Because of lots of ethical problems,military medical triage has been unaccepted by general doctors.But it's adopted by American Army in front of facts of the war.The main principles of the military medical triage are justice and efficiency.They practice the military medical triage through tow steps.First,all patients are assigned into urgent,immediate ,delayed,minimal or ambulatory and expectant status in decreasing order of medical urgency.Second,choosing the model of triage depends on nonaustere,austere or extreme conditions.The ethical issues of American military medical triage focus on four aspects - how to deal with minimally injured patient treatment first,how to treat expectants,how to care for noncombatant casualties and who decide the model of triage.

OBJECTIVE:To determine the concentration of pseudoephedrine hydrochloride in human plasma by LC/MS. METHODS:The separation of sample was performed on Zorbax Eclipse XDB C18 with diphenhydramine used as the internal standard.The mobile phase was a mixture of methanol-water(10mmol?L-1 NH4Ac plus 0.1% acetic acid)(55∶45) with a flow rate of 0.2mL?min-1.The column temperature was set at 30℃.The atmospheric pressure chemical ionization-mass spectrometry(APCI-MS) were adopted with pseudoephedrine m/z =166.1 and diphenhydramine m/z =242.3.RESULTS:The linear concentration range for pseudoephedrine was 3.2～408.96ng?mL-1(r=0.999 0) with lowest detection limit at 3.2ng?mL-1.The average recovery was 98.21% with both the intra-day RSD and the inter-day RSD at less than 13%.The stability of pseudoephedrine was stable.CONCLUSION:The method is of high sensibility and accuracy,and it can be used for blood concentration monitoring pharmacokinetic study of pseudoephedrine.

Objective To analyze diagnostic experience of children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and assess its surgical results.Methods Six children with ALCAPA had been diagnosed in our hospital from Mar. 2006 to Oct.2007 aged from 6 months to 10 years old(median 43.5 months).The medical data included common clinical presentations,the findings of electrocardiogram(ECG),the echocardiogram,ECG-gated 64-slice computed tomography,the digital subtraction angiogram (DSA),surgical records and the outcome.Results Diaphoresis,fantod,breathlessness and difficult feeding were commonly presented in 5 cases ALCAPA and the 5 children presented with left ventricular failure in infancy.The predominant ECG findings were Q waves and ST segment changes in the anterolateral chest leads in 4 cases,ST changes in 1 case,and normal ECG in 1 case.Cross-sectional echocardiography showed dilated left ventricles with poor contractility in 4 cases,medium mitral regurgitation in 2 cases and severe mitral regurgitation in 2 cases,aneurysmal dilatation of the right coronary artery(RCA) in 2 cases.CT and DSA examinations showed characteristic changes in these children.The surgical reestablishment of a two-coronary system was performed in 5 cases,direct reimplantation in 2 cases and creation of an autologous extrapulmonary tunnel in 3 cases.Simultaneous mitral annuloplasty was performed in 2 cases.After operation,the symptoms of 5 cases were all improved and none died.Conclusions Understanding the clinical manifestations and lab findings of ALCAPA is helpful to making an early diagnosis of ALCAPA.Early surgical treatment can improve the patients′ outcome.

Aphasia is an important cause of declining the living level, and the diagnosis and rehabilitation of aphasia depends on knowledge about the structure of brain and the process of language cognitive. The authors reviewed some correlative factors of recovery from aphasia, language areas recombine after stroke and the criterion of judgement prognosis, and tried to offer some theory guidance to aphasia patient for their rehabilitation.

