Clinical practice is an important transformational process for medical students to grow into qualified doctors.Interest conflict exists between patients and medical students during clinical practice,which is sketched and analyzed in this paper.It is held that it is of crucial significance to strengthen the education of medical ethics for physicians and medical students during clinical practice.

Objective To explore the value of diffused optical tomography(DOT)with ultrasonography (US)in differential diagnosis of breast benign from malignant neoplasms.Methods One hundred ard twenty-three breast neoplasms from 113 patients were checked use the optical tomography image ultrasonography(OPTIMUS).The diagnosis results of the system were compared with pathological study.Two-dimensional ultrasound features in breast neoplasms were digitalizated,and HBT and SO_2 were detected by DOT.At last,synthesis diagnostic index(SDI)was obtained by both US and DOT.Statistic process was carried out in sensitivity,specificity,and the rate of accuracy respectively by US,DOT and OPTIMUS system.Results Among breast neoplasms of 123 mass studied pathologically,78 of them were benign and the rest were malignant.HBT in benign lesions(153.02±105.78)was significantly less than malignant lesions(232.95±78.22),SO_2 in benign lesions(1.0332±0.1641)was significantly elevated compared with malignant lesions(0.8794±0.1814),SDI in benign lesions(147.26±53.76)was significantly less than malignant lesions(243.98±57.27),significant differences were found between the two groups(P＜0.05).The sensitivity of differential diagnosis of breast neoplasms by the OPTIMUS system was 93.33%,the specificity was 83.33%,and the rate of accuracy was 86.99%.Conclusions OPTIMUS can improve the specificity and the rate of early diagnosis.

Objective To investigate the effect of docetaxel combined capecitabine chemotherapy and psychological intervention after radical mastectomy. Methods 80 cases of radical mastectomy for breast cancer treated in our hospital from January 2015 to January 2017 were treated with docetaxel combined with capecitabine chemotherapy. According to different nursing methods, the patients were divided into 2 groups. The observation group was treated with psychological nursing, while the control group received routine nursing care. The anxiety and depression scores in two groups before and after nursing were observed and compared. Results There were no significant difference in the scores of anxiety and depression between the two groups before and after treatment. After the intervention group, patients in observation group were significantly improved, and better than the control group patients; The nursing satisfaction rate in the observation group was 97.5%,which was significantly higher than that in the control group (72.5%) (P<0.05). Conclusion After radical mastectomy of breast cancer with docetaxel combined with capecitabine chemotherapy and psychological clinical observation of dry pre found in breast cancer resection and chemotherapy as the basis, to patients with psychological intervention can improve the clinical situation of patients, promote their mental status improved, improve nursing satisfaction rate of patients, so it is worthy of reference.

Objective:To study the effect of B7-1 costimulatory molecule in inducing tumor immunity.Methods:The lymphocytes were examined in vitro,for both proliferation induces(PI) and specific cytotoxic activity,H22 mice were challenged subcutaneously either by the mock following which the latency,survival time and tumor mass growth were noted.Results:The H22-B7-1 cells more effectively induced the proliferation of effecter lymphocytes and the generation of specific lytic activity against H22 cells.The H22-B7-1 cells demonstrated slower rate(P

Objective To explore the operative cooperation of the intra-extra cranial bypass operation of the intracranial giant aneurysms. Methods A retrospective analysis of 7 patients who had intracranial giant aneurysm and received the intra-extra cranial bypass operation from October 2014 to June 2016. All preoperative and intraoperative nursing points of operative cooperation were analyzed. Results The post-operative digital subtraction angiographies of 7 patients without any perioperative nursing complications showed enough flow in the bypass arteries. Conclusions Operative multi-incision managing, positive temperature intervening, special instruments using and thrombosis preventing play very important roles in the nursing points of the successful operative cooperation.

Rhubarb anthraquinone derivatives (AQs) have been documented to have both therapeutic and toxic effect on liver and kidney, leading to a complex puzzle to assess their benefits and risks. In this study, the tissue distributions of AQs in SD rats after orally administrated extracts of raw and prepared rhubarb were examined whether they undergo different uptake. The total rhubarb extract (14.49 g x kg(-1) of body weight per day od, counted on the quantity of crude material) was administrated orally for 12 weeks. The concentrations of the AQs in different tissues were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The five major AQs, aloe-emodin, rhein, emodin, chrysophynol and physcion, could all be detected in the liver, kidney and spleen, while only rhein, aloe-emodin and emodin reached the quantitative limit. The tissue concentrations of AQs in raw rhubarb group were higher than that in steamed rhubarb group with rhein > emodin > aloe-emodin in the same tissue. On the whole, the tissue distribution of rhein was higher than that of emodin and aloe-emodin in liver, spleen and kidney. AQs could not be detected in those tissues after drug withdraw for 4 weeks, which suggested scarcely any accumulative toxicity of rhubarb. The result indicated that raw rhubarb had more tissue toxicity than steamed rhubarb and rhein may be one of the major poisonous ingredients. The results were concordant with the traditional Chinese medicine theory of toxicity-attenuating effect of processing.

