Evidence-based practice advocated that clinical decisions should based on the most relevant and valid evidence. The medical postgraduates in our university were investigated with questionnaires about their influencing factors of the evidence-based practice. The countermeasures were found to improve the competence of evidence-based practice.

BACKGROUND: Whole body vibration which is used to prevent and treat osteoporosis recently is uncomfortable due to its strong vibration strength. The designed compound vibration with low vibration strength could effectively prevent bone quality decrease of ovariectomized rats. OBJECTIVE: To verify the effect of compound vibration with low vibration strength on the bone quality of ovariectomized rats. METHODS: A total of 32 4-month-old female SD rats were used in this study. All SD rats were randomly dlvided into 4 groups: normal control group, ovadectomized control group, vibration Ⅰ group (45 Hz-55 Hz, 0.05 g-0.1 g), and vibration Ⅱ group (45 Hz-55 Hz, 0.12 g-0.21 g), with8 rats for each group. The intervention to each vibration group was onea day, 20 minutes/tlmes and 5 days per week. The resting interval was shorted than 2 days, and the whole vibration intervention lasted 13 weeks. Bone mineral density (BMD) before and after vibration, ex vivo bone microstructure parameters and biomechanics parameters ware measured in this study. RESULTS AND CONCLUSION: Lumbar BMD of ovariectomized control group was decreased (P < 0.05), but the BMD in the normal control group and the two vibration groups was increased significantly. Femoral BMD of all groups was increased, but there was no significant difference among the four groups. Bone microstructure parameters of the three ovariectomized groups ware decreased; however, parameters including number, thickness and distance of bone trabecula and bone volume fraction in the vibration Ⅱ group were significantly improved compared to ovadactomized control group. Moreover, bone strength of lumbar vertebra in the two vibration groups was significantly increased (P=0.025, 0.006), but there was no significant difference compared to normal control group. Compound vibration with low strength could effectively prevent BMD decrease of ovadectomized rats, lighten the dagrea of bone microstructure damage, keep bone strength, improve bone quality of ovadectomized rats, and potentially prevent osteoporosis.

[Objective]To analyze the reasons and counter treatment of complication after prosthetic disc nucleus implantation.[Method]From Feb 2002 to Aug 2004,80 patients of lumbar disc herniation were implanted with one single PDN device at our centre.65 patients of them came to the clinical,functional,and radiographic follow-up examinations,magnetic resonance images and follow-up records of all patients were reviewed carefully.They were divided into three groups.Group A:30 cases had at least 24 months follow-up data.Group B:23 cases had at least 36 months follow-up data.Group C:12 cases had at least 48 months follow-up data.[Result]After implantation,device migrations were noticed in 3 patients.24 cases experienced low back pain.In 24~48 month follow-up,the MR images of 39 patients had shown the abnormal signal pattern of the endplate where PDN-solo was implanted,even 32 of them had been found subsidence.In Group A,the height of intervertebral disc at the 24 month follow-up was decreased 4%.In Group B,at 36 month follow-up,it was decreased 12%.In Group C,at 48 month follow-up,it was decreased 18%.[Conclusion]After follow-up,the clinical effect of PDN is preferred.However,the complications of device dislocation,device subsidence remain problems that must be highlighted.This study suggested that the complications of PDN are serious.Therefore,the proper selecting patients for PDN replacement are crucial for good results.The indications for PDN must be restricted.

