Volume 95  ·  Issue 47  ·  2015

A 51-year-old male patient suddenly developed right lower abdominal pain without obvious trigger 18 h ago, which was intermittent, without radiating pain, unrelated to eating, accompanied by nausea and vomiting several times, without abdominal distension, diarrhea, chills and fever. Self-administered cephalosporins (specific unknown), the effect is not good, emergency admission, blood test routine: white blood cell count 14.9×10⁹/L, neutral granulometry ratio 0.85, right lower abdominal B-ultrasound showed no obvious abnormality, one year ago due to appendicitis underwent laparoscopic appendectomy, recovered smoothly after the operation and was discharged, so he was admitted to the hospital with "abdominal pain to be examined". Physical examination: There was abdominal breathing, no gastrointestinal peristaltic wave, soft abdomen, tenderness in the right lower abdomen, no rebound pain, no muscle guard, no palpable mass, negative mobile voiced sound, and normal intestinal sound. CT examination (Figure 1): The local intestinal wall in the proximal ileocecal area of the right ascending colon was thickened, the density in the intestinal lumen increased, and the local intestinal tube showed concentric circle-like changes, with speckled dense shadows, and the fat space around the intestine was still clear. Colonoscopy (Figure 2): The colonoscopy was delivered to the end of the ileum, and the appendix fossa was highly swollen, the appendix opening was congested and edematous, and the swollen appendix partially protruded into the cecum.

Event-related pot-entials (ERP) have the advantage of high temporal resolution that other brain imaging technologies can't match. This advantage gives ERP an important technology and means to deeply understand cognitive function, emotional changes and behavioral abnormalities in mental illness. In clinical practice, people always hope to find ERP that reflects the specific changes of mental diseases, and then use this ERP to dynamically evaluate, diagnose and predict the efficacy of diseases.

To investigate the potential association of carbonic anhydrase Ⅰ (CA1), anterior pharynx-defective 1A (APH1A), neurodevelopment protein 1-like 1 (NDEL1) and serine racemase (SRR) gene polymorphisms with the susceptibility of schizophrenia (SZ).

A case-control study was performed to identify polymorphisms of the CA1, APH1A, NDEL1 and SRR gene that may confer susceptibility to SZ in the Han Chinese population.Five single nucleotide polymorphisms (SNPs) were genotyped in 516 paranoid SZ patients and 516 control subjects by real time quantitative polymerase chain reaction.The association between genotypes and positive and negative symptoms scale was also explored.

No significant differences in genotype or allele frequencies of five SNPs were observed between schizophrenic patients and healthy controls (P=0.163, 0.322, 0.494, 0.338, 0.545; 0.259, 0.149, 0.417, 0.527, 0.720; respectively). However, the frequency of CA haplotypes in SZ group was higher than control group (P=0.041). The scores of depression/anxiety, positive and excited/hostile factors in SZ patients with genotype of rs2298161 (AG), rs4523957 (CC) and rs8081273 (GG) were higher than other genotypes (P=0.008, 0.001, 0.000, respectively).

These data suggests that the CA1, APH1A, NDEL1 and SRR gene may not be association with susceptibility to SZ in the Han Chinese population. However, the haplotype of CA may be the susceptible factor of SZ. Rs2298161, rs4523957 and rs8081273 may be associated with some phenotypes of SZ.

To evaluate the efficacy and safety of high dose transcranial magnetic stimulation (rTMS) in patients with schizophrenia with refractory negative symptoms.

From January 2013 to April 2014 at our institute, 70 hospitalized patients of schizophrenia, according to the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-Ⅳ), aged from 18 to 45 were randomly divided into study group (n=33) and control group (n=37). Both kinds and dosages of antipsychotics were preserved as before.All patients were treated with 10 Hz rTMS.rTMS was delivered to the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight solid core coil at 100% motor threshold, 2 times daily for 10 days within 2 weeks.Sham stimulation was used in control group. In both groups, Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate the efficacy and safety before treatment, at week 1 and week 2, and subjective visual analogue scale (VAS) score was checked after each rTMS session.PANSS was performed 3 times at follow up visits of week 4, week 8 and week 12.