Objective To observe the effect of low concentration Aβ1-42 monomer/oligomers and CORM-2 in different concentration on livability of SN56 cells. Methods SN56 cells were cultured in the 96-well plate with uniform concentration, and were divided into control group, Aβ1-42 group, Aβ1-42 + CORM-2 50μM group, and Aβ1-42 + CORM-2 100 μM group. Three lines of cells in Aβ1-42 group were cultured in the surroundings of 10nM,100nM and 1 μM Aβ1-42monomer/oligomers, respectively. Aβ1-42 + CORM-2 50μM group and Aβ1-42 + CORM-2 100μM group had the same culture condition as group Aβ1-42 ,except contain 50μM, and 100μM CORM-2, respectively. Control group didnt have any effect factor. Three days later,the livability of different groups was compared with MTT method. Results The livability of group Aβ1-42 with the increasing concentration of Aβ1-42 was (79.73 ±0.94)% ,(67.99 ±0.79)% ,(60.42 ±0.62)% , respectively. The higher the concentration of Aβ1-42 was,the lower the livability of SN56 cell was. The livability of group Aβ1-42 + CORM-2 50μM/100μM was( 75.15±0.096)%,(63.20 ±0.17)%, (55.33 ±0.19)%; (73.20 ±0.27)%, (64.34 ±0.11 )%, (54.17 ±0.12)% , respectively. Both were lower than group Aβ1-42. And different CORM-2 concentration had discrepancy in the ability of decreasing the cell livability. Conclusion Low concentration of Aβ1-42 can reduce the livability of SN56 cells, and higher concentration has more significant effect; CORM-2 in different concentration both can decrease the livability of SN56 cells,and there is a discrepancy in the intensity.

Objective To explore the expression of nemo-like kinase (NLK) in primary hepatic carcino-ma (HCC) and its clinicopathological significance. Methods The expression of NLK was detected in 136 HCC samples by Immunohistochemistry. Results NLK expression was significantly up-regulated in HCC specimens compared to corresponding normal liver tissues. High expression of NLK was significantly associated with Ed-mondson-steiner grade, tumor size and number of tumor nodules (all P < 0.05). There was positive correlation between NLK and proliferation marker Ki-67 (P < 0.01). Kaplan-Meier analysis showed the high expression NLK group was significantly associated with poor overall survival and disease-free survival (all P < 0.001). Univariate analysis showed that the high expression NLK was associated with poor prognosis (P < 0.001). Multivariable Cox regression analysis suggested that the expressions of NLK and Ki-67 , Edmondson-steiner grade , metastasis , tu-mor size and number of tumor nodules were independent prognostic indicators for HCC. Conclusions NLK was markedly upregulated in HCC specimens, and it might be an independent prognostic marker for HCC. NLK might play an important role in tumorigenesis, progression and prognosis of HCC.

