Tumor cells can secrete various cytokines which can enhance the activity of osteoclast in the bone microenvi?ronment, and osteoclast can promote the release of many growth factors buried in bone matrix which would promote the growth and invasion of tumor cells. Thus, a‘vicious cycle’of bone destruction is developed in the bone metastatic microenvironment. Bone metastatic microenvironment facilitate this‘vicious cycle’, while it also provides potential targets for the treatment of bone metas?tases. Osteoprotegerin, receptor activator of nuclear factor?κB and its ligand system are the typicality of molecular targets. Bone metastasis can promote the secretion of RANKL and the expression of OPG. The disbalance of RANKL/OPG is an important induc?ing factor for bone destruction. Many studies have shown that transforming growth factor?βwhich is produced by osteoclast plays an important role in mediating‘vicious cycle’. Src family tyrosine kinase, endothelin A receptor, matrix metalloproteinase, and ca?thepsin K are the potential targets of bone metastasis. Pharmacologic agents such as denosumab, can inhibit the‘vicious cycle’of bone metastasis. In addition to suppress bone destruction by Pharmacologic agents, they also can produce direct antitumor effect. They can delay the occurrence of skeletal related events, prolong the overall survival, and play an important role in patient ’s quali?ty of life at last. Patients with bone metastasis have already benefited from systemic molecular targeted therapies, and further re?searches would be of great importance in improving patient therapeutically selections and enhancing the effect.

The incidence of spine metastasis is increasing due to the aging demography and improvement of cancer diagnosis and treatments.Spine metastasis is one of the serious complications of advanced cancers,and its treatment should pay attention to patients' quality of life and consider interdisciplinary cooperation.Expected life span can guide doctors to select the appropriate treatment for spine metastasis patients,and various scoring systems have been developed.We elicited relevant literatures in WanFang,CNKI,PubMed and Embase databases.Articles aiming at developing model for spine metastasis or describing the clinical effectiveness and pitfalls of the existed systems were included.As a result,48 articles were carefully reviewed.In this review,thosc scoring systems were stratified into two groups:Traditional scoring systems,which were published before or in 2005,including original/revised Tokuhashi scoring systems,Tomita scoring system,Bauer scoring system,Linden scoring system,and Sioutos scoring system;and new scoring systems,which were designed during the last three years,including Lei & Liu scoring system,Bollen scoring system,Rades scoring system,Oswestry spinal risk index (OSRI),and Katagiri scoring system.The usefulness of the traditional scoring systems has been validated by many studies.However,the applicability of those scoring system were controversial due to improvement of cancer treatment and survival period in recent years.Although the improvement of life span was considered,those new scoring systems have not penetrated into clinical routine because of the lack of validation.Currently,which system has the highest accuracy rates still remains unclear.Next generation of scoring systems should take into account the practicality and reliability at the same time.In this review,we introduced above mentioned scoring systems,described the validity and limitation of those scoring system,and suggested the future directions of next generation of scoring systems.

Immobilization osteoporosis (IOP)is a common complication in clinic and cosmonauts. It severely impaired the patients ant the cosmonauts. The causes of IOP are weightless,immoblization and bed rest.Excercise therapy is very important for IOP. The etiology andpathogenesis of IOP are introduced in this article. the effects, mechanism and methods of the exercise therapy for preventing and treating IOP arealso discussed.

Purpose To investigate renal cortical blood perfusion in patients with nephrotic syndrome (NS) by region of interest (ROI) quantification.Materials and Methods Twenty-one patients with NS treated at Wuhan Union Hospital from September 2014 to January 2015 (NS group) and twenty-nine matched healthy subjects (control group) were enrolled in our study.High frequency blood flow dynamic images of the left kidney for all the subjects were acquired by color Doppler (Philips iU22).Resistance index (RI) of interlobar artery,arcuate artery and interlobular artery were measured.Vascularization index (VI),flow index (FI),vascularization flow index (VFI) were further analyzed by ROI quantification at Q-LAB work station.Results ① The signals of renal cortical blood flow in NS patients were sparse and slim;while the signals in the control group were continuous,most of which reached the edge of renal cortical.② No statistical differences of RI values of interlobar artery and interlobular artery were found between the two groups (P＞0.05);③ The renal cortical blood perfusion in the NS patients decreased significantly compared with that in control group,and the renal cortical VI,FI and VFI values in NS group were significantly lower (P＜0.01).④ Bland-Altman analysis showed that there was good repeatability in the measurement of renal cortical VI,FI and VFI.Conclusion Color Doppler flow imaging combined with RO1 quantitative technique can assess renal cortical blood perfusion accurately,which provides diagnostic information for early detection of renal damage.

Objective To evaluate the results of the treatment and prevention measures for pathological dislocation of the hip following septic arthritis in the newborns. Methods Twenty cases undergone open reduction were studied restropectively. In addition, greater trochanterplasty was penformed in 15 cases, acetabularplasty in 14 cases, greater and lesser trochanterplasty in 2 cases. Rusults A successful rate of reduction achieved in 90％ of the patients; however, central reduction was achieved in only 38.8％ . 20 patients were followed-up for 6 months to 12 years. The stability and motility of the hip gradually improved in majority of the patients. The cases with severe destruction followed by absence of femoral head and neck had unsatisfactory results. Shortening deformity were found in six cases, and subluxation, dislocation, rigidity of the hip in one case each. Conclusion The greater trochanterplasty had a good result for reduction and maintaining the position. Early diagnosis and early open drainage were key measures for prevention of pathological dislocation of the hip resulting from the acute septic arthritis in the newborn.