Objective To observe the impact of intrauterine hypoxia on the development of rat lungs and expression of vascular endothelial growth factor (VEGF) in the lungs as the time of hypoxia was extended.Methods To create a model of intrauterine hypoxia,12 pregnant rats were divided into four groups as follows:air-control group,hypoxic 2-day group,hypoxic 6-day group,and hypoxic 10-day group.At birth,we performed pulmonary vascular morphometry in newborn rats with Nis software,and measured pulmonary arterial diameter,wall thickness and wall thickness/pulmonary arterial diameter.We detected expression of VEGF protein by immunohistochemistry and mRNA by real-time polymerase chain reaction.Changes in pulmonary capillary endothelium under electron microscope were observed.One-way analysis of variance and the Student Newman Keuls q (SNK-q) test were applied for statistical analysis.Results As the hypoxic time was extended,wall thickness and wall thickness/pulmonary arterial diameter increased.Compared with the air-control group,pulmonary vascular wall thickness in the hypoxic 10-day group increased [(16.4 ± 5.9) vs (10.8±2.8) μm; q=-8.04,P＜0.05].Wall thickncss/pulmonary artcrial diameter in the hypoxic 10-day group increased compared with that in the air control group,hypoxic 2-day group and hypoxic 6-day group [(31.3±5.1) ％,(22.2±4.9) ％and (23.6±3.9) ％vs (24.1±3.9) ％;q=-7.08,-4.92 and-5.0,all P＜0.05].Expression of VEGF protein in the lungs increased in the hypoxic 6-day group compared with the air-control group [(13.7±3.9) ％ vs (9.3±3.5) ％; q=-6.83,P＜0.05],while the expression was higher in hypoxic 10-day group than in the air-control group and hypoxic 2-day group [(15.2±4.7) ％,(9.3±3.5) ％ vs (11.8 ± 3.3) ％] (q=-9.16 and-5.19,all P＜0.05).Expression of VEGF mRNA in the lungs increased in the hypoxic 6-day group compared with the air-control group [(1.6±0.2)vs (0.8 ±0.2); q=-5.07,P＜0.05],while the expression was higher in the hypoxic 10 day group than in the air-control group and hypoxic 2-day group [(2.2±0.3),(0.8±0.2) vs (1.3±0.2)] (q=-9.54 and-6.42,all P＜0.05).Electron microscopy showed puhnonary capillary endothelial cell swelling as the hypoxic time was extended.In the air-control group,there was no capillary endothelial cell hyperplasia and swelling; in hypoxic 2-day group,there was mild swelling of the capillary endothelial cells and a small amount of hyperplasia; in hypoxic 6-day group,there was moderate swelling of the capillary endothelial cells; and in hypoxic 10-day group:there was significant swelling of the capillary endothelial cells,and pyknosis.Conclusions Intrauterine hypoxia resulted in higher expression of VEGF protcin and mRNA.VEGF in the lungs of newborn rats was involved in the vascular development process.

Objective To explore the value of multislice spiral computed tomography ( MSCT ) in predicting the resectability of pancreatic cancer ( PC) .Methods The MSCT images of 102 PC patients ( 62 men, mean age, 61 ±9 years;40 women, mean age, 60 ±9 years) confirmed by postoperative pathology were analyzed retrospectively .The images were analyzed and evaluated by 2 senior radiologists who were double blinded.The relationship between tumor and vessels was investigated based on consensus statement on the radiological diagnosis of PC of the Society of Abdominal Radiology and the American Pancreatic Association in 2014 .The diagnostic criterion on the resectability of PC was based on the 2015 NCCN Clinical Practice Guidelines on PC . Image analysis included the lesion location , size and density , the characteristics of pancreatic and bile ducts , relationship of tumor and adjacent vessels , the extrapancreatic findings as well as T staging and resectability.Results The locations of PC were found in the pancreatic head (n=71,69.6%), body (n=23, 22.5%) and tail (n=8, 7.8%).The long-and short-axis diameter were (28.9 ±8.8)mm and (23.8 ±8.0)mm in head, and respectively, (31.2 ±11.0)mm and (23.8 ±6.3)mm in body and tail, respectively.The imaging findings included hypo-(n=98, 96.1%) and iso-density masses (n=4, 3.9%) on pancreatic phase, intra-and extrahepatic bile duct dilation (n=63, 61.8%), main pancreatic duct cut-off with dilation (n=46, 45.1%), the pseudocyst (n=4), acute pancreatitis (n=1) and chronic pancreatitis (n=2).T staging evaluation by MSCT observed T1 (n=3), T2 (n=7), T3 (n=78) and T4 (n=14), respectively.MSCT assessment for T staging was correct in 98 (96.1%), but wrong in 4 (3.9%), which was quite consistent with pathological T staging (K=0.88, P<0.05).MSCT assessment for the resectability was correct in 98 (96.1%), but wrong in 4 (3.9%).Sensitivity, specificity, positive and negative predictive values, and area under curve of MSCT in the assessment of the resectability were 96.8%, 87.5%, 98.9%, 70.0%and 92.2%, respectively.Conclusions MSCT could improve the diagnostic accuracy for T Staging and resectability of PC .

