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 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.

[Objective]To summary wound related complications and risk factors of sacral tumor surgery,and discuss the prevention and treatment strategy in order to decrease surgical risk and prevent the related complications.[Methods]From August 1997 to June 2008,302 patients with sacral tumors who underwent operations were retrospective studied to review complication types,risk factors and treatment strategies of complications.[Results]Wound nonunion,deep infection,cerebrospinal fluid leakage,viscera injuries and severe bleeding were the most common complications of peri-operation stage.Tumor diameters larger than 10cm,surgery and radiation history were the major risk factors of wound nonunion,deep infection and viscera injuries.Severe bleeding happened in 11 patients,and the major risk factors were tumor larger than 10cm,tumor locating at S2 or higher and en bloc surgery.Surgery and radiation history were the main reasons of cerebrospinal fluid leakage.[Conclusion]Understanding the risk factors of complications of sacral tumor surgery are helpful to judge and prevent complications after surgery.Some measures of prevention and treatment are effective to decrease the surgical risks.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.

Objective To investigate the expression of Smad5 gene in the cochlea and to identify its location. Methods Reverse transcription polymerase chain reaction (RT-PCR) was employed to detect the expression of Smad5, the in situ hybridization and the immunohistochemical technique were used to localize the Smad5 messenger RNA and the Smad5 protein in mouse cochlea. Results Smad5 gene expressed in cochlea at a high level. Smad5 expression was concentrated in supporting cell, hair cell, spiral ganglion, epithelium of stria vascularis and basilar membrane. Conclusion The Smad5 proteins exist in the mouse cochlea and it may be involved in the cochlear formation and the differentiation of hair cell. Smad5 might be an essential factor for the development of normal cochlea.

Objective To observe the Smad5 gene knockout and induced-changes of auditory physiology and cochlea morphology in mouse, to explore whether Smad5 gene is a new gene related to hearing function. Methods Double blind control methods were used to detect the auditory threshold of auditory brainstem responses (ABR) in the mouse of Smad5 (+/+) to Smad5(+/-) and the cochlea morphology (cochlea paraffin-cut section and basal membrane spreading section). The hair cell count was also taken. Results As shown by ABR audiometry, the average hearing of Smad5 (+/-) mouse (aged 24 weeks) is 90.63?17.65 dB (SPL) and that of Smad5(+/+) mouse is 63?19.94 dB(SPL), which are of significant difference (P0.05). Conclusion Smad5(+/-) gene knockout can cause the mouse a auditory threshold decline in moderate or severe extent. Cochlea morphology indicated that hair cells (mainly outer hair cells) in mouse cochlea basal membrane became deficient. A mechanism of Smad5 gene knockout to caused the deafness and the deficiency of hair cells remained to be further studied.

Objective To culture human pituitary adenoma cells to provide some useful experimental foundations to practice pituitary adenoma cells as donor cells in the extracranial implantation. Methods Human pituitary adenoma cells obtained by operation were cultured in vitro, and their growth state was dynamically observed. Immunohistochemical staining and RIA were used to evaluate their functional status. Results The cultured pituitary adenoma cells still had secretory function in vitro. 6 cases of GH adenoma cells secreted a large amount of GH, 5 cases of PRL adenoma cells secreted a large amount of PRL, and 3 cases of pituitary adenoma cells without function could also secrete a small quantity of FSH, LH and PRL. Conclusion 14 cases of cultured human pituitary adenoma cells had secretory function in vitro, which provides the useful experimental data to perform extracranial implantation with pituitary adenoma cells as donor cells.