objective To investigate the ideal reconstruction methods after pelvic tumor resection and to assess the feasibility of three-dimensional (3D) printing technology for pelvic reconstruction,we performed a retrospective study of patients with pelvic tumors who received tumor resection and reconstruction using 3D-printed pelvic endoprostheses.Methods Thirty-five patients received tumor resection and functional reconstruction with 3D-printed pelvic endoprostheses in our center from Sep.2013 to Dec.2015.According to Enneking' s classification,there were 3 cases of Type Ⅰ,12 cases of Type Ⅱ+Ⅲ,5 cases of Type Ⅰ+Ⅱ,2 case of Type Ⅰ+Ⅱ+Ⅲ,10 cases of type Ⅰ+Ⅱ+Ⅳ and 3 cases of type Ⅰ+Ⅱ+Ⅲ+Ⅳ resection.Methods of reconstruction included 3 patients with 3D-printed iliac endoprosthesis,12 patients with 3D-printed standard hemipelvic endoprosthesis and 20 patients with 3D-printed screw-rod connected hemipelvic endoprosthesis.Results All 35 patients underwent en bloc resection.Margins were wide in 15 cases,marginal in 14 cases and intralesional in 6 cases.After a mean followed-up of 20.5 months (6 to 30),25 patients survived without evidence of disease,5 patients were alive with diseases and 5 patients died of distant metastasis.Complications included 7 cases of delayed wound healing,2 cases of hip dislocation and no cases of deep infection.The average MSTS 93 score was 19.1 (9-26) for all of the 30 alive patients,22.7 (20 to 25) for 3 patients with iliac endoprosthesis reconstruction,19.8 (15 to 26) for 12 patients with standard hemipelvic endoprosthesis reconstruction,and 17.7 (9 to 25) for 15 patients with screw-rod connected hemipelvic endoprosthesis at the last follow up.Conclusion The application of 3D-printing technology could facilitate precise matching and osseointegration between the implants and host bone.Our clinical results proved that application of 3D-printed pelvic endoprostheses for reconstruction of bony defect was safe without additional complications,and that good functional results could be expected during short-term follow-up.

Objective To evaluate the results and toxic effects in three dimensional radiotherapy (3DCRT)with late course accelerated hyper-fractionation for advanced esophageal carcinoma.Methods From December 2001 to December 2003,115 patients were randomly divided into two groups:in 3DCRT group,55 patients were given late course accelerated hyper-fractionation radiotherapy to a total close of 66 Gy (2.0 Gy per fraction,5 times per week;to a dose of 36 Gy were changed into 1.5 Gy/f,2 f/d).In CF group,60 patients were given late course accelerated hyper-fractionation radiotherapy to a total dose of 66 Gy.Results The 1-, 2-,3-,4-year survival rates in 3DCRT group were 63.6 %, 50.9 %, 38.2 %, 30.9 % compared to 58.3 %, 38.3 %,33.3 %,23.3 % in CF group(X~2=4.44,P=0.031),and local control rates in 1-,2-,3-,and 4- years in 3DCRT group were 72.7 %,58.1%,47.2 % and 36.3 %,compared to 53.3 %,40 %,28.3 %,and 20 %(X~2=5.33,P=0.013)in CF group.However,in the 3DCRT group,the incidence of acute esophagitis was similar to CF group; hematogenous toxic and acute bronchitis were similar between the two groups. Late course lung injury in CF group was higher than that in 3DCRT group.Conclusion 3DCRT is able to improve the local control rate and survival rate,and unable to improve acute and late radiation toxie effects.

Objective: To investigate the expression difference of TRAIL and its receptors between resting and activated peripheral blood lymphocytes, and to study their role in cellular growth and proliferation. Methods: Expression of TRAIL and its receptors were detected by RT PCR and DNA sequencing. Results: Neither the expression of TRAIL nor its receptors were detected in resting peripheral blood lymphocyte. However, both expression were found in activated peripheral blood lymphocytes of various degree. Conclusion: TRAIL and its receptors may play a role in regulation and control of the activated lymphocytes in immune reaction.

Biotechnology supremacy is a newly-advanced power theory. It is a superior dominance of military biotechnological application based on the microcosm of life structure within a certain period of time. The advancement of biotechnology supremacy and modern biotechnology has created the concept of bio-micro-frontier, which involves information and defense resources of all living ultra-micro-organisms with national and regional characteristics. Being feasible both in theory and practice, the implementation of bio-micro-frontier system is strategically important. This article explores the implementation of bio-micro-frontier in terms of strategy and tactics, which will add a unique dimension to future military transformation and active defense.