Purpose To investigate the correlation between BRAF V600E mutation and clinicopathologic parameters in bilateral welldifferentiated thyroid carcinoma.Method Collected 80 patients with papillary thyoid carcinoma (PTC) (67 patients with classical type,8 patients with follicular variant,3 patients with oncocytic variant,2 patients with tall cell variant),5 patients with follicular carcinoma and 30 normal tissues near the tumor,BRAF V600E mutation was detected via polymerase chain reaction.Result The presence of BRAF V600E mutation was found in 52 patients with PTC (65.0％),the mutation was not in the 5 patients with ollicular carcinoma as well as in the 30 normal tissues near the tumor.The BRAF V600E mutation was positively correlated with age,capsule invasion,lymph node metastasis,tumor clinical stage.In the histological variant of PTC,the BRAF V600E mutation rate of classical type and tall cell variant is very high (70.1％,100.0％),but the BRAF V600E mutation rate of follicular variant is very low (33.3％).Conclusion The BRAF V600E mutation rates are different in different age groups.The BRAF V600E mutation was positively correlated with capsule invasion,lymph node metastasis,tumor clinical stage.The BRAF V600E mutation rate of classical type and tall cell variant is very higher than follicular variant.

[Objective]To analyze the clinical features and related risk factors in diabetic retinopathy(DR)and diabetic periph?eral neuropathy(DPN),the two micro-peripheral vascular diseases in newly diagnosed type 2 diabetes mellitus.[Methods]A retro?spective study of 211 cases of newly diagnosed type 2 diabetes mellitus inpatient from 2009 to 2012 ,and compare the two micro-peripheral vascular complications.[Results]The morbidity of DPN was(33.6%),which was higher than that of DR,some cases of DR co-existed with DPN,DR was related with DPN(r=0.158,P=0.020). Age and systolic blood pressure were the common risk factors in DR and DPN by single factor analysis.[Conclusion]It should be paid attention to the screening of both DR and DPN in each age group in newly diagnosed type 2 diabetes mellitus. Except for the control of blood glucose ,the control of the systolic blood pressure is important in the prevention and treatment in the two micro-peripheral vascular diseases.

Objective To assess the effect and influencing factors on 131I treatment for cervical lymph node metastasis (LNM) after operation in patients with PTC.Methods PTC patients (n =117;45 males,72 females;average age (45.17± 15.50) years) with postoperative cervical LNM from January 2010 to December 2014 were analyzed retrospectively.LNM was diagnosed by surgical pathology,imaging results and clinical follow-up.Single factor analysis was performed in age,gender,operation mode,TNM stage,131I treatment time and other factors.The results for 131I treatment effect included CR,PR,NC.Two-sample t test and x2 test were used.Results Among the 117 PTC patients with postoperative LNM,53 (45.3％) cases had non-131 I-avid metastasis.Fifty of the 64 (54.7％) patients with 131I-avid metastasis were treated with 131I.Nineteen patients (38.0％) achieved CR,22 (44.0％) achieved PR,and 9 (18.0％) showed invalid results.Fourteen of the 64 patients underwent another cervical lymph node dissection.Nine patients achieved CR,5 patients achieved PR,and 4 PR patients were then treated with 131I and finally achieved CR.Single factor analysis showed that the influencing factors of non-131I-avid lymph node included patients' age (t =3.459),serum Tg level (x2 =6.698) and metastasis with 1s F-FDG uptake (x2 =26.928;all P＜0.05).The influencing factors of 131I treatment effect included lymph node dissection procedure (x2 =6.487),unilateral or bilateral lesion (x2=5.187) and LNM size (x2=8.099;all P＜0.05).Conclusions 131I treatment is ineffective for nearly 50％ of patients with non-131I-avid LNM.The influencing factors of 131I treatment effect include the lymph node dissection procedure,unilateral or bilateral lesions and LNM size.

The degree of satisfaction of the curriculum is related not only to the degree of the curriculum but also to the degree of the students' development. With the concept of teaching reform micro system engineering, using the SIMPP analysis of the degree of satisfaction of the curriculum, the relevant factors of the students are studied. The results show that, the learning state, learning objec-tives, and the education level of mother affect the students more easily on the curriculum satisfaction. Research shows, in the present curriculum condition, educators should guide the students to study hard, establish a clear and reasonable learning goal, give the students the introduction and analysis of the curriculum, can effectively improve the students on the curriculum satisfaction, enhance the enthusiasm of the study.