Objective To investigate the early clinical efficacy of percutaneous kyphoplasty using the Sky Bone Expander system in the treatment of osteoporotic compression fractures. Methods Twelve cases of osteoporotic vertebral body compression fracture (17 vertebrae) underwent percutaneous kyphoplasty using the Sky Bone Expander system. During the operation the unipedicle technique was applied and the expansion height was 14 mm for bone cement injection. Surgical complications and the restoration of vertebral height and kyphosis angle were observed. The pain of thoracic and lumbar region on the back was evaluated with the visual analogue scale (VAS). Results The operative time for each vertebra was 52.4?28.7 min (range, 23～90 min), with a volume of 5.4?1.0 ml (range, 3.5～7 ml) of cement injected. A follow-up was made for 3～6 months (mean, 4.5 months). The VAS scores were 7.6?1.8 points preoperatively, 2.8?1.1 points at day 1, 2.6?1.2 points at day 3, and 2.2?1.0 points at last follow-up. Preoperatively, the anterior vertebral height was 13.8?5.3 mm (compression by 49.1%?19.1%) and the midline vertebral height was 9.9?4.6 mm (compression by 39.8%?18.4%), while postoperative anterior and midline vertebral height were 16.6?4.8 mm (compression by 59.1%?17.2%) and 15.2?4.0 mm (compression by 60.6%?16.9%), respectively. The kyphotic angle was decreased from 22.3??8.5? preoperatively to 12.5??6.4? postoperatively. Intervertebral disc leakage of bone cement was observed in 1 case with no symptoms. There were no other surgical complications. Conclusions Kyphoplasty using the Sky Bone Expander system is an effective and safe treatment for osteoprotic vertebral compression fractures. The long-term outcomes are subject to further observations.

Objective To analyze the related factors of surgical site infections after spine surgery so as to provide basis for clinical prevention. Methods We retrospectively reviewed the clinical data on 2,083 patients who had undergone spine surgery during the period of June 2010 to May 2013, and then conducted a statistica analysis. Results A total of 38 patients developed surgical site infections. The incidence of surgical site infections after spine surgery was 1.8%. 11 risk factors including gender, history of smoking, and history of prolonged uses of medications were related to surgical site infections The logistic regression analysis indicated that surgical site infections were more closely related to gender, length of hospital stay, and spine surgical invasiveness index. Conclusions Multiple factors can be attributed to surgical site infections after spine surgery. Gender , length of hospital stay, and spine surgical invasiveness index are the independent risk factors.

Objective To establish osteoblasts osteoclasts co culture system in vitro for the study of the biological characteristics of osteoblasts and osteoclasts and also to analyze the interactions between osteoblasts and osteoclasts. Methods The osteoblasts and osteoclasts were isolated from cancellous bone in illium. Osteoblasts osteoclasts co culture system was built to prevent these two kinds of cells from contact with each other although with the facility of their medium exchange. The osteogenety of osteoblasts was evaluated by MTT and ALP activity; the resorption activity of osteoclasts was investigated by TRAP activity and the area of absorption lacuna. Results Osteoblasts are full fusiform, ALP stain positive cells, while osteoclasts are multinuclear and TRAP stain positive, with the ability of forming bone lacuna; while in the co culture system, the proliferation of osteoblasts in co culture (0.60?0.08)OD is quicker(P=0.000)than that in mono culture (0.36?0.03)OD, and the ALP activity increased significantly (P=0.000)from (18.33?0.34)u/mg to (23.37?2.48) u/mg; while the average area of bone resorption formed by osteoclasts [(6.55?0.34)?10-2] ?m2 was also increased obviously(P=0.000)from [(5.15?0.17)?10-2] ?m2. Conclusion In co culture system, osteoclasts were able to enhance ossification effects of osteoblasts by accelerating their proliferation and differentiation; at the same time, osteoblasts upregulated the ability of bone resorption of osteoclasts. This implied that osteoblasts and osteoclasts can promote each others function. This study provide reliable model for bone metabolism research.

[Objective]To study the degradation of nano-nacre powder and the biocompatibility of the composite artificial bone made from this nano-scale powder in vivo.[Method]The nano-nacre powder made through mechanical grinding and the artificial bones made from this powder and PDLLA(poly-D,L-lactide acid) were implanted into the femoral holes and the femoral muscle sacs of rats respectively.Normal micron-nacre powder and the artificial bones made from this powder and PDLLA were implanted as control group,and blank group was set up without implanting anything.X-ray photography was performed immediately and at 2,4 and 8 weeks after operation.The animals were injected with tetracycline for fluorescent mark before being killed.Then,the gross specimens,histological and SEM(scanning electron microscope) observations were performed.[Result]All the observations showed that nano-nacre powder degraded faster than micron-nacre powder,meanwhile,the bone defect recovery was the fastest in this group.Both of the composite artificial bones made from those two kinds of nacre powder had the good connection with the adjacent tissue.[Conclusion]The degradation of nano-nacre powder is faster than that of micron-nacre powder in vivo,and it can promote the growing of new bone.Nano-nacre composite artificial bone also has good biocompatibility.It is a kind of better bioactive degradable material.

