Evidence-based medicine(EBM) is a new medical model,which is an inevitable tendency of modern clinical education.This article analyses the advantages and disadvantages of the evidence-based medical education(EBME) and emphasizes the great significance of EBM in paediatrics teaching.

Objective To evaluate the performance of surgical approaches in the treatment of linear scleroderma of the head and face. Methods Forty-three patients with stable linear scleroderma of the head and face were included in this study. Surgical approaches, which included direct suture,skin flap translocation, soft-tissue augmentation and filling operation with dermal tissues, were selected and utilized alone or in combination according to the size, location and degree of atrophy and depression of lesions. Results After surgical treatment, wound dehiscence developed in one of these patients, but the wound healed after two sessions of suture. During one year of follow up, all the patients achieved favorite color, feeling and blood supply in the filling areas as well as good facial profile and visual appearance with no obvious convexity and concavity. Skin flaps matched well with surrounding tissues, incision lines were inconspicuous, and hairline looked naturally with well-distributed hairs in these patients after treatment. Patients were satisfied with treatment results. Conclusion Satisfied cosmetic outcomes can be achieved by using surgical approaches in patients with stable linear scleroderma of the head and face.

Objective To investigate ?-catenin and lymphoid enhancing factor 1 (LEF-1) expression in malignant melanoma. Methods ?-catenin and LEF-1 protein expression was examined using the PowerVisionTM immunohistochemical method in 25 cases of intradermal nevus and 45 cases of malignant melanoma. Results Comparing malignant melanoma with intradermal nevi, there was a significant difference in the expression of ?-catenin (33/45= 73% vs. 9/25 = 36%, respectively; P

Objective To investigate the inhibition of lymphoid enhancer factor-1 (LEF-1) expression in human malignant melanoma cell line A375 by RNA interference method. Methods Sense and antisense oligonucleotides with hairpin structures, targeted specifically at LEF-1 mRNA, were designed, synthesized, then linked to the expression vector psilencer3.1-H1 neo after annealing. After identification, the re-combinant psilencer3.1-H1/LEF-1 siRNA was used to transfect the cultured A375 cells by a liposome-medi-ated method. The cells expressing the recombinant RNA was detected by G418 screening. The mRNA and protein levels were detected by RT-PCR, Western blotting and immunocytochemistry, respectively. Results The expression vector psilencer3.1-H1/LEF-1 siRNA was successfully constructed, and its stable expression in cell clones was achieved. The mRNA and protein levels of LEF-1 were both down-regulated in the trans-fected cells. Conclusion The recombinant of psilencer3.1-HI/LEF-1 siRNA can inhibit the mRNA and protein expression of LEF-1 in A375 cells.

Objective To evaluate the efficacy and safety of endoscopy-assisted percutaneous interventional procedure with a 980-nm laser for the treatment of venous malformations.Methods A total of 167 patients with venous malformation were enrolled,including 102 females and 65 males,whose age ranged from 0.5 to 60 years.Skin lesions occurred on the limbs in 66 patients,on the head and face in 48,on the chest and abdomen in 24,on the back in 13,on the neck in 10,as well as on the scrotum in 6.A 980-nm laser operated at pulse width of 0 ms-2.5 s and pulse energy of 0-20 W with a 400 μm-diameter optical fiber.Puncture was performed after circular infiltration anesthesia around skin lesions,and then the optical fiber was inserted at the same puncture point to directly or indirectly destruct the vascular wall by photothermal effects and thermal coagulation.For deep lesions around important anatomical structures,the interventional therapy was performed with the assistance of endoscopy or ultrasound.According to the size and shape of tumors,these tumors were irradiated back and forth with speeds of 2 cm/s-4 cm/s.The optical fiber was also inserted in different directions in a fan-shaped pattern for 3-5 sessions until tumors were shrunken or even disappeared.The time interval between two treatments was 3 months,and all the patients were followed up for 4 months on average.Results Of the 167 patients,148 (88.6％)were cured,11 (6.6％) markedly improved,4(2.4％) improved,and 4(2.4％) unimproved.The response rate was 97.6％.Totally,159 patients were satisfied with the therapeutic effects after 1 session of treatment,and 8 were improved after 2 sessions of treatment with a time interval of 3 months.In addition,mild postoperative pigmentation occurred in 6 (3.6％) cases,and skin burns in 3 (1.8％) cases.After 3 months,the above symptoms were improved significantly.Two (1.2％) patients had vascular recanalization and residual lesions,but they were improved after reoperation.No adverse reactions were observed,such as bleeding,scar,tendon and nerve injuries,and dysfunction.Conclusion A 980-nm laser percutaneously delivered through an optical fiber is safe and effective for the treatment of venous malformation.

