5 mm) had a significant influence on the frequency and distribution of cervical lymph node metastasis. The local recurrent rate in palpable lymph node group was significantly higher than the non-palpable lymph node group. Conclusions Careful palpation, B type ultrasonography, exploratory operation and frozen section are very important factors to heighten diagnosis of PTMC. We believe that PTMC could be divided into two subsets: with the former of non-aggressive behaviors treated by conservative surgery, and the later of a potentially aggressive clinical course treated by a more aggressive procedure.

Nissl stain and immunocytochemical methods were used to observe the structure of the subnuclei of interpeduncular nucleus in human neonatal brain and their localization of substance P-, leu enkephalin-, and serotonin (5-HT)-like immunoreactive elements. It was detected that the human neonatal interpeduncular nucleus could be divided into five subnuclei, including: the dorsal, dorsolateral, lateral, central, and intermediate subnuclei. The immunocytochemical results showed that the substance P-containing cell bodies and fibers or terminals were distributed chiefly in the dorsolateral, lateral subnuclei and the ventral part of the intermediate subnucleus; the enkephalin-containing cell bodies and fibers or terminals were concentrated in the central subnucleus; and meanwhile the serotonin-containing cell bodies and fibers or terminals were found mainly in the dorsal subnucleus.

Using immunohistochemical technique, the distribution and development of substance P (SP)-, L-enkephalin (L-Enk)- and serotonin (5-HT)-like immunoreactivity in Gudden's dorsal tegmental nucleus (GDTN) of human foetus (fetal age 11.5 to 35 weeks)and neonate (two days) were demonstrated. Gudden's dorsal tegmental nucleus in the human might be divided into pars centralis and pars peripheralis; and the time of initial appearance for SP-, L-Enk- and 5-HT-like immunoreactivity in GDTN was different. SP-like immunoreactive fibers and terminals appeared first and were distributed mainly in the pars centralis and their density was very high. L-Enk-like imunoreactive cells, fibers and terminals were distributed in the pars peripheralis. 5-HT-like immunoreactive cells, fibers and terminals were distributed in the medial part of the GDTN; As the foetus developed further, SP-, L-Enk- and 5-HT-like immunoreactivity in the GDTN showed their own special ontogenetic changes respectively

This paper is to introduce our experiences in treating 2 batches of 13 burn victims transferred from remote areas on postburn days 3 and 4. Methods Thirteen burn victims of 2 mass casualties were transferred to our burns institute from remote areas on postburn days 3 and 4 on June 27, 2001 and June 2, 2002, respectively. There were 4 males and 9 females, age ranged from 20 to 43 years, with a mean age of 31.1±6.2 years. The mean total burn area was 74.3%±24.7% TBSA (range, 25% to 97%). Among them, 10 patients suffered from serious burn with mean total burn area involving 86.0%±11.5% TBSA (range, 60% to 97%), and mean full-thickness burn of 63.9%±26.3% TBSA. Four patients also manifested signs of severe inhalation injury, and 6 patients with moderate inhalation injury. In three patients with mean total burn area covering 35.5%±10.0% TBSA (range, 25% to 45%), with mean full-thickness burn of 15.3%±5.0%, were al having moderate inhalation injuries. Among these 13 patients, 3 were having high body temperature (39℃), while 3 manifested hypothermia. The heart rate was 140-160/min, and respiratory rate 26 to 32/min in 6 patients. Abdominal distension or loss of bowel sound were found in 4 patients. Low white cell and platelet count were found in some patients. In 13 cases, liver function, renal function, myocardiac enzyme, and coagulation function were abnormal. Results Among 13 burn victims, one patient died of myocarditis on postburn day 29, and another one died of hepatic failure (history of chronic hepatitis B) on postburn day 45 with only 2% TBSA of burn wound remained open. Conclusion Burns victims occurred in mass casualties who were transferred from remote areas to our Burns Institute were all in critical condition, usually with multiple complications, demanding most meticulous care. Our strategies in this regard consisted of dispatch of experienced surgeons and nurses to the referring hospitals and the airport to receive the patients to offer appropriate care to them during the journey,organization of the medical staff so that each of them was ordained specific function, thus conditions of the patients were evaluated immediately and appropriate treatment started expeditiously for those lethal complications on arrival. Timely and exact comprehensive treatments were prerequisite to save the patients’ life. Adequate metabolic support should be emphasized, and coagulant of anticoagulant treatment should be carried out when indicated.

