Burn surgery belongs to disaster medicine. Burn is a common trauma that occurs in social activities of human beings in all ages, either in the time of peace or war. During the development of human medicine in modern times, the summary of experience in treating massive burn casualties due to severe fire accidents has effectively promoted the renovation of treating technology and theory of burns and the development of burn surgery. The results of treatment of burn injury in casualties occurred in the fire of Cocoanut Grove night club in Boston in 1942, and the high-rise apartment house fire in Shanghai in 2010 were summarized and analyzed in this article, emphasizing the correlating issues of inhalation injury.
Burns ; therapy ; Burns, Inhalation ; therapy ; Disaster Medicine ; Disaster Planning ; Fires ; Humans

Objective To analyze the outcomes of the surgery repair for total anomalous pulmonary venous connection(TAPVC),and to investigate the risk factors which influence the mortality of the operation.Methods Comparative analysis was performed in the children with TAPVC who were treated operatively from Sep.2001 to Sep.2011 in the Third Affiliated Hospital of Zhengzhou University,Henan Diagnosis & Treatment Center of Congenital Heart Disease.The children included 37 male and 20 female,aged from 15 days to 6.5 years[(4.27 ± 8.63) months],with body weight 4.0-21.0 (6.33 ± 2.70) kg,and the clinical records in hospital including echocardiogram operation records were collected.The clinical data including the age on operation,body weight,diagnosis,anatomic type of TAPVC,the emergency event before operation,cardiopulmonary bypass time,aortic crossclamping time,were analyzed by chisquared test and Logistic multivariable regression analysis.The risk factors influencing the early mortality of TAPVC were analyzed.Results Fifty-seven children underwent the operation,and 7 (12.2％)cases died during the operation.The univariate analysis on outcomes indicated that the risk factors influencing the mortality of the operation included body weight(P =0.035),anatomic type of TAPVC (P =0.037),the emergency event before operation (P =0.021),and aortic crossclamping time(P =0.046).The Logistic multivariable regression analysis indicated that the emergency events before operation was the independent risk factor for the mortality of TAPVC(P =0.003).Conclusion TAPVC children with preoperative emergency events have higher postoperative mortality.

OBJECTIVETo summarize the clinical experience in repair of deep burn and traumatic wounds with combined transplantation of different types of pedicled skin flaps in lower extremities.

METHODSTwo hundred and thirty-six patients with 271 deep wounds in lower extremities after burn or trauma were repaired with muscular skin flaps, local fascial flaps and island flaps with vascular pedicle (more than 20 types) in our department from Jan. 1998 to Sept. 2008.

RESULTSComplete necrosis of skin flaps occurred in 1 case, congestion and necrosis over the edge of skin flaps occurred in 3 cases, which were healed after grafting, and other skin flaps survived well with soft texture. Skin flaps were too bulky in 26 cases, among them 17 cases were thinned, and the appearance of other skin flaps were satisfactory. In 68 patients with functional region injury were recovered to certain extent without contracture.

CONCLUSIONSSkin flaps with pedicles, multiple transplantations if necessary, can repair deep wounds satisfactorily in lower extremities after deep burn or trauma injury.

Adolescent ; Adult ; Aged ; Burns ; surgery ; Buttocks ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; Wound Healing ; Young Adult

OBJECTIVETo investigate the perioperation medication on the first patient who was operated facial allotransplantation, including immunosuppressive drug and adjunctive drug, so that to search a effective medication schedule to the patient operated facial allotransplantation.

METHODSFK506, MMF, Prednisone and Zenapax was performed as immunosuppressive regiment in perioperative treatment; meanwhile, anti-infectives was administered to take precautions against all sorts of infections, such as bacterium, virus and fungus. Furthermore, all kinds of adjunctive drug, Losec, glucurolactone and so on, was administered to protect those function of stomach, liver, kidney and so on. Clinical observations were made on the signs and symptoms of graft survival or rejection, as well as immunological indexes were tested in laboratory. Biopsies of graft were also made at 30 d after operation. Side effect and complication of drug was monitored, in case the body suffered harm.

RESULTSFacial allograft was survived, and the temperature and color of skin were normal. Swelling of tissue was gradually subsidise after 4 days, and recovered in a half month. The count and ratio between Th and Ts were normal, skin Biopsies of every time had no found of hyperacute or acute rejection, and side effect and complication of drug had no monitored.

CONCLUSIONSThe regiment of perioperation medication was successfully performed.

Adult ; Face ; surgery ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Tissue Transplantation ; methods ; Transplantation, Homologous

BACKGROUNDMore and more Chinese drink hot water from water dispensers while many children were scalded due to this change. The present study aimed to propose a feasible strategy for prevention.

