Through the analysis of bioethics in the cultural context of China and west,the article elaborated the important influence of culture on bioethics and analysed the debate on bioethics in the present globalization from the angle of culture to make the reasonable choice in the globalization.

Objective To study the effect of cold and heat treatment on metastasis and the peripheral blood immune response in patients with breast cancer. Methods A total of 124 breast cancer patients were randomly di-vided into a hot and cold therapy group and a control group, each of 62. Both groups were given conventional surgical resections, and the hot and cold therapy group was given cooling and heating physical therapy for one month before the operation. The efficacy of the treatment and the patients′ spiritual state were compared after the treatment. The effect on lung metastases was evaluated using tomographic images of the chest, and the changes in immune cell levels in the peripheral blood were detected using flow cytometry. Results After the treatment, the remission rate (54.8%), spiritual life ratings on the Karnofsky scale and the area of lung cancer nodule transfer were significantly better in the hot and cold therapy group than in the control group. Twelve weeks after the treatment, the percentage of MDSCs in the control group patients was 72.5%, significantly higher than the 5.3% of the therapy group. The CD4+and CD8+ T cells were 2.2% and 1.8%, significantly lower than the 26.7% and 13.9% of the control group. Con-clusion Cold and hot therapy before a mastectomy can effectively inhibit the metastasis of breast cancer and promote patients′physical rehabilitation and spiritual life. It may regulate the microenvironment of their immunosuppression and stimulate antitumor immunity.

Objective To study the causes of pancreatic fistula following pancreatioduodenectomy, and evaluate the effect of total pancreatic uncinate process resection on the prevention of pancreatic fistula by analyzing the potential aetiology of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 68 patients, who were admitted into the No. 1 ward of Surgical Department of Peking University First Hospital during the period from Jan. 2004 to Jun. 2009, were retrospectively analyzed. The day-average level of amylase higher than 3 times of normal value, as measured from the drainage of peritoneal cavity, serves as the diagnostic criterion of the postoperative pancreatic fistula.Factors relevant to fistula, which result in the abnormal increase of the amylase in the drain, such as the extent of resection of pancreatic uncinate process, the anastomotic manners of pancreas and digestive tract, and the pancreatic fibrosis were statistically analyzed. Results The incidence of pancreatic fistula was 33. 8% according to the diagnostic criterion mentioned above; Single factor analysis showed that the resection extent of uncinate process (P = 0. 000) and the level of serum glucose ( P = 0. 045 ) were correlated with the occurrence of pancreatic fistula. Multivariate analysis identified that the independent risk factor for pancreatic fistula was the resection extent of uncinate process(P =0. 000). Pancreatic fibrosis, the manners of the anastomosis of pancreas and digestive tract were not independent risk factors. Conclusion Total resection of uncinate process could prevent pancreatic fistula from residual pancreatic uncinate process, hence reduce the incidence of pancreatic fistula following pancreaticoduedenectomy.

Objective To evaluate the diagnostic effect of intro-operative tissue puncture biopsy and find its influential factors.Methods The clinical data of 94 patients with pancreatic mass treated in our hospital from July 1994 to December 2007 and undergoing intro-operative tissue puncture biopsy were retrospectively analyzed.Results The sensitivity,the specificity,the positive predictive value and the negative predictive value were 74.6%,93.8%,98.0%and 46.9%,respectively.The single factor analysis showed that the size of pancreatic mass,the number of puncture and complicating with pancreatic fibrosis or not were related to the diagnosis of tissue puncture.The multiple factor analysis showed that the size of pancreatic mass(P=0.014)and the number of puncture(P=0.020)were crucial to the diagnosis of puncture.The sensitivity and specificity of intro-operative tissue puncture biopsy for the pancreatic mass less than 25 mm were lower than that for the mass larger than 25 mm (P=0.000).The sensitivity and specificity would be increased as the number of puncture increased (P=0.000).For the mass less than 25 mm,increasing the humber of puncture would improve the sensitivity(P=0.002).Conclusion Intro-operative tissue puncture biopsy is a simple and accurate procedure for differentiating the pancreatic mass.The sensitivity and specificity could be improved by increasing the number of puncture,especially for the patients with pancreatic mass less than 25 mm.