Objective:To investigate the levels of serum high mobility group box (HMGB) 2 and HMGB3 and clinical significance in patients with non-small cell lung cancer (NSCLC) .Methods:A total of 137 NSCLC patients admitted to the First Affiliated Hospital of Xi'an Medical University from January 2020 to January 2022 were selected as the NSCLC group, and another 90 cases who underwent healthy medical checkups during the same period were selected as the healthy group. Serum HMGB2 and HMGB3 levels were compared between the two groups. The relationship between serum HMGB2 and HMGB3 levels and the clinical and pathological characteristics of NSCLC patients was analyzed. NSCLC patients were divided into a good prognosis group ( n=86) and a poor prognosis group ( n=51) according to the prognosis, and the clinical data of the two groups were compared. Multivariate logistic regression was used to analyze the influencing factors of the prognosis of NSCLC patients. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum HMGB2 and HMGB3 on the prognosis of NSCLC patients. Results:Serum HMGB2 [ (6.35±1.66) ng/ml vs. (2.58±0.76) ng/ml, t=20.19, P<0.001] and HMGB3 [ (2.48±0.56) ng/ml vs. (1.09±0.13) ng/ml, t=23.13, P<0.001] levels in NSCLC group were higher than those in healthy group. Serum HMGB2 and HMGB3 levels of NSCLC patients with a history of smoking ( t=2.80, P=0.006; t=5.04, P<0.001), lymph node metastasis ( t=3.53, P=0.001; t=4.02, P<0.001), and TNM stage Ⅲ-Ⅳ ( t=2.58, P=0.011; t=3.82, P<0.001) were significantly higher than those of patients with no history of smoking, no lymph node metastasis, and TNM stage Ⅰ-Ⅱ. The serum levels of HMGB2 [ (7.80±1.83) ng/ml vs. (5.49±1.56) ng/ml, t=7.85, P<0.001] and HMGB3 [ (2.91±0.78) ng/ml vs. (2.23±0.43) ng/ml, t=6.58, P<0.001) ] in the poor prognosis group were higher than those in the good prognosis group, and the proportion of patients with lymph node metastasis ( χ2=4.81, P=0.028), history of smoking ( χ2=11.67, P=0.001), and TNM stage Ⅲ-Ⅳ ( χ2=6.18, P=0.013) was significantly higher than that in the good prognosis group. Multivariate logistic regression analysis showed that lymph node metastasis ( OR=1.96, 95% CI: 1.14-3.36, P=0.015), smoking history ( OR=2.02, 95% CI: 1.33-3.06, P=0.001), TNM stage ( OR=2.28, 95% CI: 1.35-3.86, P=0.002), HMGB2 ( OR=2.01, 95% CI: 1.40-2.91, P<0.001), and HMGB3 ( OR=1.99, 95% CI: 1.25-3.15, P=0.003) levels were independent influencing factors of prognosis of NSCLC patients. ROC curve analysis showed that the area under the curve (AUC) of serum HMGB2 and HMGB3 alone and in combination to predict the prognosis of NSCLC patients were 0.833, 0.862 and 0.922, respectively, and the AUC predicted by the combination was significantly higher than that predicted by serum HMGB2 ( Z=2.44, P=0.015) and HMGB3 ( Z=2.54, P=0.011) alone. Conclusion:Serum HMGB2 and HMGB3 levels are up-regulated in NSCLC patients and are closely associated with poor prognosis, and the combined detection of the two has certain predictive efficacy for prognosis of NSCLC patients.

Objective:To investigate the effect of trastuzumab deruxtecan (T-DXd) in the treatment of metastatic breast cancer (MBC) patients with different expression levels of human epidermal growth factor receptor 2 (HER2) and the influencing factors of prognosis.Methods:The retrospective case series analysis and cohort study were conducted. Clinical data of 20 MBC patients with different expression levels of HER2 treated with T-DXd at Xi'an International Medical Center Hospital from August 2021 to August 2023 were retrospectively collected to analyze the efficacy and safety of T-DXd. The Cox proportional hazards model was used for multivariate analysis of prognostic factors.Results:All 20 patients were female, with a median age [ M ( Q1, Q3)] of 49 years old (40 years old, 58 years old). Of the 20 cases, 12 had low expression of HER2 [immunohistochemistry HER2+, or immunohistochemistry ++ and fluorescence in situ hybridization (FISH)-negative], and 8 had overexpression of HER2 (immunohistochemistry HER2+++, or immunohistochemistry ++ and FISH-positive); median number of lines of treatment with T-DXd was 6 lines (3 lines, 7 lines); 14 patients had partial remission, 3 patients had stable disease, and 3 patients had disease progression, with an objective remission rate (ORR) of 70% (14/20) and a disease control rate of 85% (17/20). Eight patients with overexpression of HER2 had objective remission in 6 cases, and 12 patients with low expression of HER2 had objective remission in 8 cases, and the ORR difference between the two groups was not statistically significant ( P = 1.000). The main adverse reactions of the patients were nausea (14 cases), vomiting (12 cases), leukopenia (10 cases), elevated aspartate aminotransferase (10 cases), elevated alanine aminotransferase (9 cases), anemia (8 cases), fatigue (8 cases), alopecia (8 cases), neutropenia (6 cases), and thrombocytopenia (5 cases); ≥ grade 3 adverse reactions were bone marrow suppression and gastrointestinal reactions, all with an incidence of ≤10%. The median follow-up time was 7.1 months (1.9 months, 11.5 months). The median progression-free survival (PFS) time was 6.5 months (95% CI: 3.9-9.1 months), and the median PFS time of patients with overexpression of HER2 was longer than that of patients with low expression of HER2 [7.0 months (95% CI: 6.4- 7.6 months) vs. 4.0 months (95% CI: 1.7-6.3 months)], and the difference in PFS between the two groups was statistically significant ( P = 0.025). Multivariate Cox regression analysis showed that overexpression of HER2 was an independent protective factor for PFS in MBC patients treated with T-DXd ( HR = 0.265, 95% CI: 0.075-0.945, P = 0.041). Conclusions:MBC patients with overexpression or low expression of HER2 have a good therapeutic effect and safety profile when treated with T-DXd. The overexpression of HER2 may predict good PFS in MBC patients treated with T-DXd, and may serve as a biomarker for predicting PFS in such patients, but it may not affect the ORR.