Analysis was conducted and rights concerning teachers,students and patients in practice teaching was defined from the perspectives of medicine,pedagogy,ethnics and law through investigating on reasons leading to problems and conflicts in medical universities' practice right.Effective solutions were proposed from the examination of doctor' s qualification,law and pedagogy.Standardization and legalization of clinical teaching was promoted from the perspective of ethnics.

Objective:To discusses the professional quality cultivating mode construction for nursing students based on the second classroom as well as its mechanism and effects .To investigate the cognition and evaluation of nursing students on recessive education of the second classroom .Methods:Questionnaire was used in nursing un-dergraduates in three grades .The professional spirit , professional skills , humanity qualities were involved .Re-sults:For professional spirit , 44 .13% agreed for significantly increasefor their professional quality , and 33 . 20%for improved, 6.48%forreduced, or a significant reduction.For professional skills, 51.82%forsig-nificantly increase, 41 .70%for improved, 1 .21%forreduced , or a significant reduction.For humanistic quality, 91.1% of the students thought it significantly increasetheir humanistic quality .In grade 2009 and 2011 , over 50% students thought this quality was improved by the second classroom .Conclusions:Professional quality cultivating mode based on the second classroom makes nursing students 'professional spirit , professional skills, the humanities quality improved , and this cultivating mode received wide recognition and affirmation in the nursing students .

Baizi Yangxin tablets are common Chinese medicine used for the treatment of heart palpitations, insomnia and irritable forgetful. To evaluate the total amount of heavy metals evaluation, artificial gastric juice was used as juice samples and the extracted soluble heavy metals were extracted by microwave digestion technology. An analytical method of bionic extraction microwave digestion with inductively coupled plasma mass spectrometry ( ICP-MS ) was established for the determination of trace metals, such as Co, Cr, Cu, Ba, Cd, Mn, Ni, Pb, Hg, Sr and Zn, in 18 batches of Baizi Yangxin tablets. The correlation coefficient of linear regression equation for different elements ranged from 0. 9989 to 1. 0000, the detection limit was 0. 19-5. 6 μg / L, and the repeatability of the method was less than 6. 2% , the precision of the RSD value was less than 5. 6% , and the recovery rate was 87. 7% -101. 9% . According to “the standard of the heavy metal in the standard of import and export of medicinal plants and preparations”, the contents of Cd, Cu and Pb in the 18 batches were not exceed the standard, but the Hg content (7. 68 mg / kg) exceeded the standard value. The bionic extraction-ICP-MS method provide a reference basis for the safety of the proprietary Chinese medicine's study.

Medical education should combine clinical professional skills with humanities skills,integrate humanities knowledge into vocational education.Taking 2008 grade seven-year program clinical medicine students in the 2nd affiliated hospital of Harbin Medical University as fostering object,we made researches into students' understanding of doctor-patient relationship before practice and their mastering of skills.Through conducting questionnaire,we got to know the effect of humanities practice skill training for seven-year program clinical medicine students.Meanwhile,we compared students' self evaluation results before and after training,discussed on how to improve medical students' communication skills,cultural skills and the reform direction in an aim to guide students to transit from students to clinical doctor.

Clinical decision-making is a series of activities of medical scheme selection, which determines the direction of medical behavior and the level of patients' welfare. In practice, clinical decision-making is not only restricted by medical technology factors, but also by non-technical factors. Therefore, it is necessary to analyze and predict the possible influence of non-technical factors in clinical decision-making. Game theory is a scientific system of strategic choice, which can effectively predict and analyze the impact of non-technical factors on clinical decision-making process. According to the game analysis results between doctors and patients, medical management and pharmaceutical enterprises, we can predict the non-technical impacts in clinical decision-making and their influence paths, guide clinical decision-makers to choose excellent strategies, abide by rationality and give up moderately, so as to improve the level of clinical decision-making and the welfare of patients.