Objective To evaluate the pelvic floor function in post-hysterectomy patients. Methods Transperineal pelvic ultrasound was used to observe the pelvic organs in post- hysterectomy patients, and parameters of pelvic floor were measured. Taking the inferior margin of public symphysis as the reference plane,the shape and motion of the proximal urethra and bladder neck were observed at rest and on maximum Valsalva maneuver. Bladder neck-symphyseal distance(BSD) and retrovesical angle were measured. And the bladder neck descent(BND),urethral rotation angle and the rotation angle of the bladder neck were also calculated. Interclass correlation coefficients were calculated to evaluate the consistency of data. Results At rest,the BSD and retrovesical angle were (-2.73±0.37)cm and (119.00±22.40)°, while on maximum Valsalva maneuver was (-0.25±0.67)cm and (114.74±21.50)°,respectively. BND was (2.46±0.59)cm,the urethral rotation angle and the rotation angle of the bladder neck was (70.68±19.91)° and (60.81±17.34) °,respectively. Combined with pelvic ultrasound and clinical manifestations,29 cases of pelvic floor dysfunction after hysterectomy were diagnosed (58.00%, 5 cases of stress urinary incontinence, 8 cases of proctoptoma and 16 cases of bladder prolapse). The consistency was very high in measuring BNS, retrovesical angle at rest and on maximum Valsalva maneuver and BND by different observers. The interclass coefficient was 0.90,0.89,0.91,0.88,0.92,respectively. And the interclass coefficient of urethral rotation angle and the rotation angle of the bladder neck was 0.79, 0.88,respectively. These results showed a good interobserver agreement. Conclusion Transperineal pelvic ultrasound is a simple,reproducible and noninvasive imaging method, which can reveal the position and function of female pelvic organ dynamically and evaluate postoperative pelvic floor function.

ObjectiveTo explore the relationship between serum markers and liver fat content predicted by hepatorenal ratio in type 2 diabetic mellitus (T2DM) patients.Methods A total of 120 T2DM patients were recruited from January 2011 to September 2012 in the Affi liated Hospital of Qingdao University. The sagittal liver-right kidney diagrams of the patients were obtained by two-dimensional ultrasonic examination, and the hepatorenal ratio were analyzed by NIHimage. Then, the related serum markers were tested 24 hours later. The relationship between hepatorenal ratio and serum markers was analyzed by Spearman rank correlation on the patients of T2DM. Then, the affective factors on the hepatorenal ratio were analysed by multivariate linear regression analysis, with hepatorenal ratio as dependent variable, and the concentration of triglyceride (TG,X1) , total cholesterol (TC,X2), high density lipoprotein cholesterol (HDL-C,X3), low density lipoprotein cholesterol (LDL-C,X4), alanine aminotransferase (ALT,X5), aspartateaminotransferase (AST,X6), glutamyltransferase (γ-GT,X7) , and alkaline phosphatase (ALP,X8) as independent variables. The receiver operating characteristic curve (ROC) was drawn to diagnose the point of the hepatorenal ratio when the TG began to increase (>1.92 mmol/L).Results There was positive correlation between hepatorenal ratio and TG, AST, ALT,γ-GT (r=0.420,P=0.000;r=0.383,P=0.000;r=0.309,P=0.001;r=0.253,P=0.005), while no correlation between hepatorenal ratio and glycosylated hemoglobin, TC, HDL-C, LDL-C, ALP or blood uric acid (BUA) (r=0.0.067,P=0.368;r=0.145,P=0.115;r=?-0.148,P=0.106;r=0.002,P=0.986;r=0.160,P=0.081;r=0.064,P=0.489) were found; the linear regression analysis showed that TG level (X1) was the only markers which had correlation with hepatorenal ratio in the T2MD patients with the regression equation ofY=1.245+0.062X. The ROC curve analysis showed that the optimal cutoff value for hepatorenal ratio to in diagnosinge increased TG (>1.92 mmol/L) was 1.236 in T2DM patients, and the area under the curve was 0.677. The sensitivity and specifi city were 86.7% and 45.3% respectively. Conclusions Hepatorenal ratio can be a reliable indicator to predict liver fat content, which has correlation with TG, ALT, AST andγ-GT. The increased TG level can refl ect the increasing fat content in the liver, and TG begin to increase when the hepatorenal ratio reach 1.236.