Compared with before treatment, the total score of PANSS and the score of negative symptoms at week 2 declined in study group (q=3.780, 4.258, P<0.05), especially the factors of blunted affect, emotional withdrawal and passive/apathetic social withdrawal (q=3. 829, 4.089, 4.072, P<0.05). At the follow-up of week 4, week 8 and week 12 after treatment, none of the above factors got significant changes in study group (P>0.05). After 2 weeks' treatment, the effective rates were 43.75% and 11.43% in study group and control group, respectively, and there was a significant difference between two groups (χ²=8.888, P=0.003). The incidence of headache in study group was higher than that in control group (37.50% vs 8.57%, χ ²=8.051, P=0.005). The highest score of pain was (49±14) in study group, which occurred after the first rTMS treatment.Along with the treatment, the score gradually became lower, and the lowest was (11±5) after 20^th treatment.

Among schizophrenia patients with refractory negative symptoms, 10 Hz rTMS applied 2 times daily within 2 weeks is effective and safe, especially, may improve blunted affect, emotional withdrawal and passive/apathetic social withdrawal.

To investigate the relationship between the variations of event-related potentials (ERP) and clinical symptoms and treatment in first episode schizophrenia patients.

The ERP (P50, color map of N400 and prepulse inhibition of the startle reflex (PPI)) were tested in 85 first episode schizophrenia (FES) patients and 78 normal controls (NC), and followed-up at 1, 2 and 3 years after treatment in FES.Positive and negative symptom scale (PANSS) was used to evaluate the psychotic symptoms of patients.

(1) Compared with NC, FES showed decreased PPI% (41%±37% vs 68%±42%, P<0.001), increased P50 S2/S1(87±41 vs 51±47,P<0.001), prolonged N400 latency and decreased N400 amplitudes (P<0.05-0.01). (2) Significant correlations were found between variations of color map of N400 latencies and general scores of PANSS (r=0.321, P=0.042), N400 amplitude and positive symptom scores (r=-0.437, P=0.008) and total scores of PANSS (r=-0.392, P=0.023), but the variations of PPI and P50 latencies and amplitudes did not show significant correlation with the positive symptom scores and total scores of PANSS.(3) The color map of N400 latencies and amplitudes in FES group showed significant difference (P<0.05) but the major indexes of PPI and P50 did not show significant difference (P>0.05) among the 1, 2 and 3 years' follow-up after treatment.

This follow-up study suggests that the variations of PPI and P50 is probably a trait marker of FES, and the variations of color map of N400 might be a status marker of FES.

To measure serum levels of high mobility group protein B-1 (HMGB1), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before and after antipsychotic treatment, and further study the role of HMGB1 in schizophrenics.

Thirty first-episode schizophrenics who were never treated with neuroleptics from First Affiliated Hospital of Zhengzhou University and thirty healthy subjects were enrolled.Serum levels of cytokines such as HMGB1, IL-1β, IL-6 and TNF-α were examined with enzyme linked immunosorbent assay (ELISA) before and after antipsychotic treatment.

The serum levels of HMGB1, IL-1β, IL-6 and TNF-α in schizophrenics [(80 zophμ8/L, (51 zo, 441 zo, 591 zopng/L] were significantly higher than those in the healthy subjects [(54 gni)μ4/L, (25 gni, 17 gn, 41 gni) ng/L] (P<0.05). After treating the schizophrenics with the neuroleptic risperidone for 6 months, the serum levels of HMGB1, IL-1β, TNF-α and IL-6 were decreased.The serum levels of HMGB1 were positively correlated to IL-1β, IL-6, TNF-α and Negative Symptoms (r=0.377, r=0.426, r=0.454, r=0.558, P<0.05).

Schizophrenics show activation of the cytokine system and immune disturbance.HMGB1 may play a proinflammatory role in schizophrenia and the decrease of HMGB1 after neuroleptic risperidone treatment may be a marker of mental symptoms remission.

To investigate the value of serum matrix metalloproteinase-3 (sMMP-3) in the assessment of active disease in patients with rheumatoid arthritis (RA).

