Locally advanced nasopharyngeal carcinoma ( NPC) invaded with paranasal sinus as death is associated with disease and independent prognostic factors for local recurrence .Its symptoms are various and atyp-ical,and often causes misdiagnosis or missed diagnosis .Local recurrence and distant metastasis are the main cause of treatment fails .Currently , there are few literature about NPC intruding paranasal sinus .Its occurrence rate,clinical manifestation,imageological change,intruding pathways,diagnosis,treatment and prognosis are sum-marized in this paper .

In modern warfare,ethical problems correlated to combat stress reaction contain three aspects: the perplexities of reactor's role orientation,the issues of the PIE pattern treatment,and the defects of the broken-discipline reaction.In order to cope with these problems,medical officers and battle commandants should insist on the scientific principle,the permissible principle and the commonweal principle.

Good clinical results were shown in nasopharyngeal carcinoma (NPC) patients received radiotherapy. The patients with long term life partially had radiation induced injuries that severely affect the quality of life (QOL). The study on QOL of those patients is important. Our article reviewed the effects of NPC QOL by treatment options, health education, rehabilitation therapy, traditional chinese medicine and qigong. The current measurement scale of NPC QOL in China was also discussed.

Based on the development of our psychological service in amy , this paper pointed out that our psy-chological services that exist in the following ethical issues:some psychological services staff is competency inade-quacy and lack of professionalism;psychological services exist in the complicated ethical relationship and multiple roles;military secrecy of psychological service in consciousness does not reach the designated position The right of privacy infringement .And according to the above problem is pointed out that our army in the military psychological service work should be:stick to professional ethics , improve professionalism;clear professional role , reducing the recessive harm;improve secrecy consciousness , safeguard privacy rights .

Moral injury in the war has been taken seriously since it has been gradually raised as an important military psychological problem.War is not the flavor of a quiet life,nor is it the ideal place to achieve the hero dream.Strong battlefield impact and ethical challenges likely cause moral injury to those innocent soldiers.Based on the American classic war films such as“ Closed Island”,“Born on July 4”,“Field Row” and “Snowden”,this paper mainly expounded the ethical thinking off our causes of moral injury including massacre of the prisoners of war,injustice war,betrayal of the senior officer,and hegemonic government.

As a young discipline imported from the West,Chinese bioethics has made tremendous achievements in the last three decades.However,at the same time,there are also certain confusions about its ideaistic origins and academic development.Observing the trends in the growth of western bioethics and the changes in the contemporary real social life,we can see that it is the time to break the current bottleneck for the contemporary development of Chinese bioethics.Specifically,Chinese bioethics should shift its attention to the quality of life,and manifests its thought depth and academic value through reflecting the reality.Advancing with the times,the bioethics is bound to have a brighter future.

Originated from the practice of wars,military medical ethics generated great concern on bioethics from its origination.Bioethics is generated independently in military field,thus forms particular domains in military medical ethics: battlefield euthanasia,battlefield organ transplants,military medical research,vaccine use,public health emergencies,and ecological ethics.

Objective To understand the level of neonatal pain knowledge and attitudes of neonatal and obstetric department nurses, in order to supply the clinical basis for neonatal pain management. Methods Self-designed questionnaires to fill out on-site were distributed to 107 neonatal and obstetric department nurses (of which 40 were from neonatal department, 67 from obstetric department) for neonatal pain knowledge and attitudes. Results About question of neonatal pain, the average percentage of correct answers in the neonatal group was 75.5%, higher than 66.3% of the obstetric group, in the neonatal group, correct rate of seven questions was more than 80%,while in the obstetric group the correct rate of only one question was more than 80%, and 5 questions correct response rate was significantly lower than that of the neonatal group, the difference was significant. All nursing staff considered it essential or necessary to carry out the nursing knowledge of pain-related training. 95.0%(38/40) of neonatal nurses believed that they could properly assess the extent of neonatal pain, but only 83.6% (56/67) for the obstetric group, the difference between the two groups was significant. 97.5% (39/40) of neonatal nurses believed that they could make the right judgments on neonatal crying, and only 85.1%( 57/67) in the obstetric nurses, the difference between the two groups was significant.Conclusions Neonatal pain has gradually been recognized and paid attention to by the clinical front-line medical staff, they believe that it is necessary to receive training on neonatal pain, knowledge of neonatal pain of neonatal nurses is better than obstetric nurses.

