The clinical classification of metastatic spinal tumors is based on the degree of malignancy, nervous system function, osteoclasia, and prognosis of patients. The application of this classification system is relatively simple. The assessment and evaluation of patients to estimate the period of survival can guide the individualized treatment of patients. Patients with clear surgical indications can choose to undergo a palliative operation, tumor resection, or total spondylectomy. Alternatively, other patients can opt to have mini-mally invasive surgery aside from the normal surgical approach. Stereotactic radiotherapy and intensity-modulated radiation therapy combined with the use of radiofrequency ablation, radiation, and other therapies can achieve local tumor control, relieve pain, and main-tain normal neurological function. Thus, the quality of life of the patient is improved. Percutaneous vertebroplasty, radiofrequency abla-tion, spinal endoscopy, and other modern forms of minimally invasive surgery will have more applications in the treatment of spinal metastatic tumors.

CD44 has been the subject of extensive research because of its role in cancer and many physiological processes.Through binding to different ligands,CD44 can initiate a series of cascade.CD44 not only can promote tumorigenic and tumor metastasis,but also can suppress tumor growth and progression.In-depth study of CD44 and its role in signal pathway may provide a new path for cancer treatment.

The acetylation status of histories regulates access of transcription factors to DNA and influences levels of gene expression.Histone deacetylase(HDAC)activity diminishes acctylation of histones,causing compaction of the DNA-histone complex.This compaction blocks gene transcription and inhibits cell differentiation.HDAC inhibitom decompact the DNA-histone complex and promote cell growth arrest,differentiation,and apoptosis of tumor cells.Meantime,HDAC inhibition also affects acetylation status and function of non-histone proteins.HDAC inhibitors not only possess significant anti-tumor effects with single use,but also has great significance in combined therapy with other drugs.

Objective To compare the efficacy of proximal femoral anti-rotation nail and artificial femoral head replacement with bone cement in the treatment of intertrochanteric fracture of femur in elderly patients.Methods70 elderly patients with intertrochanteric fracture of femur were selected as the research subjects,and they were randomly divided into the observation group and the control group according to the digital table,35 cases in each group.The observation group was treated with proximal femoral anti-rotation nail,the control group was treated with artificial femoral head replacement with bone cement.The clinical efficacy of the two groups was observed and compared.Results The operation time,intraoperative bleeding volume of the observation group were (52.63±13.72)min,(115.26±35.17)mL,respectively,which were significantly better than those of the control group[(86.69±21.15)min,(328.72±47.62)mL,t=3.98,9.86,all P<0.05].The time of standing and walking after operation in the observation group were (12.36±3.61)d,(17.51±3.60)d,which were longer than those of the control group[(9.42±3.18)d,(15.18±3.55)d],but the differences were not statistically significant(t=1.36,1.08,all P>0.05).There was no significant difference in the Harris hip score 30 months after operation between the two groups(t=0.18,P>0.05),while the Harris hip score of the observation group after 6 and 12 months were higher than those of the control group,the differences were statistically significant(t=9.04,3.75,all P<0.05).ConclusionCompared with artificial femoral head replacement with bone cement,proximal femoral anti-rotation nail for elderly patients with intertrochanteric fracture of femur has more significant effect,it is worthy of clinical promotion.

Objective To compare the advantages and disadvantages between the Mammotome ( MMT ) and conventional resection operation in the diagnosis and treatment of breast tumors . Methods A total of 288 patients during the period from February to July of 2014 were divided into MMT group ( 137 cases ) and control group ( 151 cases ) according to patient ’ s willingness .The surgical and post-operative results , postoperative complications and burden of disease were compared between the two groups . Results As compared to the control group, the MMT group had shorter operation time [(28.3 ±9.1) min vs.(37.5 ±14.2) min, t =-6.472, P=0.000], larger amount of tissue cut [(29.2 ±8.1) g vs.(16.5 ±7.9) g, t=13.462, P=0.000], lower visual analogue scales at one day after surgery [(4.2 ±3.6) points vs.(4.9 ±1.5) points, t=-2.189, P=0.029], lower incidence of postoperative breast shape change [10.2% (14/137) vs.55.0% (83/151), χ2 =64.392, P =0.000], and higher patient satisfaction scores [(7.2 ±1.8) points vs.(5.3 ±2.9) points, t=6.601, P=0.000], but more intraoperative bleeding [(22.3 ± 4.3) ml vs.(12.6 ±5.9) ml, t=15.807, P=0.000], higher incidence of postoperative breast hematoma [9.5% (13/137) vs. 2.6%(4/151),χ2 =6.050, P=0.014], and higher total costs [(5.12 ±1.97) ×103 yuan vs.(3.18 ±2.01) ×103 yuan, t=8.258, P=0.000]. Conclusion The MMT operation has advantages of short time , more cut tissue volume, mild postoperative pain, good postoperative breast shape , and high patient satisfaction , but disadvantages of easy development of hematoma and high total costs.

Objective To evaluate the prognostic value of three different staging system based on positive lymph nodes,lymph node ratio and log odds of positive lymph nodes in breast carcinoma.Methods In 472 breast carcinoma patients,survival analysis was performed with Kaplan-Merier and COX regression model,the hazard ratio (HR) of the three staging system were compared.Results When more than 10 lymph nodes were dissected in the operation,there was statistical differences in survival among the staging systems based on lymph node ratio and log odds of positive lymph nodes (P ＜ 0.05),while the prognosis was highly homologous between the staging systems based on positive lymph nodes in stage N0 and N1.Univariate analysis showed age,tumor size,Her2 status,estrogen receptor status and the total lymph nodes dissected were related to overall survival (all P ＜ 0.05).COX multivariate analysis showed that the staging system based on lymph node ratio (5.495) and log odds of positive lymph nodes (4.662) had the higher HR than the N staging system (2.722).Conclusions Compared with the number of involved lymph nodes,the staging system based on lymph node ratio and log odds of positive lymph nodes were superior to the staging system based on positive lymph nodes for prognostic assessment of breast carcinoma.