One hundred and ninety-one RA patients were recruited from the Department of Rheumatology of Sun Yat-sen Memorial Hospital from June 2010 to June 2014.sMMP-3 level of these RA patients and 58 healthy people was tested by enzyme-linked immunosorbent assay, while clinical data was collected simultaneously.Receiver operating characteristic (ROC) curve was used for the analysis of optimal cut-off point for the evaluation of disease activity.

There were 128 female patients and 63 male patients recruited.sMMP-3 was significantly higher in RA patients than healthy control and it was higher in patients with active disease than that in patients in remission (all P<0.01). ROC curve analysis showed that the optimal cut-off point for diagnosing active RA was 84 μg/L with area under the curve (AUC) 0.822 in female and 168 μg/L with AUC 0.824 in male (bothP<0.01). According to the optimal cut-off points, the sensitivity of sMMP-3+ CRP combined detection was 97.2% for diagnosing active RA, which was significantly higher than that of sMMP-3 (84.7%) or C-reactive protein (CRP) (88.2%, bothP<0.05). The specificity of combined detection was 95.7%, which was significantly higher than that of sMMP-3 (68.1%,P<0.01). And Youden's index of combined detection (0.951) was significantly higher than that of sMMP-3 (0.528) or CRP (0.754, bothP<0.05).

sMMP-3 is a helpful indicator for disease activity measurement in RA patients.Combined detection of sMMP-3 and CRP can improve the accuracy of disease activity assessment.

To observe the effect of follicular fluid IL-6, TNF-α on the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with ovarian endometriosis.

From June 2013 to June 2014, the data of 64 (from Tangshan Maternal and Child Health Hospital IVF center) ovarian endometriosis patients was analyzed retrospectively.58 infertility cases caused by male side were used as control group.Oocyte retrieval rate, MⅡ oocytes rate, fertilization rate, recovery-intracytoplasmic sperm injection (R-ICSI) rate, good quality embryo rate, biochemical pregnancy rate and clinical pregnancy rate were analyzed and compared between two groups.Changes in the expression of follicular fluid IL-6, TNF-α were detected.

Oocyte retrieval rate, MⅡ oocytes rate, fertilization rate, good quality embryo rate, biochemical pregnancy rate and clinical pregnancy rate in ovarian endometriosis group were significantly lower than those in the control group (all P<0.05), while R-ICSI rate increased in ovarian endometriosis group compared with control group (P<0.05). IL-6, TNF-α expressions of follicular fluid were higher in affected side of ovarian endometriosis patients than those in the unaffected side and those in control group.

Inflammation microenvironment of the follicular fluid may influence IVF-ET outcomes in ovarian endometriosis patients.

To evaluate the feasibility of CT angiography of lower extremities by using 100 kVp as tube voltage and Iodixanol(270 mg I/ml) as contrast medium combined with iDose⁴ iterative reconstruction technique.

A total of 52 continuous patients with clinically suspected lesions of lower extremity arteries underwent CT angiography of lower extremities, divided into 2 groups, and different scan protocols were adopted."double low"group included 26 patients using 100 kVp, Iodixanol(270 mg I/ml) and iDose⁴-4 iterative reconstruction algorithm; routine group included 26 patients using 120 kVp, Iopromide(370 mg I/ml) and filtered back projection reconstruction algorithm.The total amount of contrast medium in both groups was 95 ml.Artery CT value and background noise at the level of L4 vertebral, hip, knee and ankle were measured, signal to noise ratio(SNR) and contrast to noise ratio(CNR) were calculated, and the quality of images was evaluated subjectively. Scan length(L), volume CT dose index(CTDI_VOL) and dose length product(DLP) were recorded, and the effective dose(ED) was calculated.The measurement results and subjective evaluation were analyzed statistically.CTA results were analyzed with the digital subtraction angiography(DSA) as the"gold standard".

