Objective To observe the effects of different posture on hemodynamics and plasma atrial natriuretic polypeptide(ANP) during laparoscopic surgery. Methods Forty patients who scheduled for elective laparoscopic surgery under general anesthesia were allocated into two groups according to their posture during laparoscopic surgery,20 cases for each group. In group A, the patients were arranged in a head-down tilt position, in group B, the patients were arranged in a head-up tilt position systolic blood pressure (SBP),diastolic blood pressure (DBP),central venous pressure (CVP) and electro cardio gram (ECC) were monitored continuously. Blood samples were taken from central venous at four time points of prepneumoperitoneum(T1), 10 minutes after that(T2) and 20 mintues(T3) when the patients were arranged at the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg (1 mm Hg = 0.133 kPa),and at 5 minutes (T4) after deflation of pneumoperitoneum when the patients returned to supine position. The plasma ANP was assessed by radioimmunoassay. Results In group A,the CVP at T2 and T3 [(14.45 ±2.72),(14.20 ±2.46) mm Hg] was significantly higher than that at T1 [(6.05 ±1.76) mm Hg] (P<0.01), in group B,the CVP at T2 and T3 [(8.90±1.27),(9.02 ±0.47) mm Hg] was significantly higher than that at T1[(6.30 ±1.34) mm Hg](P< 0.01) ,with a higher level in group A than those in group B at the same time point during pneumoperitoneum(P< 0.01). The ANP level in group A was higher at T2 than that at T1, and there was significantly higher at T3 than that at T1 (P < 0.05). But the ANP level was significantly higher in group A than that in group B at the same time points of T2 and T3 (P < 0.05). Conclusion The posture may have obvious effect on CVP and plasma ANP level during laparoscopic surgery.

Objective To evaluate the clinical value of the regional wall motion in patients with suspected coronary artery disease by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods A total of 143 hospitaized patients with suspected coronary artery disease and normal wall motion de?tected by two-dimensional echocardiography (2DE) were enrolled and devided into group A (coronary stenosis ≥75%) 73 cases and group B (coronary stenosis<75%) that include 70 cases according to coronary angiography results. Left ventricu?lar segmental ejection fraction (sEF) was measured by RT-3DE and peak systolic longitudial strain (SL) was measured by 2D-STI. ROC curves of the two measurements were generated and compared. Differences in sEF and SL between group A and group B were respectively analyzed. Results (1)Both sEF of RT-3DE and SL of 2D-STI in group A were significantly low?er than those in group B (P<0.05);(2)sEF was positively correlated with SL(r=0.689,P<0.05);(3)Compared with SL, sEF had larger area under ROC curve in some segments of left ventricle where both parameters are abnormal for the diagnosis of the coronary stenosis ≥75% (0.922 vs 0.874). Conclusion Regional wall motion of left ventricular can be measured by both RT-3DE and 2D-STI which can be both used to estimate the extend of stenosis of coronary artery. And RT-3DE is su?perior over 2D-STI.

The application of fetal echocardiography in clinical is increasing , more and more patients need de-tailed consulting services .The following suggestions are made:Echocardiographic doctors should set up the consulting service consciousness , provide consulting with patience , popularity and carefulness; the doctors should understand the patients and their family′s emotions and also pay attention to the psychological care;environmental requirements for patients′echocardiographic examination and counseling service;encouraging multidisciplinary join the participa-tion of consulting services .

Objective To study on the attributive Zang-Fu of TCM to the EBV infection according to the malignant tumor. Methods The malignant tumor in-patients were reviewed to survey the EBV infection, and the nasopharyngeal carcinoma infected the EBV were reviewed to survey the transfer cancer occurance. Results Of the malignant tumor in-patients, there were high EBV infection appearances in the nasopharyngeal (87.5%), the liver (15.0%) the lung (8.3%). There was no EBV infection in the other malignant tumor in-patients. The transfer cancer of the nasopharyngeal carcinoma occurred in the liver (40%) and lung(25%). Conclusion The attributive Zang-Fu of TCM to the EBV infection are liver and lung.

Objective Speckle is the inherent problem exists in B-Mode ultrasound image,and effective speckle noise reduction will improve the image quality and contribute greatly to clinical doctors to diagnose,especially in fine ophthalmic examination with high frequency ultrasound.Methods This paper proposed a new speckle reduction method based on the Laplacian pyramid and multiscale analysis.In the Laplacian pyramid,true clinical features were separated from noise,according to the different bandpass ultrasound image characteristics in each layer,and the advanced eight directions speckle reduction anisotropic diffusion (SRAD)was adapted to suppressed the speckle noise,and the identified noise and the extracted features were selectively emphasized by suitable edge,coherence and contrast enhancement filtering from fine to coarse scales.The performance of the proposed method was compared to the traditional SRAD method and coherence-enhancing diffusion method by measuring the equivalent number of looks (ENL) and Time cost.Results The ENL and Time cost value of the proposed method were higher compared to the SRAD and the cedif method,i.e 1.172 3 vs 1.122 3,0.929 3 and 0.864 0 vs 1.396 0,1.468 3.Conclusions In summary,the proposed method can more effectively remove the speckle noise while preserving the edge and details of the images.