Objective:Investigated the effect of recombinant urease A subunit and catalase vaccines on protection against Helicobacter pylori (HP) infection Methods:Recombinant plasmids expressing UreA or KatA were constructed Expression was induced with IPTG,analyzed by SDS PAGE and Western blot UreA and KatA were purified with Bulk GST purification module Results:The recombinant plasmids could express GST UreA and GST KatA fusion proteins,which accounted for 35% and 19% of total bacteria proteins respectively,and could specially react with antibody against GST The purity of the purified UreA and KatA was over 95% Conclusion:The work laid a foundation for further studies of HP vaccine The recombinant vaccines may play an important role in preventing and treating HP infection and related diseases

Objective To observe the structure of cognitive injury and the effect of psychologic behavior training on cognitive function in community chronic schizophrenic patients. Methods80 healthy adults (control group) and 76 community chronic schizophrenia patients (research group) were assessed with World Health Organization-battery of cognitive assessment instrument for elderly (WHO-BCAI), mini-mental state examination (MMSE), and activities of daily living (ADL) pre- and post-psychologic behavior training. ResultsThere were significant differences in the scores of WHO-BCAI, MMSE, ADL between control group and research group (P<0.05 or P<0.01). 12 months after training, all the scores of research group significantly improved compared with that before training (P<0.05 or P<0.01). ConclusionCognitive disorders have occurred in the community chronic schizophrenia patients in wide range. Psychologic behavior training can improve their cognitive function.

Objective To explore the application of optical coherence tomography in vascular tissue engineering culture by dynamic monitoring its changes.Methods Human umbilical artery smooth muscle cells were isolated and culture by tissue block method.After passage culture and cell surface markers evaluation, smooth muscle cells were seeded onto polyglycolic acid scaffold and placed into the bioreactor based on Luo-Ye pump with pulsatile stress for three-dimensional culture.At 1、4、 7 、10、14、17、21 days in culture, the image data was obtained by optical coherence tomography technology.The ability of imaging TEBV via OCT was analyzed combined with histopathological observation.Results As the incubation time extended,OCT clearly showed PGA gradual degradation, decreased composite scaffold thickness and the wall structure from loose to tight.At 21 days in culture, the vessel mimics had smooth surface with extracellular matrix evenly distributed and achieved complete reconstruction in the PGA scaffold.Combining with histopathological staining, the blood vessel mimics were similar to natural blood vessels.OCT measured TEBV thickness compared with histopathological measurement had good correlation (r =0.922,P ＜ 0.05).Conclusion Optical coherence tomography could clearly image microstructures of tissue engineered blood vessels cultured in three-dimensional culture system based on Luo-Ye pump, delineate the reconstruction of TEBV-like tissue in the bioreactor and provide as a dynamic and convenient monitoring tool in vascular tissue engineering.