(1)No significant difference was existed in gender, age, height, weight and body mass index(BMI) of these two groups(P>0.05). (2)No significant difference was existed in artery CT value, SNR and CNR at the level of L4 vertebral, hip, knee and ankle of the two groups(P>0.05). Compared with routine group, background noise of"double low"group at the level of hip and knee increased by 16.6% and 13.8%, respectively(P<0.05). (3)The image quality of the two groups met the requirement of diagnosis, no significant statistical difference was existed in subjective evaluation(P>0.05). (4)The CTDI_VOL, DLP, ED of"double low"group were lower than that of routine group, with significant statistical difference(P<0.05). The total amount of iodine in"double group"was lower than that of routine group(25.6 g vs 35.2 g). (5)A total of 7 cases from"double low"group underwent DSA examination, and 18 pathological changes(stenosis and occlusion) were found totally, in which 16 matched CTA; 6 cases from routine group underwent DSA examination, and 15 pathological changes(stenosis and occlusion) were found totally, in which 13 matched CTA.No significant statistical difference was existed between the two groups in diagnostic efficacy(P=0.626).

Using 100 kVp and Iodixanol(270 mg I/ml) combined with iDose⁴-4 iterative reconstruction technique for CT angiography of lower extremities, the image quality could meet the requirement for clinical diagnosis, the radiation dose and the volume of contrast medium could be lowered.

To analyze the correlation between the concentration of plasma cell free DNA (cfDNA) of patients with lung cancer or esophageal cancer and clinical features, and to assess the coincidence rate of the EGFR/KRAS mutations between the cfDNA and tumor tissue DNA.

A total of 30 cases lung cancer and esophageal cancer (including 15 lung cancer, 15 esophageal cancer) were enrolled in this study.The tumor tissue and plasma sample of patients were collected.The tumor tissue DNA and plasma cfDNA were extracted.The EGFR/KRAS mutations of the tumor tissue DNA and plasma cfDNA were detected by fluorescence PCR.

The concentration of cfDNA of patients with lung cancer (5.0±1.4) μg/L and esophageal cancer (7.0±0.8) μg/L were positively correlated with tumor size ( r=0.574, P=0.01). There was no significant correlation between the concentration of cfDNA and TNM stage of tumor, gender, and age of patients.There was no EGFR/KRAS gene mutations in tumor tissue DNA and plasma cfDNA of esophageal cancer.A total of 6 tumor tissue samples of lung cancer patients were detected EGFR mutation, and 1 tumor tissue sample was detected KRAS mutation.Meanwhile, 4 plasma cfDNA samples of lung cancer patients were detected EGFR mutation, and 1 plasma cfDNA sample was detected KRAS mutation.

The concentration of cfDNA of patients with lung cancer and esophageal cancer was positively correlated with tumor burden.There was high coincidence rate of the EGFR/KRAS mutations between the cfDNA and tumor tissue DNA.

To evaluate the diagnostic value and potential therapeutic impact of Peking Union Medical College Hospital critical ultrasonic management (PCUM) in the early management of critically ill patients with acute respiratory failure (ARF).

Patients admitted into the ICU of Peking Union Medical College Hospital for ARF were consecutively recruited over a 18-month period.Patients were randomly divided into conventional group and PCUM group (critical care ultrasonic examination was added in addition to conventional examinations). The two groups were compared with respect to time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to treatment response, time to other examination.

A total of 187 patients were included in this study.The two groups showed no significant differences in general clinical information or final diagnosis (P>0.05). The PCUM group had a shorter time to preliminary diagnosis, time to final diagnosis, time to treatment response, time to X-ray/CT examination, and a higher diagnostic accuracy than the conventional group (P<0.001). PCUM had high sensitivity and specificity for the diagnosis of acute respiratory distress syndrome (ARDS) (sensitivity 92.0%, specificity 98.5%), acute pulmonary edema (sensitivity 94.7%, specificity 96.1%), pulmonary consolidation (sensitivity 85.7%, specificity 98.6%), COPD/asthma (sensitivity 84.2%, specificity 98.7%).

The PCUM is seem to be an attractive complementary diagnostic tool and able to contribute to an early therapeutic decision for the patients with ARF.

To evaluate the efficacy of total elbow arthroplasty in treatment of distal humeral fracture in the elderly.

A total of 24 elderly patients who were diagnosed of distal humeral fracture and received Coorad-Morry prosthesis arthroplasty were retrospectively selected and analyzed from Beijing Jishuitan Hospital from 2003 to 2009.X ray examination of elbow joint and clinical evaluation were conducted in the follow-up; Mayo Elbow Performance Score (MEPS) was used in the last follow-up to evaluate patients' elbow function.