Objective To summarize the experience during early stage of postoperative monitoring and treatment for the patients follwing lung transplantation in surgical intensive care unit,and to improve the patient's outcome of lung transplantation.Methods A retrospective analysis of 9 cases of orthotopic lung transplantation admitted to surgical intensive care unit (SICU) of Beijing Anzhen Hospital from May 2005 to May 2011 was made.Results There 5 male patients and 4 female patients with the age 21 -67 (46.1 ± 14.1 ) years old in present group,and among them 6 patients survived (survival rate:66.7％ ).The etiological indication of admission were idiopathic pulmonary fibrosis (n =4),pulmonary lymphangioleiomyomatosis ( n =3 ),and bronehiectasis ( n =2).Bilateral sequential lung transplantation ( n =5 ),single left lung transplantation ( n =1 ) and single rigbt lung transplantation ( n =3) were performed.The postoperative duration of mechanical ventilation,stay duration in SICU and in hospital were 2 -32 d,3 -42 d,and 3 -60 d respeetively.Postoperative complication taking place after surgery were acute rejection in 2 cases and pneumonia 4 cases (3 cases were treated with extracorporeal membrane oxygenator).Postoperative in hospital death was 3 cases of 9 resulting from severe intection (n =2) and cireulation failure ( n =1 ).Conclusion Well-planned postoperative management stroategy in SICU plays an important role in outcome control after lung transplantation,including monitor and respiratory and cardiacvascular management,reasonable implementation of vasoactive medications and diuretics,protective mechanical ventilation strategy,reducing the time of ventilation.

Objective To evaluate the effects of Met inhibitor XL-880 on radiosensitivity of breast cancer cells MDA-MB-231.Methods MDA-MB-231 cell lines were assigned to the following treatment groups:control group,radiation group,XL-880 group and combination group.Cell apoptosis,cell cycle distributions and tumorigenicity were investigated by flow cytometry or clonogenic assay.The expression of apoptosis and cell cycle related proteins (p21,Cyclin B1,Bcl-2,Caspase-3 and PARP),and phosphorylation levels of c-Met were measured by Western blot.Results XL-880 combined with radiation significantly decreased the proliferation activity of MDA-MB-231 cells (P ＜ 0.05).Flow cytometry results showed that the rate of G2/M cell were increased with XL-880 (P ＜ 0.05),and the rate were (17.3 ±1.3) ％,(20.0 ± 4.0) ％,(28.5 ± 3.1) ％,(57.0 ± 3.3) ％,respectively.Annexin V/PI double-staining assay showed that XL-880 obviously induced the apoptosis of MDA-MB-231 cells after radiation (P ＜ 0.05),of which the apoptotic rates were (7.3 ±0.9)％,(14.1 ±0.6)％,(35.5 ±4.4)％,(48.2±5.3)％,respectively.XL-880 downregulated the expressions of Cyclin B1 and anti-apoptosis protein Bcl-2,while promoted the expression of apoptosis related protein cleaved Caspase-3 and PARP.Conclusions XL-880 enhance the radiosensitivity of breast cancer cell MDA-MB-231 by inhibiting Met pathway.

Objective To investigate the clinicopathological characteristics and prognosis of lung metastases from breast cancer.Methods The clinical data of 119 breast cancer patients treated at our institution from January 2000 to January 2007 were retrospectively reviewed.Results Among 119 patients with lung metastasis,35.3％ was hormone receptor (HR) +/human epithelial growth factor receptor (HER2)-,17.6％ was HR +/HER2 +,21.8％ was HR-/HER2 + and 25.2％ was trriple negative breast cancer (TNBC).The rate of grade Ⅲ in triple negative breast cancer was higher than the other subtypes(P =0.016).The median overall survival was 60 months (9-141 months),the median time to lung metastases was 29 months (3-99 months),and the median survival after lung metastasis was 33 months (range,6-98 months).The 1-,2-,3-and 5-year survival rate was 72.9％,54.1％,35.1％ and 14.4％.Conclusions TNBC,number of lung metastases,time to lung metastases less than 24 months,and a history of systemic chemotherapy were important factors for prognosis of patients with lung metastases.

Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous (TRAM) for breast reconstruction.Methods Female breast cancer patients were divided into 4 groups:group A (immediate breast reconstruction + radiation therapy,123 cases),group B (immediate breast reconstruction,262 cases),group C (radiation therapy + delayed breast reconstruction,34 cases),group D (delayed breast reconstruction,53 cases) from June 2009 to June 2012 at Department of Breast Oncology,Tianjin Medical University.Patient demographics,operative details,radiation therapy details,postoperative complications,patient-centered evaluation of aesthetic and psychological outcomes were assessed.Results The average follow-up duration was 24.98 ± 6.99 months.2.5％ patients developed delayed wound healing postoperatively.Fat necrosis and flap contracture were seen in 7.0％ and 3.6％ of all patients,respectively.Irradiated patients had a significant statistical difference in cancer staging,involved lymph nodes,tissue invasion and neoadjuvant chemotherapy (P ＜ 0.05).No significant statistical differences were observed in post-operative early complications,but in advanced stage complications.There was no significantly statistical difference in breast aesthetic outcome before and after radiation therapy within four groups.Conclusions For breast reconstruction patients,those without postoperative radiotherapy were suggested immediate breast reconstruction,and those with postoperative radiotherapy were proposed to accomplish breast reconstruction after postoperative radiotherapy.