BACKGROUND: T-type or linear type external fixator is applied in transcervical fracture in the elderly. Because its fixing force is weak, so it is difficult to avoid the aggravation of complication due to long term lay up in severe osteoporosis. Based on this reason,percutaneous penetrating arch tri-claw external fixator is designed to treat elderly transcervical fracture with strong fixing force for the realization of early restoration to the active status before injury to reduce complication.OBJECTIVE:To design pereutaneous penetrating arch tri-claw external fixator for the treatment of elderly transcervical fracture for the investigation of its feasibility.DESIGN: A self-controlled study by employing patients as subjects.SETTING: Department of orthopedic surgery of the first affiliated hospital of a universityPARTICIPANTS: Thirty-one cases of elderly transcervical fracture including 18 males and 13 females aged between 71 and 86 years old with an average age of 79 years were admitted by the Department of Orthopedics of the First Affiliated Hospital of Nanhua University between December 2002 and June 2004.METHODS: Percutaneous penetrating arch tri-claw external fixator was applied in the treatment of 31 cases with elderly transcervical fracture for the observation of its clinical effects, and the force-bearing situation and stability of the external fixator during application were analyzed by theoretical mechanics.MAIN OUTCOME MEASURES: ① The functional effects of percutaneous penetrating arch tri-claw external fixator applied in the therapy of transcervical fracture(sub-femoral head type,transcervical type and femoral basilar type); 2② The force-bearing situation and the stability of the fixing point on the fixator; ③ The restoration of activity in hip joint and fracture union time RESULTS: ① Patients could sit and stand immediately after the applicationof the fixator, and its fixing reinforce was analyzed by theoretic mechanics during standing(the force on upper fixing point A, B or C was 1/22, 1/2 or 1/2 of the lower fixing point) . The unidirectional flexion and extension activity of the hip joint overcame hip-inversion and rotational disposition at the distal end of the fracture. The hip-joint axial compression board caused compact embedment and insertion of the fracture end and vertical crush to simulate fracture union by stability and compressive strain. ② The stability of percutaneous penetrating arch tri-claw external fixator: No disposition was found during the application except rotational disposition during activity in sub-femoral head type fracture. The fixation was stable, the operative trauma was less,and the operation was simple with good accommodation. No complication was found due to long-term lay up and no re-disposition due to the loosening of the external fixator was found. ③ The hip-joint flexion-extension function was restored within 7 days averagely and fracture healing time was about 2 to 3 months, average of 2.4 months.CONCLUSION: No re-injury is found dter the application of percutaneous penetrating arch tri-claw external fixator, which has small force bearing at upper fixing point with strong stability. There is strain stimulation on the cross section of the fracture to promote fracture healing. The articular function status before injury could be restored at early stage.

Objective To assess the dynamic changes of bacteria culture of patients with chronic suppurative otitis media (CSOM ) preoperative ,intraoperative ,and postoperative the mastoidectomy .Methods Secretions or tissues in 86 CSOM patients were collected for bacterial culture and drug sensitivity tests ,and analyzed the rusults between cholesteatoma group and nonchol-esteatoma group .Results Hospitalized CSOM patients with positive culture rates preoperatively ,intraoperatively and postopera-tively were 75 .6% ,41 .9% and 1 .2% respectively ;Before the mastoidectomy ,positive bacteria ,positive fungus and no pathogenic bacteria were found correspondingly 49 .1% ,25 .0% and 28 .6% of positive bacteria during the surgery .Culture positive rates be-tween the cholesteatoma group and noncholesteatoma group were significantly different intraoperatively (P<0 .05);while during in-traoperative samples ,no significant differences of positive rates were found between pyogenic fluids and tissues ,as well as tissues of mastoid tympanic antrum area and tympanic antrum entrance area (P>0 .05) .Different bacteria showed different drug sensitivity results .Conclusion Intraoperative bacteriological results shows the different bacteria and drug sensitivity from the preoperative bacteriological results ;CSOM patients with cholesteatoma are more likely to develop bacteria ;it is necessary to carry out dynamic detection on bacterial culture and drug sensitivity tests before ,during and after the surgery .