Objective To discuss the effect of applying evidence-based medicine (EBM) in orthopedic clinical teaching for eight-year program medical students in military medical university. Methods Totally 50 eight-year medical students in Shanghai Changzheng Hospital were equally divided into two groups:experimental group(EBM teaching group) and control group. The teacher of experimental group selected appropriate cases and set up the questions according to the difficulties encountered in clinical situation. Students retrieved the relevant medical literature and found out the most useful information for EBM system analysis. The results combined with the current cases were discussed. The teachers summarized clinical experiences and data according to the relevant depart-ment. Traditional direct infusion teaching mode was used in control group. Clinical work experiences were used to guide the students . After-department examination was conducted for both group after finishing the internship and questionnaire investigation was made among students in experiment group. Statistical analysis was carried out on the examination results with SPSS 17.0 software. Mea-surement data were expressed as x±s and comparison on mean differences between two groups was analyzed by t test. Results Average scores of subjective topic and military related topic in the theory exam were higher in experimental group than in traditional teaching group, with statistically significant differences(P<0.001). Excellent rate was 80%(20/25) in case discussion in experimental group and 60%(15/25) in control group. Experimental investigation questionnaire showed that: students got enhanced in learning initiative and broadened knowledge. 96%(24/25) students strengthened the learn-ing efficiency of military related chapters. 88%(22/25) students accepted this method and expected to continue. Conclusions Using the method of evidence-based medicine in eight-year program medical students in military medical university can cultivate the spirit of the stu-dents' self-study actively and rigorous earnest attitude. Students can grasp learning methods and sci-entific thinking. It also can strengthen students' awareness of military medicine and research.

Objective To assess the value of ultrasonography in distinguishing pharyngoesophageal diverticulum from thyroid nodule.Methods High-frequency sonography was used to detect the size,shape, echo and blood flow of cervix masses in 1219 patients in a lateral decubitus position after drinking water. Results On enhanced power,the image changing rates of pharyngcesophageal diverticulum and thyroid nodule were 71.43% and 14.19% respectively,and their difference was statistically significant(P<0.05). On drinking water,the image change rates of pharyngoesophageal diverticulum and thymid nodule were 100.00% and 1.98% respectively,and their difference was statisfically significant(P<0.05).The detection rates for pharyngoesophageal diverticulum and thyroid nodule were 0.098% and 17.042% respectively. Conclusions Ultrasound examination is of value in distinguishing pharyngoesophageal diverticulum from thyroid nodule in general health check up and regular health examination.

Objective To investigate the effects of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF)on the gingival wound healing, and to lay a foundation for its application in the field of oral cavity.Methods 16 healthy rabbits were randomly divided into experiment and control groups(n=8).2 mm upper and lower incisors’labial gingivae were removed by scalpel. After operation, rhGM-CSF gel was applied to the surface of the wound gum in experiment group,while saline instead of drugs to the control group.2 rabbits were executed at 3,7,11,and 15 d after operation.HE staining was performed to observe the epithelium and epithelial connective tissue structure, distribution, and the changes of various cells of the rats;the number of positive epithelial cells and fibroblasts were observed by PCNA dyeing.Results On the 3rd day,the inflammatory cell infiltration was found in two groups, but a greater number of the cells were observed in experiment group;neovascularization was seen in both groups on the 7th day,and the fibroblasts and collagen fibers were observed too,but the extent of neovascularization in experiment group was more significant. On the 11th day, the fibroblasts proliferation was seen in two groups,but the extent in experiment group was more widely;on the 15th day,the trauma of gingivae of the rabbits in two groups returned to normal,there was no significant difference between two groups.Over time,the number of epithelial cells in proliferation was gradually increased,reached the peak on the 15th day.The number of fibroblasts began to increase from the 3rd day and reached the peak on the 11th day,and significantly reduced to the lowest value on the 15th day.The number of proliferative epithelial cells in experiment group was significantly higher (P<0.01)on the 3rd day and the 11th day than those in control group (P<0.01);the number of proliferative fibroblasts was significantly higher (P<0.05)on the 11th day and the 15th day than those in control group (P<0.05 ), but there were no significantly statistical differences between two groups at other time pionts(P>0.05).Conclusion RhGM-CSF can promote the infiltration of inflammatory cells, angiogenesis,proliferation of epithelial cells and fibroblasts in gingivae. RhGM-CSF is beneficial with wound healing on gum tissue.

Objective To evaluate neurofunctional and radiographic results of transpedicular screw fixation reduction and anterior column fixation with use of screw-red system in treatment of multiple segment lumbar pedicle and vertebral body fractures combined with spondylolisthesis. Methods A consecutive series of 12 patients with unstable multiple segment lumbar pedicle fracture, vertebral body fracture, spondylolisthesis and neurologic deficit were managed with posterior transpedicular screw fixation including fractured pedicle and anterior screw-rod fixation instrumentation from January 2002 to December 2007. Results Patients were followed up for 24-30 months (mean 26 months). All the patients with incomplete neurologic deficits got improvement by at least one Frankel grade. Transpedicular screw brought satisfactory reduction. At the time of the latest follow-up, no screw breakage occurred. Con-clusions Excellent reduction of unstable multiple segment lumbar pedicle fractures combined with spon-dylolisthesis can attain better reduction and maintenance by means of selective pedicle screw fixation via fractured pedicle and anterior screw-rod instrument.