A total of 20 patients with intact follow-up information were included in the final analysis, with mean follow-up length 92 months (65-136), mean VAS score 0.8 (0-2), extension degree of elbow 25 (0-60)°, flexion degree 112 (80-135)°; Mean MEPS was 88.5, with 7 excellent, 8 good, and 1 fair.Two patients had severe heterotopic ossification, 3 patients had ulnar neuropathy, 2 of which were temporary.One patient had superficial infection, and 1 had aseptic loosening in the humeral part, but did not receive revision surgery.

Total elbow arthroplasty can successfully treat distal humeral fracture in the elderly and achieve satisfactory result which can last for a long time.

To compare the preliminary clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for lumbar disc herniation in the adolscents and further to summarize the clinical experience.

The data of 56 patients with single segment lumbar disc herniation who were adopted by our department from January 2011 to December 2013 were retrospectively studied.All patients were divided into 2 groups, including 30 patients undergoing PTED and 26 patients undergoing FD respectively.The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared.Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later.The visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes.

There were significant differences in the observation factors such as the skin incision length, amount of intraoperative bleeding, operation time and duration of hospitalization between the PTED and FD groups (P<0.05). After surgery, the patients in both groups were followed up for 12 months on average respectively.The postoperative lumbar disc degeneration in PTED group was decreased than that of in FD group.The postoperative VAS scores, ODI and JOA scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P<0.05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate (P>0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (P>0.05).

The preliminary clinical efficacy of both PTED and FD in the treatment of single segment lumbar disc herniation in the adolscents is satisfactory.However, PTED is a better minimally invasive surgical method with such advantages as less trauma, less blood loss, early function recovery, less effect on lumbar spinal stability and so on.The shortterm outcomes of PTED are similar to that of FD.

To evaluate the efficiency of the descending hypoglossal branch-facial nerve anastomosis for the severe facial palsy after acoustic neuroma resection.

The clinical data of 14 patients (6 males, 8 females, average age 45.6 years old) underwent descending hypoglossal branch-facial nerve anastomosis for treatment of unilateral facial palsy was analyzed retrospectively.All patients previously had undergone resection of a large acoustic neuroma. House-Brackmann (H-B) grading system was used to evaluate the pre-, post-operative and follow up facial nerve function status. 12 cases (85.7%) had long follow up, with an average follow-up period of 24.6 months.

6 patients had good outcome (H-B 2-3 grade); 5 patients had fair outcome (H-B 3-4 grade) and 1 patient had poor outcome (H-B 5 grade). Only 1 patient suffered hemitongue myoparalysis owing to the operation.

Descending hypoglossal branch-facial nerve anastomosis is effective for facial reanimation, and it has little impact on the function of chewing, swallowing and pronunciation of the patients compared with the traditional hypoglossal-facial nerve anastomosis.

To investigate the suitable fresh embryo transfer strategy for mild ovarian stimulation with clomiphene citrate in vitro fertilization-embryo transfer (IVF-ET).

The data of the 286 patients for IVF-ET from 1^st January, 2013 to 30^th June, 2015 in Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed to find the difference of clinical pregnancy rate in different endometrial thickness groups.

It had been described that clomiphene citrate had adverse effects on endometrium.Our data showed that these effects were decreased along with the increase of endometrial thickness.When the endometrial thickness reached 9 mm before embryo transfer, the clinical pregnancy rate for fresh embryo transfer was close to the regular ovarian stimulation protocol.

When the endometrial thickness reaches 9 mm before embryo transfer, fresh embryo transfer is suitable for patients undergoing mild ovarian stimulation with clomiphene citrate.

To investigate the efficacy of MSCs autografting with fibrin sealant could for the closure of cervical anastomotic fistula.