Objective To discuss the selection of surgical procedures for the treatment of spinal tu-berculosis according to the status of segmental stability of the spine. Methods One hundred adult patients with spinal tuberculosis were treated surgically between January 1998 and December 2003. There were 57 males and 43 females with an average age of 39.4 years and an average history of 16 months. The lesion ranged from T2 to S 2, and involved single vertebral body in 3 cases, double vertebral bodies in 66 cases, and more than two vertebral bodies in 31 cases. Of 100 cases, 32 were with neurological dysfunctions, and 65 were accompanied by kyphotic deformity with an average Cobb angels of 36.4? (20? to 48?). Preoperative chemotherapy of four drugs lasted more than two weeks. Three surgical procedures were performed according to the status of segmental stability of the spine: 12 cases without spine instability underwent single debride-ment, 8 cases of spine instability with debridement and interbody fusion, and 80 cases of significant insta-bility with debridement, fusion and internal fixation. Results All patients' incision healed without chronic infection and sinus formation. 95 patients were followed up with an average of 2.9 years ranged 1 to 77 years except 5 patients lost at follow up. 68 cases with anterior fusion achieved solid fusion in average 3.5 months. 65 cases with kyphotic deformity had an average correction of 20.2? postoperatively, and 2? to 4? loss during follow-up. 32 cases with neurological deficits had an improvement of neurological function postoperatively. One patient of L 4,5 tuberculosis treated with anterior debridement, fusion and instrumentation recurred at 7 months due to an inadequate postoperative chemotherapy of 6 months, and healed with a continuous chemotherapy for 18 months, However, satisfactory clinical results were obtained in other patients without any recurrence. A left external iliac vein was torn and repaired successfully in 1 case. Conclusion The maintenance of segmental stability has significant effect in the surgical treatment of spinal tuberculosis. Sta-tus of segmental stability of each patient should be evaluated preoperatively. Satisfactory clinical results can be achieved by proper selection of the surgical procedure according to the status of segmental stability.

[Objective]To study the biocompatibility of nacre on cultured human osteoblasts in vitro.[Method]The iliac bone of human were added with collagenase-trypsin,a lot of osteoblasts were released out.Then the osteoblasts were purified and cultured.Subsequently,the 3rd generation cultured human osteoblasts were inoculated with the extract of three materials:nacre,hydroxyapatite,and rubber.The appearance of osteoblast was observed under the phase contrast microscope.Microstructure of the osteoblast was observed under transmission electron microscope.Additionally,to determine whether these three materials affect cell proliferation,the numbers of BrdU-labeled cells were examined at three groups.MTT assay was tested to observe the viability of human osteoblasts.[Result]Under the phase contrast microscope,the appearance of the osteoblasts in two groups were spindle or triangle like,and black nodes were seen in confluent cell layer 19 days after cultured.The observation of electron microscopy showed that the nucleus of the osteoblasts in two groups were big and round,and there were a large number of mitochondrion and rough endoplasmic reticulum in two groups.Stereological analyses of the numbers of BrdU-labeled cells revealed that females produced more cells than males in the dentate gyrus but not in the subventricular zone.[Conclusion]The nacre have no harmful effect to character of biology of human osteoblasts in vitro.

Inflammatory bowel disease ( IBD ) is a group of chronic non-specific inflammatory conditions of the intestine with unknown etiology.IBD has variety of intestinal manifestations and complications and there is lack of gold standard for diagnosis, so the disease should be diagnosed on the basis of clinical manifestations, endoscopic findings and histopathological examination.Most patients require surgical treatment and long-term maintenance of medication.Multi-disciplinary team (MDT), consisting of gastroenterologist, general surgeon, anorectal surgeon, nutritionist and psychologist, is needed for individualized treatment of patients.This article introduces the MDT model of diagnosis and treatment, and its application in inflammatory bowel disease.