Object To investigate clinical features,surgical strategy and prognostic factors of bone metastasis from thyroid cancer.Methods A total of 46 patients with bone metastasis from thyroid cancer,who had undergone surgical treatment from January 1999 to July 2011 and had complete follow-up data,were enrolled in this retrospective study.There were 20 males and 26 females,aged from 40 to 87 years (average,56.87 years).Forty two (91.3％) cases of metastatic lesion located in axial skeleton,while 4 (8.7％) in limbs.The tumor histology type was well-differentiated in 35 patients and poorly differentiated in 11 cases.Nineteen patients (41.3％) had an isolated metastatic bone lesion,while other 27 patients (58.7％) had multiple lesions.Kaplan-Meier survival curve and Cox regression model were performed to identify prognostic factors among 19 factors including gender,age,tumor subtype,number of bone metastasis,site of bone metastasis,visceral metastasis,skeletal-related events,timing of metastasis,whether metastatic lesion was detected when thyroid cancer was diagnosed,whether thyroid surgery was performed,whether 131Ⅰ therapy was performed,whether chemotherapy or radiotherapy were performed,preoperative general condition (good or poor),surgical type (excisional surgery or palliative surgery),characteristics of metastatic lesion (osteolytic or mixed),intraoperative blood loss,whether measures were applied to prevent intraoperative bleeding,perioperative complications and long-term complications.Results Excisional surgery was performed in 36 patients (78.3％),while palliative surgery in other 10 patients (21.7％).The average amount of blood loss was 2603.26ml.The postoperative 5-year survival rate and 10-year survival rate were 37.3％ and 12.4％,respectively.Univariate analysis showed the significant prognostic factors include tumor subtype,number of bone metastasis,whether 131Ⅰ therapy was performed,and preoperative general condition (good or poor).Multivariate analysis showed the independent prognostic factors were number of bone metastasis (solitary or multiple) and whether 131Ⅰ therapy was performed.Conclusion For patients with bone metastasis from thyroid cancer,the prognostic factors are useful for determining indications for operation and improving treatment outcome.

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 The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.

Objective To explore clinical significance of subtemporal decompression in traumatic total anterior circulation infarcts(TTACI).Methods 24 TTACI cases accepted subtemporal decompression were analyzed including CT scan feature, pre operative observation to temporal superficial artery, operative cranial pressure classification and blood circulation in cortical small artery.Results Clinical symptom compared between before and after operation: good 4 cases, unchanged 14 cases, dead 6 cases. CT scan showed infarct areas became smaller in 4 cases, unchanged in 9 cases, larger in 2 cases three months after operation.Conclusion Subtemporal decompression cannot reduce the areas of infarcts and mortality, nor improve neurological function and promote quality of survivor.

Objective:To clarify the effects of the BMP receptor inhibitor LDN-193189 in the dedifferentiated chondrosarcoma (DDCS) cell line NDCS-1 and to explore the anti-tumor mechanism of LDN-193189 in DDCS. Methods:NDCS-1 was treated with 5 nmol/L of LDN-193189. MTT assay and clone formation experiments were used to verify that LDN-193189 suppressed cel proliferation. Transwel and wound healing tests were performed to demonstrate that LDN-193189 inhibited cell invasion. Western blot detection was used to show that LDN-193189 inhibited the suppression of BMPR2, p-Smad1/5, and RUNX2 protein expression. Results:The BMPR2 signaling pathway was inhibited by LDN-193189;thus, cell viability and invasion were significantly suppressed. Conclusion:LDN-193189 induces the inhibition of progression in vitro via the BMPR2-p-Smad1/5-RUNX2 signaling pathway in the human DDCS cell line NDCS-1.

[Objective]To evaluate the diagnostic strategy for bone metastasis from unknown primary. [Method]One hundred and twenty five patients with unknown primary bone metastasis were treated from June 2003 and December 2006.The distribution of bone metastasis while initial diagnosis mainly focused on spine,sacrum,pelvis,femur and humerus.The diagnostic strategy contained a series of physical examination,laboratory test,imaging study and pathological examination.[Result]The primary tumor was found in 70.4% cases,while 40% was in the lung,8% in kidney,5.6% in prostate,4.8% in liver,4% in breast,both 2.4% in thyroid and gastric,and 3.2% in other visceras.The physical examination revealed the occult primary site of the malignant tumor in only 9.6% cases.Although,43.2% patients had higher level of tumor antigen,but most of them were non-specific.Sixty percent of primary tumor was found by various imaging studies including plain radiograph,computed tomography and ultrasound.The pathological result after biopsy or operation identified or suggested the primary tumor in 66.4% cases.The one year survival rates after diagnosis were 58.57% and 22.93% in patients of bone metastasis with known and unknown origin,respectively.[Conclusion]The primary tumor can be diagnosed in most bone metastasis patients with no cancer history after careful examination,and patients will get benefit on survival time for targeted treatment.

[Objective] A retrospective study of patients with osteosarcoma in the proximal humerus was carried out to evaluate the effect of limb salvage surgery.[Methods]Thirty-eight patients received neoadjuvant chemotherapy and limb salvage were included in the study.Extraarticular or intraarticular resections of the proximal humerus were performed in 5 patients and 33 patients,respectively.The reconstructions included 31 custom-made prosthetic replacements,4 allograft prosthetic composites,1 bone cement spacer,and 2 autografts.The image files of patients receiving intraarticular resection were studied to identify tumor invasion of glenoid and deltoid muscule.[Results]Local recurrence encountered in 5 patients(13.2%)including 1 with extraarticular resection and 4 with intraarticular resection.In patients with intraarticular resection,image study revealed gleoid and deltoid muscule invasion occurred in 7 patients,of whom only 4 had local recurrence.The overall 5-year survival rate was 56.4%,and the disease-free survival rate was 40.5%.Complication rate of limb salvage surgery was 18.4%,which included two autograft bone fractures,one embolism of upper limb artery combined with radial nerve injury,and 4 shoulder joint instabilities.The functional outcomes of mean MSTS 93 score was 22.7 points(75.6%).The active external extension of shoulder joint was restricted in patients with extraarticular resection of no more than 30 degrees,and in patients with intraarticular resection of mean 45 degrees.[Conclusion]Acceptable oncological result and better function could be obtained after intraarticular resection of osteosarcoma in proximal humerus if glenoid or deltoid muscle invasion was not found on image study.Prosthetic replacement in these patients had lower complication rate,and better upper limb or hand function.