Twenty-one healthy New Zealand rabbits were involved and randomly assigned to treatment group (n=12) or control group (n=9). After the bone marrow were aspirated, the MSCs were isolated, purified and labelled by transfection of Lenti.GFP.The rabbit models of cervical esophageal anastomotic fistula were established by leaving a caliber rubber tube inside esophageal lumen.One week later, a 0.2 ml FS with 2×10⁶ GFP⁺ MSCs was employed to close the fistula for each animal in the treatment group, while the same procedure was performed without MSCs in the control group.MRI examination was performed to evaluate the closure of fistula after 5 weeks.All animals were killed and the esophageal tissues were collected 7 weeks later.Histology and immunohistochemistry study were performed.

The rabbit models of cervical anastomotic fistula were successfully established.There was no significant difference of fisutla caliber between both groups ((2.30±0.15) mm vs (2.20±0.17) mm, P<0.05), MRI exam revealed that there was only inflammation sign in the treatment group, by contrast, most of the rabbits were showed purulent infection sign which induced by persistent fistula in the control group.At the end of the study, the mortality of the treatment group and the control group were 3/12 and 5/9 (P=0.20). However, the closure rates of the fistula were 10/12 and 1/9, respectively, with significant difference between two groups (P=0.02). Histological study indicated that there was mild inflammation response and less collagen deposition for treatment group, compared to control group.Immunohistochemistry study further demonstrated that the autografted MSCs colonized to the fistula and differentiated into myofibroblasts.

Auto-transplantation of MSCs and FS can increase the closure rate of the cervical anastomotic fistula through the mechanisms of immunomodulatory, extracellular matrix reconstruction and anti-immigration effect of FS.

idiopathic pulmonary arterial hypertension (IPAH) is a progressive disease characterized by a progressive increase in pulmonary vascular resistance, which eventually leads to right heart failure and even death^[1]。 Jia Weibin et al.^[2]A study of 161 patients with IPAH in China showed a mean age of (33 ± 15) years, predominantly female (70.2%). The diagnostic criteria proposed by the World Health Organization (WHO) are: mean pulmonary artery pressure (MPAP)>25 mmHg (1 mmHg =0.133 kPa) at sea level at rest or MPAP>30 mmHg under exercise, pulmonary capillary wedge pressure (PCWP) Or left ventricular end-diastolic pressure (≤15 mmHg) and pulmonary vascular resistance>3 Wood units (1 kPa =0.125 Wood units) (the latter two are not included in the diagnostic criteria for general pulmonary hypertension).

Pituitary adenoma is a common benign tumor in the cranium, accounting for 10% ~25% of intracranial tumors^[1]。 Among them, non-functional pituitary adenomas account for about 30% of pituitary adenomas. Non-functioning pituitary adenomas are usually large in size, and transsphenoidal pituitary adenoma resection is currently the preferred treatment option for non-functioning pituitary adenomas. But the surgical resection rate is usually lower than that of other types of pituitary adenomas^[2]。 Postoperative radiotherapy can reduce the size of residual tumors in some patients, but it can cause complications such as hypopituitary function, optic neuropathy and cognitive dysfunction, and the results are not satisfactory^[3]。 Therefore, finding targeted drugs to inhibit tumor growth has important clinical significance for the clinical treatment of nonfunctional pituitary adenoma. PI3K/Akt/mTOR pathway is closely related to cell growth, differentiation and tumorigenesis. There have been many studies on targeting drugs for this pathway in nonfunctional pituitary adenomas. The current research status of PI3K/Akt/mTOR pathway in nonfunctional pituitary adenomas is summarized as follows.

The most common primary sites of bone metastases are lung, breast and prostate^[1]Bone metastasis suggests poor prognosis^[2]。 Bone-related events (SREs) such as pathological fractures, spinal cord compression, hypercalcemia and pain caused by the "vicious circle" of bone metastases seriously affect the quality of life of patients. Bone metastasis of malignant tumors is a sequential multi-step process, including the escape of tumor cells ("seeds") with bone metastasis ability from the primary tissue, survival activation, bone marrow homing and "seeding", dormancy, and invasion and activation after termination of dormancy. Bone marrow homing and "seeding", the "vicious circle" of bone destruction and/or bone formation after the termination of dormancy are unique processes of bone metastasis of malignant tumors. Each step of the cascade of tumor bone metastasis is rich in biological targets and metastatic pathways, which provides an opportunity for the prevention and treatment of tumor bone metastasis.