Objective To compare the effectiveness and safety of different concentrations of elastin-like polypeptides (ELP) as novel submucosal injection material for endoscopic submucosal dissection.Methods Forty healthy New Zealand white rabbits were randomly divided into two groups (n=20).The first group by submucosal injection of different drugs were randomly divide into five groups (n=4).Four concentrations of 50 ku ELP (0.05,0.025,0.012 5,0.005 g/ml) were used separately in each group,while glycerin fructose was used for control group.Each solution (2 ml) was injected into the submucosa through the resected margin,the increase of mucosal thickness and surface changes were observed and recorded at 0,5,10,and 30 min.The subgroup by submucosal injection of different drugs were randomly divide into five groups (n=4).The injection pressure of each solution (2 ml) with the 25-gauge needle was calculated by a manometer,which was connected between the needle and syringe.Results The submucosal uplift heights in groups using the 0.05 g/ml ELP and 0.025 g/ml ELP injection were significantly thicker than that of glycerin fructose (P＜0.05),the 0.012 5 g/ml ELP and glycerin fructose injection showed no significant difference (P＞0.05),whereas the uplift height in glycerin fructose group was thicker than that of the 0.005 g/ml ELP (P＜0.05).The injection pressure correlated with the ELP concentration.The injection pressures of 0.05,0.025,0.012 5,0.005 g/ml ELP solutions were (332±36) kPa,(223±24) kPa,(174±22) kPa and (142±19) kPa,respectively,and that of glycerin fructose was (269±17) kPa.The 0.025 g/ml ELP solution was easily injected into the porcine stomach to create submucosal uplift.The injection pressure of the 0.025 g/ml ELP solution showed significantly lower value compared with that of glycerin fructose (P＜0.05).Conclusions ELP might be a promising agent for submucosal injection for endoscopic submucosal dissection (ESD),and 0.025 g/ml ELP might be efficient concentration for maintaining mucosal elevation,injection pressure and safety.

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Objective To evaluate the clinical effect of one-stage posterior-anterior approach surgery for patients with cervical fracture and dislocation combined with locked facet.Methods A retrospective review was conducted on 21 cases of cervical dislocation and fracture combined with locked facet treated by one-stage posterior-anterior approach surgery between April 2011 and December 2012.There were 16 males and 5 females at age ranging from 23 to 61 years (mean,38.3 years).Posterior unlocking reduction by partial facetectomy and lateral mass screw fixation was performed,followed by anterior decompression,internal fixation and interbody fusion by titanium meshes.Outpatient or telephone follow-up was performed to evaluate bone fusion and recovery of neurologic function.Results Mean operation time was 140 minutes (130-210 minutes) and mean blood loss was 340 ml (range,150-600 ml).All incisions got primary healing with no operation-correlated complications.Five patients complicated with severe lung infection after surgery and one died of respiratory failure two week later.Titanium meshes achieved bone fusion within 3-9 months (mean,6 months) after surgery.At a mean follow-up of 17 months (range,12-30 months),there was no implant breakage and mesh displacement or collapse.According to the American Spinal Injury Association (ASIA) score,preoperative neurologic deficit restored by mean one grade at final follow-up.Conclusion One-stage posterior-anterior approach surgery is an ideal choice for cervical fracture and dislocation combined with locked facet,for it provides unlocking reduction,canal decompression,and rigid reconstruction of the anterior-posterior column.

Objective To synthesize a quantum dot (QD) to recognize glioma cells for imaging and photodynamic therapy. Methods By one-pot aqueous approach, near infrared-emitting CdTe was produced. After detection of its physicochemical characterizations, RGD was conjugated. Emission images were observed with confocal microscopy. To test its toxicity, CdTe-RGD with various concentrations was separately added into U251 and 3T3 cells for incubation in dark circulation. To test its photodynamic effect, U251 and 3T3 cells were then irradiated for 5 ~ 60 min using 632.8 nm laser. Results The QD (Φ = 3.75 nm, PL peak wavelength =700 nm, PLQY=20%) achieved was a spherical crystal with excellent monodispersity. Under confocal microscope , U251 cells were visualized but 3T3 cells not. In dark circulation, the survival rates of both U251 and 3T3 cells were above 85%. After laser irradiation, the survival rate of U251 cells decreased to (37 ± 1.6)%with the increasing of irradiation time and CdTe-RGD concentration. Conclusion With good physicochemical characterization and low toxicity, CdTe-RGD could be applied in biomedical imaging and photodynamic therapy of gliomas.

Objective·To evaluate the clinical value of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound in the diagnosis of uterine space-occupying lesion.Methods·A total of 75 patients with uterine space-occupying lesion were enrolled in this study from March 2015 to February 2016 at Hospital of Southwest Medical University.Patients received both two-dimensional ultrasound and four-dimensional color Doppler ultrasound to determine the location,number and nature of the lesions,as well as the clinical staging of malignant lesions,then the diagnostic accuracy was evaluated.Results·Among 75 patients,there were 26 cases with endometrial carcinoma,21 cases with hysteromyoma,16 cases with metropolypus,and 12 cases with uterine adenomyosis.The diagnostic accuracy of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound for the uterine space-occupying lesion was 88.0％,which was significantly higher than that of two-dimensional ultrasound (64.0％) (P＜0.05).What's more,the diagnostic accuracy of two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound for the clinical staging of endometrial carcinoma was 88.5％,which was significantly higher than that of two-dimensional ultrasound (61.5％) (P＜0.05).Conclusion·Two-dimensional ultrasound combined with four-dimensional color Doppler ultrasound is more effective to improve the diagnostic accuracy of uterine space occupying lesion and clinical staging of endometrial carcinoma in comparison with two-dimensional ultrasound,which will favor the clinical strategy for the treatment of uterine space-occupying lesion.