OBJECTIVE To analyze the influential factors of cardioto xicity in patients with positive breast cancer of human epidermal growth factor receptor 2（HER-2）treated by trastuzumab combined with chemotherapy. METHODS From April 2017 to January 2021，200 HER-2 positive breast cancer patients receiving pirarubicin + cyclophosphamide combined with sequential paclitaxel+trastuzumab were collected from our hospital. According to the presence or absence of cardiotoxicity ，the patients were divided into cardiotoxicity group and non-cardiotoxicity group. The clinical data and echocardiographic results of the patients were collected，and the influential factors of cardiotoxicity were analyzed. RESULTS Among 200 patients，43 patients suffered from cardiotoxicity with the incidence of 21.5％. The proportion of patients with cardiotoxicity during pirarubicin+cyclophosphamide therapy accounted for 5.5％（11/200），and the proportion of patients with cardiotoxicity during sequential paclitaxel+trastuzumab therapy accounted for 20.5％（41/200）；the latter was significantly higher than the former （P＜0.01）. At the same time ，the decrease of left ventricular ejection fraction during sequential therapy of paclitaxel and trastuzumab was significantly higher than that during pirarubicin+cyclophosphamide therapy [ 14％（12％，17％）vs. 7％（3％，10％），P＜0.001]. Compared with patients without cardiotoxicity ，the proportion of patients with cardiotoxicity with a history of hyperlipidemia was significantly higher （P＜ 0.01），while the proportion of patients receiving dexrazoxane was significantly lower （P＜0.01）. Results of binary Logistic regression analysis showed that the history of hyperlipidemia [OR ＝3.672，95％ CI（1.499，8.992），P＝0.004] and the use of dextrazoxane [OR ＝0.154，95％ CI（0.072，0.330）， P＜0.001] were associated with the occurrence of cardiotoxicity. CONCLUSIONS Hyperlipidemia is an independent risk factor for cardiotoxicity induced by pirarubicin + cyclophosphamide combined with sequential paclitaxel+trastuzumab in HER 2 positive breast cancer patients ，while the use of dextrazoxane is a protective factor.

ObjectiveTo investigate the virological features of patients with chronic hepatitis B （CHB） and metabolic associated fatty liver disease （MAFLD） through a stratified analysis. MethodsA retrospective analysis was performed for 131 patients with CHB and MAFLD and 168 patients with CHB alone who underwent percutaneous liver biopsy and did not receive antiviral therapy or withdrew from drugs for more than 6 months in Beijing YouAn Hospital， Capital Medical University， from January 1， 2013 to December 31， 2019. The two groups were compared in terms of general data， biochemical parameters， and virological parameters. The patients in the two groups were stratified according to liver inflammation grade （G） and liver fibrosis stage （S）， and the patients with CHB and MAFLD were further analyzed based on the degree of hepatic steatosis and NAFLD activity score （NAS）. Virological features （the serum levels of HBV DNA and HBV HBsAg） were compared between groups. The Wilcoxon test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups； the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the CHB group， the CHB+MAFLD group had a significantly higher proportion of male patients， a significantly higher proportion of patients with hypertension or type 2 diabetes mellitus， and significantly higher levels of the blood biochemical parameters of triglyceride， low-density lipoprotein cholesterol， apolipoprotein B， alanine aminotransferase， gamma-glutamyl transpeptidase， uric acid， and fasting blood glucose （all P<0.05）， as well as significantly lower levels of high-density lipoprotein cholesterol， apolipoprotein A1， and HBV DNA （all P<0.05）. The stratified analysis based on liver fibrosis stage showed that for both the patients with CHB alone and those with CHB and MAFLD， the significant fibrosis （S2‍ ‍—‍ ‍4） group had a significantly lower level of HBV DNA than the non-significant fibrosis （S0‍ ‍—‍ ‍1） group （P<0.05）， and for the patients with CHB alone， the significant fibrosis （S2‍ ‍—‍ ‍4） group had a significantly lower level of HBsAg than the non-significant fibrosis （S0‍ ‍—‍ ‍1） group （P<0.05）. The stratified analysis based on inflammation grade showed that for the patients with CHB and MAFLD， the high inflammation grade （G3） group had a significantly higher level of HBV DNA than the low inflammation grade （G1‍ ‍—‍ ‍2） group （P<0.05）， and in the low inflammation grade （G1‍ ‍—‍ ‍2） group， the patients with CHB and MAFLD had a significantly lower level of HBsAg than the patients with CHB alone （P<0.05）. The stratified analysis based on the degree of hepatic steatosis showed that the level of HBV DNA gradually decreased with the increase in the degree of steatosis， and the severe steatosis group had a significantly lower level of HBV DNA than the mild group （P<0.05）， while there was no significant difference in HBsAg level between the groups with different degrees of hepatic steatosis （P>0.05）. The stratified analysis based on NAS score showed that the NAS≥4 group had significantly higher levels of HBV DNA and HBsAg than the NAS<4 group （both P<0.05）. ConclusionPatients with CHB and MAFLD have significant abnormalities in metabolic markers and aminotransferases， while virological indicators show different features in stratified analyses based on various indicators.