Objective To review the long-term oncologic and functional outcomes of surgical treatment for pelvic chondrosarcoma at a single institution to further delineate surgical strategy of resection and function reconstruction.Methods All of 165 patients with pelvic chondrosarcoma that had been surgically treated between July 2000 and Dec 2013 were reviewed retrospectively.There were 102 male and 63 female patients who had a mean age of 43.5 (range,13 to 75) years.The resection type included Type T 16,type Ⅱ 18,type Ⅲ 11,type Ⅰ+Ⅱ 19,type Ⅱ+Ⅲ 63,type Ⅰ+Ⅳ 15,type Ⅰ+Ⅱ+Ⅲ 10 and type Ⅰ+Ⅱ+Ⅳ 13 cases.The pathology diagnosis was grade Ⅰ in 15,grade Ⅱ in 88,grade Ⅲ in 20,dedifferentiated in 28,mesenchymal in 12 and clear cell chondrosarcoma in 2 patients.Nine cases were secondary lesion following multiple exostoses.114 patients received no previous treatment while others were referred due to recurrent tumor.En bloc resection was achieved in 142 patients and intralesional resection in 23 cases.Twelve patients had a hemipelvectomy to achieve local tumor control,whereas 153 patients underwent a limb-salvage procedure.Spinal screw-rod system was used to reconstruct anterior pelvic ring after ilium resection.Modular hemipelvic endoprosthesis was utilized to reconstruct periacetabular defect after tumor resection while no reconstruction was performed after ischium and pubis resection.Results The median duration of follow-up was 54.1 (range,l0 to 159) months.147 (89.1％) patients were alive at the final follow-up,seven of which were alive with tumor.The estimated 5-year survival was 81.5％.Thirty-three patients (20％) had local recurrence,and twenty (12.1％) had lung metastasis.Recurrent case,sacroiliac joint involvement and intralesional resction were three risk factors for postoperative recurrence.Patients who received type Ⅱ+Ⅲ resection and reconstruction had a mean functional score of 23 according to MSTS 93.The mean MSTS 93 for patients with type Ⅰ+Ⅱ and type Ⅰ+Ⅱ+Ⅳ resection and reconstruction was 18.The wound complication rate was 15.8％.Two aseptic loosening and 2 pubic connection plate breakage were observed in hemipelvic endoprosthesis reconstruction.Conclusion Tumor grade correlates with overall or disease-free survival.For low-grade chondrosarcoma,adequate surgical margin can provide long-term local control while for high-grade cases,distant metastasis is the main case of treatment failure.Adequate surgical margin can be achieved in cases with acetabulum involved.However,aggressive surgical resection of pelvic chondrosarcoma still remains as a challenge for orthopaedic oncologists when the tumor invades the iliosacral joint,which necessitates careful preoperative plan and skilled surgical techniques.

Objective To compare the advantages and disadvantages of non-irrigation and irrigation in the surgical approach of chronic subdural hematoma (CSDH),thus to provide reference for clinical treatment of CSDH.Methods Clinical data of 102 patients with CSDH were retrospectively analyzed.According to the different operation methods,the patients were divided into the non-irrigation group(52 cases) and the irrigation group(50 cases).The blood loss during the procedure,operative time,length of stay and postoperative complication rate between the two groups were compared,and the causes of postoperative complications were analyzed.Results The blood loss during the procedure,operative time and length of stay in the non-irrigation group were (6.73 ± 1.17) mL,(15.06 ± 2.64) min and (10.74 ± 2.20) d,respectively,which in the irrigation group were (19.52 ± 3.18) mL,(38.54 ± 6.95) min and (10.44 ± 2.07)d,respectively,there were statistically significant differences between the two groups in the blood loss during the procedure and the operative time (t =-27.11,-22.72,all P ＜ 0.05),there was no statistically significant difference between the two groups in the length of stay (t =0.70,P ＞ 0.05).The incidence rates of postoperative complication in the non-irrigation group and irrigation group were 8.00％ and 7.69％,respectively,there was no significant difference between the two groups (x2 =0.003,P ＞ 0.05).Conclusion Each of the two methods has its own advantages and disadvantages in the treatment of CSDH.Compared with burr hole irrigation,burr hole non irrigation has the advantages of less blood loss and shorter operative time.However,burr hole non-irrigation is more likely to suffer serious complication.We should select suitable surgical approach by the specific circumstances of the patients.The causes of postoperative complications of CSDH are varied.In particular,there is an important relationship between the non-standard operation and postoperative complications.