Objective To investigate the effect of dexmedetomidine on the serum concentrations of S-100 β protein and neurone specific enolase (NSE) in elderly patients undergoing surgery.Methods One hundred ASA Ⅱ or Ⅲ patients,aged 65 ～75 yr with a body mass index of ＜25 kg/m2,scheduled for elective hip joint replacement surgery under general anesthesia,were randomly divided into 2 groups (n =50):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.5 μg/kg was infused intravenously over 15 min before anesthesia induction in group D and was maintained 0.4 μg/(kg·h) until 30 min before operation end,while the same volume of normal saline was infused in group C.Anesthesia was induced by iv injection of sufentanil 0.4 μg/kg and propofol 1 ～ 2 mg/kg until loss of consciousness.Tracheal intubation was facilitated with 0.6 mg/kg rocuronium bromide and the patients were mechanically ventilated.Anesthesia was maintained with sevoflurane by target controlled inhalation (TCI) (end-tidal concentration set at 1％～3％) and sufentanil 0.2 μg/(kg·h) in both groups.BIS was maintained at 40～60 during operation.Venous blood samples were obtained for determination of serum concentrations of S-100β protein and NSE before anesthesia (baseline),operation end and at 12h after operation.Patients were sent to Intensive Care Unit when operation end.All the patients were assessed for the development of delirium by experience research staff using Confusion Assessment Method for Intensive Care Unit.The incidence of postoperative delirium within 24h after operation were recorded,and compared between the two groups.Results The serum concentrations of S-100β protein and NSE was significantly increased at T1～2 than at T0 in two groups.The total dose of each anesthetic (propofol,sevoflurane),the serum concentrations of S-1005 protein and NSE,and the incidence of postoperative delirium were significantly lower in group D than in group C (P＜0.05).Conclusions Dexmedetomidine can reduce the serum concentrations of S-100 β protein and NSE,and can also reduce the occurrence of postoperative delirium in elderly patients undergoing hip joint replacement surgery.Dexmedetomidine can provides cerebral protection in elderly patients undergoing surgery.

Objective To determine the median effective target effect-site concentration (EC50) of sufentanil when intraoperative wake-up test was successful in patients undergoing scoliosis surgery.Methods Ninety ASA Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index ＜ 30 kg/m2,scheduled for scoliosis surgery under sevoflurane and sufentanil anesthesia,were randomly divided into Ⅰ-Ⅵ groups (n =15 each).Anesthesia was induced with sufentanil,etomidate and cisatracurium,and maintained with sevoflurane,sufentanil and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Before the wake-up test,infusion of cisatracurium was stopped and the end-tidal concentration of sevoflurane was adjusted to 0.The EC50 was determined by the K(a)rber method.The target effect-site concentration of sufentanil was set at 0.19 ng/ml in group Ⅰ,0.18 ng/ml in group Ⅱ and gradually decreased in decrements of 0.01 ng/ml.The wake-up test was performed 5 min later.The EC50 and 95 ％ confidence interval of sufentanil were calculated by the K(a)rber method.Results EC50 of sufentanil obtained was 0.164 ng/ml and 95％ confidence interval of sufentanil obtained was 0.157-0.172 ng/ml when the wake-up test was successful.Conclusion The EC50 of sufentanil is 0.164 ng/ml when the intraoperative wake-up test is successful in the patients undergoing scoliosis surgery.