METHODSA retrospective study was conducted for all water dispensers related pediatric burns admitted to Changhai Hospital from January 2005 to December 2009.

RESULTSThe number of new cases and incidences of pediatric burns due to hot water from water dispensers was significantly increasing year after year. In the total 238 involved cases, 175 cases happened on males and 78.9% were at the age of 1 - 4 years. The burn areas were mainly located in upper extremities. All water dispensers in the surveyed families had no isolate protection devices and 85.2% of their locations were easy for children to reach. Nearly half of the children were in the same room with their guardians when injured. Total 196 burned children were playing the taps of water dispensers before injured, unfortunately, 80.6% of them have not been stopped until burned.

CONCLUSIONAs the kind of burns is quite serious and with bad outcome, some recommendations should be followed, such as buying water dispensers with protection devices, keeping children from touching them and so on.

Accidents, Home ; Adolescent ; Burns ; epidemiology ; etiology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Retrospective Studies ; Water

Objective:To study and investigate the expression effects of interleukin-8 (IL-8)in interstitial fibroblast cells of breast cancer before and after the application of docetaxel chemotherapy.Methods:46 cases of breast cancer without chemotherapy surgical resection in patients with resected tissue specimens from August 2014 to February 2016 in our hospital were selected,all specimens were cultured to form stable breast cancer stromal fibroblast cells,each cell line after raising Daipei were divided into the observation group and control group,the control group cells without any treatment,the observation group of 24h cells treated with docetaxel(20ng/mL),two groups of cells were extracted from the mRNA and analyzed the gene expression and differential gene expression analysis,and then to PCR and protein to detected the expression level of electrophoresis detection of interleukin two interleukin-8 cells,the expression of interleukin-8 in two groups of breast cancer cells was observed and compared.Results:After docetaxel chemotherapy,the breast cancer stromal fibroblast gene expression changed,and compared to the control group,the observation group were given docetaxel chemotherapy after breast cancer between matter into fiber cell interleukin-6 serum IL-8 mRNA and protein expression levels were significantly higher than that of the control group,the difference had statistical significance (P＜0.05).Conclusions:Interleukin IL-8 in the breast cancer matter into fiber cells were significantly up-regulated after docetaxel chemotherapy,indicating that the expression changes of breast cancer may be related with the effect of chemotherapy and chemotherapy drug resistance related.

OBJECTIVETo investigate the efficacy and toxicity of nedaplatin combined with tegafur in the treatment for patients with advanced esophageal cancer.

METHODSAmong the 65 patients with advanced esophageal cancer, 27 had no history of prior chemotherapy and the other 38 had ever received postoperative adjuvant chemotherapy before. The median age of those cases was 58.0 years. Nedaplatin was given daily by intravenous infusion at a dose of 20 mg/m(2) for 2 hours and tegafur at a dose of 500 mg/m(2) for 8 hours on D1 approximately D5, every 21 days as a cycle.

RESULTS193 cycles of chemotherapy were accomplished in the 65 patients, and 63 patients were evaluable for response evaluation. Of 27 patients with no prior history of chemotherapy, 6 achieved complete response and 16 partial response, with a response rate (CR + PR) of 81.5%. Among the 36 patients who had ever received postoperative adjuvant chemotherapy, 6 obtained complete response and 10 partial response with a response rate (CR + PR) of 44.4%. The overall median time to tumor progression in this series was 5.6 months. The overall median actuarial survival was 9.3 months, and the one-year survival rate was 24.9%. Nausea and vomiting were the major toxicities, but were mild and well tolerable. Grade 3 to 4 neutropenia was only observed in two patients (3.2%).

CONCLUSIONThe regimen of nedaplatin combined with tegafur is effective and tolerable for the treatment of advanced esophageal cancer.

Adenocarcinoma ; drug therapy ; pathology ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; Esophageal Neoplasms ; drug therapy ; pathology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nausea ; chemically induced ; Neoplasm Staging ; Neutropenia ; chemically induced ; Organoplatinum Compounds ; administration & dosage ; adverse effects ; Remission Induction ; Survival Rate ; Tegafur ; administration & dosage ; adverse effects ; Vomiting ; chemically induced

BACKGROUNDUnplanned extubation is associated with adverse outcomes in intensive care unit. The massive burn patient differs from other critically ill patients in many ways. However, little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit. This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.

METHODSA case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively. A total of 21 patients with 29 UD events were identified. Demographic data, diagnosis, intervention, UD events and outcome of UD patients were collected. Differences in proportions were compared using the chi-square (χ(2)) or Fisher's exact test.