Objective To investigate the effect of standardization regional lymphadenectomy in radical resection of ductal adenocareinoma in the pancreatic head.Methods On the basis of routine panereaticoduodenectomy(whipple proceduce),we performed the standardization regional lymphadenectomy,the emphasis of the procedure was the resection of wide nodes,particularly the mesenteric root lymph nodes(14abcd),the paraaortic lymph nodes(16a2b1),the hepatoduodenal ligament lymph nodes(12abpeh),hepatic artery(Group 8)and coeliacus lymph nodes(Group 9). Results Eleven patients underwent this procedure,there was no operative mortality,1 case occurred pancreatic fistula,the lymph nodes metastasis occurred in 7(63.6%)patients,the posterior pancreaticoduodenal lymph nodes(Groupl3)and superior mensenteric artery(Groupl4)was the predominant metastatic site of the tumor,the rate of the second site metastasis to lymph nodes was 57.1%.of the 11 cases follow-up 1 died. Conclusion The radical pancreaticoduodenectomy combined with wide resection of standardization regional lymph nodes is a safe and effective procedure of the treatment of adenocarcinoma of the head of the pancreas.but the long-term survivalrate must be valued objectively with many cases.

Objective: To study the relationship between Framingham risk score for coronary artery disease (CAD) and cognitive function in healthy community elders.
Methods: A total of 276 healthy community elders were evaluated by Framingham score to predict the risk for suffering from CAD in 10 years. The subjects were divided into 3 groups. High risk group (the risk > 20%), n=46, Mid risk group (the risk at 10%-20%), n=76 and Low risk group (the risk < 10%), n=154. The cognitive function was measured by mini-mental state examination (MMSE) and China adult intelligence scale (CISA). The differences of cognitive function levels to 3 CAD risk groups were studied.
Results: With the increased CAD incidence from Low risk, Mid risk to High risk groups, the MMSE score reduced accordingly (26.9 ± 1.45) vs (24.3 ± 1.53) vs (22.2 ± 1.43), P=0.014. Pearson analysis presented that MMSE score was negatively related to Framingham risk score (r=-0.213, P<0.001). There were several elements of cognitive function related to Framingham risk score including MMSE score, question answering, grid filling, oral arithmetic and word distinguishing (r=-0.247), (r=-0.167), (r=-0.132), (r=-0.152) and (r-0.256), all P<0.05.
Conclusion: CAD risk level was negatively related to cognitive function, the higher Framingham risk score resulted in the lower cognitive function in healthy community elder subjects.

This paper presents the general principles and usual problems involved in the development of Institutional Review Board in research institutions. And suggestions are made in this regard. Meanwhile, it discusses two common difficult issues involved in ethical review.

Objective: To study the effects of hydrolysed casein in different doses on plasma and liver antioxidant capacities in mice. Methods: Fifty mice were divided into 5 groups: control group, vitamin E group (VE), low dose of hydrolysed casein group (CH1), medium dose of hydrolysed casein group(CH2)and high dose of hydrolysed casein group(CH3). The mice were supplemented with 0.25ml normal saline,7.2 mg/ml Vitamin E,4,12 and 20 mg/ml hydrolysed casein respectively by gavage one time a day. The mice were euthanatized after ten days. The activities of SOD, GSH-PX and the level of MDA were determined. Results: Hydrolysed casein in different dosese vidently increased the activities of SOD and GSH-Px in serum, and reduced the level of MDA in serum and liver of mice; group CH3 significantly increased the activities of GSH-Px in liver. Conclusion: Different doses of hydrolysed casein could raise plasma and liver antioxidant capacities in mice, especially the high dose of hydrolysed casein.

Objective To compare the agreement among Chinese 1992, 2008 and UICC 2010 staging systems of nasopharyngeal carcinoma (NPC) and evaluate their predictive value of radiotherapeutic prognosis.Methods 347 NPC patients without distant metastasis treated in our hospital from 2000 to 2005 were retrospectively analyzed.Every patient was categorized into T, N, and clinical stage by Chinese 1992, 2008 and UICC 2010 staging systems, respectively.Kappa value was used to evaluate the agreement among three systems.Kaplan-Meier method was used to analyze the 5-year overall survival (OS), local-free survival (LFS) and distant metastasis-free survival (DMFS), the difference between subgroup was tested by Logrank.Results The agreement of clinical stage, T and N stage between Chinese 2008 and UICC 2010 staging system was better than that of them compared to 1992 staging system, Kappa value were 0.700、0.881 and 0.722.The agreement of T stage was better than N and clinical stage among these three staging system.The difference of OS between stageⅢ and stage Ⅳ was significant in Chinese 2008 and UICC 2010 staging system (χ2=4.48,P=0.034;χ2=8.88,P=0.003), and with no different in 1992 staging system (χ2=0.40,P=0.526).There was no significant difference of LFS between T1 and T2,T2 and T3,T3 and T4 in all staging systems (χ2=1.85,0.53,0.50,P=0.174,0.467,0.479;χ2=1.25,2.10,1.99,P=0.264,0.148,0.159;χ2=0.77,0.60,0.87, P=0.381,0.441,0.350).There were no significant differencesin 1992 staging system, while there was significant differences of DMFS between N1 and N2, N2 and N3 in 2008 stage system, N1 and N2 in UICC 2010 stage system.Conclusions The predictive value of Chinese 2008 and UICC 2010 staging system for prognosis were similar, and were better than that of 1992 staging system in NPC.