Objective To investigate the risks and benefits of different surgical treatments for cystic neoplasms of the pancreas (CNP).Methods The clinical data of 243 CNP patients were reviewed retrospectively.Different surgical treatments were adopted according to the site,size and invasiveness of the tumors.A long term follow-up was carried out for patients with small benign CNP,and a surgical excision is proposed if tumors progressed during the observation.Results 58 outpatients with no evidence of malignancy was followed up and had long-term survival,in which 4 patients received a surgical resection in case of tumor progression,and all of them were confirmed benign tumors.185 cases received surgical treatments,with a resection rate of 97.3％ (180/185),including 127 non-invasive tumors,and 58 cases of invasive tumors.Perioperative mortality was 2/185,and morbidity rate was 41/185.Pancreatic fistula was the most frequent complication,which was significantly associated with tumor site and excision extension.All patients with non-invasive CNP acquired a long term survival after surgical treatments.The postoperative 1,3,5 year survival rates for patients with invasive lesions were 89.6％,52.1％ and 29.2％,respectively.Conclusions Long term follow-up and observation is feasible for asymptomatic patients with benign CNP.A radical resection should be performed for malignancy,and a combined multi-organ resection may improve the prognosis for local advanced tumors.

Objective To provide valuable references for ultrasonic diagnosis of pelvic organ prolapsed (POP) by finding an eas ily detecting referential line based on MRI.Methods Data of 107 patients who underwent pelvic MRI were retrospectively analyzed.All the patients were divided into 6 groups according to age:Group 1 (20 29 years old),group 2 (30-39 years old),group 3 (40-49 years old),group 4 (50-59 years old),group 5 (60-69 years old) and group 6 (≥70 years old group).Four reference lines were set basing on the median sagittal view of T2WI:PS-PS line (the line connecting the two endpoint of the pubic symphysis),PIAS line (the line connecting the inferior margin of pubic symphysis and the bottom of sphincter internal anal sphincter),PPC line (the line connecting of the inferior margin of pubic symphysis and the point of the pubococcygeous attached on the rectum) and PM line (the line connecting of the inferior margin of pubic symphysis and the M point [the midpoint of the line from the crosspoint of PPC line and the front wall of the rectum mucosa to the bottom of sphincter internal anal sphincter]).The angles between the horizontal line and PS-PS line,PIAS line,PM line,PPC line (angle 1,angle 2,angle 3,angle 4) were measured,respectively.The differences of the angle among various age-groups were compared.The consistency between the two observes were evaluated.Results PM line was the closest line to the horizontal line.There was no statistical differences of angle 1,angle 2 and angle 3 among the 6 groups (all P＞0.05).The difference of angle 4 among the 6 groups were significant (F=3.42,P=0.01).Intergroup pairwise comparisons showed that significant differences were found between group 1 and group 4,group 5,group 6,between group 2 and group 4,group 5,group 6,between group 3 and group 4,group 5,group 6,respectively (all P＜0.05).And no significant difference was found in the other comparisons.The consistency of the two observers in meaning angle 1,angle 3 and angle 4 were good,but the consistency of angle 2 was poor.Conclusion Of all the referential lines,PM is the closest to the horizontal line and is less influenced by the patient's age.However,the feasibility of using PM lines as the ultrasound referential line is still unclear.

Objective To avoid medical mistake,improve service quality of medical care,insure the security of patients. Methods The wireless Lan was deployed in ward to implement the scheme of using wireless Lan and avoid medical mistake,and then use wireless nursing system to prove it. Results This scheme can reduce the work intensity of medical staff,decrease the probability of medical mistake,and improve the service quality of medical care. Conclusion The wireless technology can avoid medical mistake effectively.

[Summary] Elastographic and contrast-enhanced ultrasonographic features were reviewed in 160 thyroid nodules co-existed with Hashimoto's thyroiditis. Significant differences in the elastography scores and enhancement pattern were found between malignant and benign thyroid nodules. For the differential diagnosis of benign and malignant thyroid nodules co-existed with Hashimoto's thyroiditis, the combined scores of elastography scores and contrast-enhanced ultrasound features may offer greater values.