RESULTSPatients with UD were often burned with head and neck (67%) and combined with inhalation injury (62%). The majority of them (76%) were transferred patients, occurred early (55%) and were accidental UD (79%). UD events tended to happen in day shift (90%) and to be associated with the medical procedure that was performing by caregivers at besides (79%). Loose of the stabilizing rope, medical procedure and tracheotomy malposition were the main causes of UD. Early UD and reintubation failure were associated with patients' death.

CONCLUSIONSUD happened to massive burn patients can lead to patient death. Careful management of respiratory tract was essential for massive burn patients.

Adult ; Burns ; mortality ; surgery ; Device Removal ; adverse effects ; mortality ; Female ; Humans ; Intensive Care Units ; statistics & numerical data ; Intubation, Intratracheal ; Male ; Middle Aged ; Retrospective Studies ; Tracheotomy ; adverse effects

OBJECTIVETo develop a rapid and specific method for hepatitis C virus ( HCV) genotyping using reverse dot blot hybridization technique and investigate the distribution of HCV genotypes and subtypes in Guangdong.

METHODSThe primers and the probes targeting the 5'untranslated region (5'UTR) and core region of HCV genotypes 1b, 2a, 3a, 3b and 6a were designed, and the RT-PCR reverse dot blot hybridization (PCR-RDH) method for HCV genotyping was established. A total of 115 patients with hepatitis C were genotyped using this method, and 38 of them were also genotyped by sequencing and phylogenetic analysis to evaluate the accuracy and specificity of the method.

RESULTSOf the 115 patients, 111 were successfully genotyped to be 1b, 2a, 3a, 3b, 6a and mix-infection of 1b/2a at frequencies of 56.8%, 8.1 %, 3.6%, 5.4%, 25.2% and 0.9% respectively, and all the 15 healthy control samples showed negative results. The accuracy and reliability of the genotyping method of PCR-RDH was confirmed in 38 cases by amplification of HCV core and NS5B regions followed by DNA sequencing and phylogenetic analysis.

CONCLUSIONThis method for HCV genotyping, with high reliability and specificity, is suitable for clinical and epidemiological investigations. The prevalence of HCV genotypes 1b and 2a decreases while 1b remains the dominant genotype in Guangdong, where the prevalence of 6a significantly increases as compared with that 10 years ago.

Genes, Viral ; Genotype ; Genotyping Techniques ; methods ; Hepacivirus ; classification ; genetics ; Hepatitis C ; virology ; Humans ; Immunoblotting ; Nucleic Acid Hybridization ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo evaluate the efficacy and safty of the humanized anti-epidermal factor receptor monoclonal antibody h-R3 in combination with radiotherapy for locoregionally advanced nasopharyngeal carcinoma.

METHODSTotally, 137 patients from 7 medical center around China were randomly divided into combined therapy group or control group. There was no difference in Karnofsky performance score between two groups. All patients in both groups received radical conventionally fractionated radiotherapy to the total dose of D(T) 70-76 Gy. For the combined therapy group, h-R3 was added at a dose of 100 mg i.v. weekly for 8 weeks started at the beginning of radiotherapy.

RESULTSOf the 137 eligilbe patients, 70 were in the combined therapy group treated by h-R3 plus radiotherapy and 67 in the control group by radiotherapy alone. The intent-to-treat (ITT) population consisted of 130 patients, while the per-protocol (PP) population was composed of 126 patients. The efficacy was assessed respectively at three point of time: the end of treatment, the 5th- and 17th-week after treatment. The complete response (CR) of the combined therapy group was significantly higher than that of the control group in both ITT and PP (ITT: 65.63%, 87.50%, 90.63% versus 27.27%, 42.42%, 51.52%; PP: 67.21%, 90.16%, 93.44% versus 27.69%, 43.08%, 52.31%; P < 0.05, respectively). The most common h-R3-related adverse reactions were fever (4.3%), hypotension (2.9%), nausea (1.4%), dizziness (2.9%) and rash (1.4%), which could be reversible if treated properly. Radiotherapy combined with 100 mg h-R3 i. v. weekly was tolerable and did not aggravate the side effects of radiation. The quality of life in the combined therapy group was comparable to that in the control group.

CONCLUSIONThis phase 1 multicenter clinical trial shows that h-R3 in combination with radiotherapy is effective and well-tolerated for the treatment of locoregionally advanced nasopharyngeal carcinoma.

Adult ; Aged ; Antibodies, Monoclonal ; adverse effects ; therapeutic use ; Carcinoma, Squamous Cell ; pathology ; therapy ; Combined Modality Therapy ; Female ; Fever ; etiology ; Humans ; Hypotension ; etiology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; therapy ; Neoplasm Staging ; Quality of Life ; Radiotherapy ; adverse effects ; methods ; Receptor, Epidermal Growth Factor ; immunology ; Remission Induction