Objective To explore the use of Swedish medical company CMS 4.6.4 radiotherapy XIO system for the design process of cervical cancer postoperative IMRT plans in different iterative times of the same case,and to observe the Segment Weight Optimization(SWO)effect generated after the plan results.Methods Ten cases of cervical cancer patients were chosen ,the use of XIO 4.6.4 CMS treatment system was performed for the development of the intensity modulated radiation therapy .In the SWO process , iterative times were used to generate different plans ,without affecting the clinical dose target area requirements , and compared the organs at risk( OAR) by determining whether there were differences between dose and the number of segments ,monitor units (MU).Results For the same patients,different iterative times within a certain range of SWO IMRT plan were selected to compare the different iterative times plan ,femoral head,rectum and the bladder dose did not change the basic plan.The total number of segments and MU did not change significantly (P>0.05).Conclusion IM-RT plans in the use of CMS XIO 4.6.4 design of cervical cancer after operation in the process of using the itera-tive times below 100 times for SWO is the most suitable method for ensuring the organ dosimetry in radiotherapy . The total number of segments and the MU reduces the radiotherapy plan time so as to improve work efficiency .

Objective To summarize the clinical experience of one stage hybrid operation for aortic arch replacement and explore the indication. Methods From July,2009 to March,2010, 22 consecutive patients received one stage hybrid operation in our hybrid suite for aortic dissection or aortic aneurysm involving aortic arch. Two operative methods are used. (1)Bypass from ascending aorta to brachiocephalic arteries using midstemotomy and normothermia with antegrade aortic arch endovascular stented graft implantation. (2) Ascending aorta replacement and/or aortic valve replacement and/or coronary artery bypass grafting using midstemotomy and cardiopulmonary bypass with antegrade aortic arch endovascular stented graft implantation. Results All patients were technically successful. Angiography during the operation showed 100% patency of all the bypass grafts and no obvious translocation or endoleak of the stents. One patient in the first group died on sixth day after operation due to distal dissection rupture. There was one case of mediastinal lymph effusion in the second group and one case of death due to renal failure and respiratory failure 12 days after operation in the second group. The ICU stay and hospital stay were obviously shorter in hybrid open chest group than that in traditional open chest operation group(P ＜0.05). The blood product consumption and expenditure were also obviously less in hybrid open chest group than that in traditional open chest operation group (P ＜0.05). All the patients were followed up with a mean period of (14.45 ±2.33) months (range: 12 -20 months). All other patients were recovered with normal social life. CT showed neither endoleak nor translocation of the stented grafts. Faulse lumen closure rate at stented-graft segment is 100%. There was no obvious change of distal part of the dissection three months after operation except some thrombosis formation in some of the false lumen. Conclusion One stage hybrid operation for aortic arch replacement is safe and effective in shortening the duration of the operation and reducing the surgical trauma and risk of interval between procedures, shortening the hospital stay and reducing the blood product consumption compared with conventional operation with satisfactory early results. The midterm and long term results are still needed to be followed up.

Objective To investigate the clinical outcomes using posterior percutaneous endoscopic cervical discectomy (PECD) for single level cervical spondylotic radiculopathy (CSR).Methods From October 2015 to June 2016,33 patients (23 men,10 women,mean age 54.0 years,range from 30 to 85 years) who had single level CSR were treated by PECD,and the medical records were reviewed.All patients were followed up for an average of 13.5±4.6 months (range from 12 to 22 months).The operation related parameters (operation time,estimated blood loss,length of hospitalization,complications) and clinical parameters,including neck visual analog scale (Neck-VAS),ann visual analog scale (Arm-VAS),neck disability index (NDI) and the modified Macnab criteria were assessed at 3,6,and 12 months postoperatively and last follow-up.Disc height,shell angle,C2-C7 Cobb angle and range of motion were recorded preoperatively and at 3 months,6 months,12 months and last follow-up postoperatively.Results The mean operation time was 76.4±26.6 minutes (range from 40 to 120 minutes),the mean estimated blood loss was 30.2±15.6 ml (range from 20 to 80 ml),and the mean length of hospitalization was 3.5± 1.1 days (range from 2 to 8 days).There was significant decrease at different time points postoperatively in Neck-VAS,Arm-VAS,and NDI when compared with preoperatively (P＜ 0.05).According to the modified Macnab criteria,there was excellent concordance in 20 patients (60.6％),good in 7 patients (21.2％) and fair in 6 patients (18.2％) at the last follow-up.The disc height was significantly decreased at postoperative 3 months and 1 year compared with at preoperative (F=95.1,P＜0.01).The shell angle of index level (F=35.4.,P＜0.01),upper adjacent level (F=30.1,P＜0.01),lower adjacent level (F=1 1.7,P＜0.01) as well as spinal function units (F=22.2,P＜0.01) were increased significantly at postoperative compared with at preoperative.The range of motion of index level (F=8.1,P＜0.01) and upper adjacent level (F=64.0,P＜0.01) increased significantly at postoperative compared with at preoperative.The range of motion in lower adjacent level (F=1.5,P=0.23),spine functional unit of index level (F=2.9,P=0.06),as well as C2-C7 (F=0.6,P=0.56) had no significant difference between preoperative and postoperative 1 year (P＞0.05).One patient turned into traditional ACDF procedure because of hemorrhage limiting the vision during PECD operation.Upper extremity numbness and pain deteriorated in one case after a PECD procedure and was revised with ACDF at last.No other complications,like spinal cord injury,cervical root injury,cerebral spinal fluid leakage,infection as well as recurrence were found.Conclusion PECD,which can maintain normal cervical range of motion and intervertebral disc height,is a minimally invasive and essential procedure for CSR treatment with minor trauma,excellent outcome and quick recovery.Surgeon's experience,however,is needed in case of turning into open surgery for good outcome.