Objective To explore the Chinese culture oriented palliative care content for people with heart failure. Methods After a comprehensive literature review and expert interviews, two-round expert consultation was conducted to confirm the Chinese culture oriented palliative care content indicators for people with heart failure. Results A scientific literature review was performed and finally 102 articles were included.Totally 13 experts were interviewed and 525 meaning units were identified in the interviews.The Chinese culture oriented palliative care content for people with heart failure contained 4 first-grade indicators,10 second-grade indicators and 42 third-grade indicators.The expert′s enthusiasm of the two rounds of expert consultation were both 100%,the authoritative coefficient were 0.82 and 0.83, the coordination coefficient of Kendall′s W were 0.14 to 0.40 (P<0.01). Conclusions The Chinese culture oriented palliative care content for people with heart failure contributes to the development of new models for integrated heart failure care and palliative care which set with Chinese culture.

OBJECTIVE: To explore the relationship between extend types and distant metastasis of nasopharyngeal carcinoma (NPC). METHOD: Retrospective analyze 260 patients with nasopharyngeal carcinoma, among which 162 cases were distant metastasis (metastasis group) and 98 cases were neither distant metastasis nor recurrence (disease-free group) over 5 years after radiotherapy. All these patients were staged depending on CT or MRI image before treatment and divided into local-regional type(T(1-2)N(0-1)) for 36 cases and upward invasion type (T(3-4)N(0-1)) for 68 cases and downward invasion type (T(1-2)N(2-3)) for 75 cases and mixed type (T(3-4)N(2-3)) for 81 cases. The differences between two groups was analyzed using Chi-square test. RESULT: The local-regional type and upward invasion type was 25.3% for the metastasis group and 64.3% for the disease-free group. The downward and mixed invasion was 74.7% for the metastasis group and 35.7% for the disease-free group. The rate(proportion) of N(2-3) was significantly higher in metastasis group than in disease-free group with limited extension (84.4% vs. 33.3%, P < 0.01). The rates(proportion) of N(0-1) and N(2-3) were also significantly higher in metastasis group than in disease-free group with severity extension (T(3-4) (60% vs. 36.1% and 68.4% vs. 40%, P < 0.01). CONCLUSION The extent of cervical lymph node metastases is one of the most important factors of NPC with distant metastasis, severity extension of primary disease should also be in consideration. Even the limitations of primary disease, once cervical lymph node metastasis occurs, the risk of distant metastasis is significantly increased.
Adolescent ; Adult ; Aged ; Carcinoma ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; pathology ; Neck ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Young Adult

Objective: To summarize the measures and experience of treatment in mass extremely severe burn patients. Methods: The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment. Results: Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients. Conclusions Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.

OBJECTIVETo investigate the therapeutic effect of drug treatment for patients with sudden sensorineural hearing loss (SSNHL) accompanied with feeling of ear fullness (FEF).

METHODSA prospective clinical multicenter research was carried out from August 2007 to October 2011. SSNHL patients aged between 18 to 65 years old and accepted no medication were recruited, with a duration less than two weeks. The patients were divided into four types according to the hearing curve: type A was acute SSNHL in low tone frequencies, type B was acute SSNHL in high tone frequencies, type C was acute SSNHL in all frequencies, and type D was total deafness. Each type was subdivided into two groups by the accompaniment of SEF or not. And each type had four different treatment programs, based on the unified designed randomized table. All patients were followed up for four weeks from the initial examination.

RESULTSA total of 1 024 cases with single side SSNHL were recruited in the study from 33 hospitals in China, including 565 cases accompanied with FEF (55.18%), and 459 cases without FEF (44.82%). By classification of audiogram, 205 cases were type A (20.20%), of whom 122 were accompanied with FEF (59.51%); 141 cases belonged to type B (13.77%), of whom 74 were accompanied with FEF (52.48%); 402 cases were type C (39.25%), of whom 229 were accompanied with FEF (56.97%); and 276 cases were classified as type D (26.95%), of whom 140 were accompanied with FEF (50.72%). No significant difference was observed in total effective rate between the SSNHL patients accompanied with FEF or not in four acoustic types (P > 0.05). Among four acoustic types, the clinical cure rate of patients accompanied with FEF in type A was 93.44%, ranking the first; followed by 84.28% for type C; 75.71% for type D; and 70.27% for type B, respectively.

CONCLUSIONSThe therapeutic effect for patients accompanied with FEF in type A is satisfactory. The presence of FEF do not impact the therapeutic effect for SSNHL patients.

Adolescent ; Adult ; Aged ; China ; Hearing Loss, Sensorineural ; therapy ; Hearing Loss, Sudden ; therapy ; Hearing Tests ; Humans ; Middle Aged ; Prospective Studies ; Young Adult